H. Rpt. 119-271 accompanies appropriations legislation for Labor. Appropriations bills provide the actual funding that allows federal agencies and programs to operate. Without appropriations, even authorized programs cannot spend money. The Appropriations Committee prepared this report to explain funding recommendations, account-by-account allocations, policy directives attached to the spending, and the committee's rationale for the specific funding levels proposed. Appropriations reports are essential reading for understanding where taxpayer money goes and why.
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House Report 119-271 - DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL, 2026
[House Report 119-271]
[From the U.S. Government Publishing Office]
119th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 119-271
_______________________________________________________________________
DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS
BILL, 2026
----------
R E P O R T
OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
together with
MINORITY VIEWS
[TO ACCOMPANY H.R. 5304]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
September 11, 2025.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2026
119th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 119-271
_______________________________________________________________________
DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS
BILL, 2026
__________
R E P O R T
OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
together with
MINORITY VIEWS
[TO ACCOMPANY H.R. 5304]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
September 11, 2025.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
______
U.S. GOVERNMENT PUBLISHING OFFICE
61-598 WASHINGTON : 2025
119th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 119-271
=======================================================================
DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS BILL, 2026
----------------
September 11, 2025.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
----------------
Mr. Aderholt, from the Committee on Appropriations,
submitted the following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 5304]
The Committee on Appropriations submits the following
report in explanation of the accompanying bill making
appropriations for the departments of Labor, Health and Human
Services (except the Food and Drug Administration, the Agency
for Toxic Substances and Disease Registry, and the Indian
Health Service), and Education, and the America First Corps
(formerly known as AmeriCorps), the Committee for Purchase from
People Who Are Blind or Severely Disabled, Corporation for
Public Broadcasting, Federal Mediation and Conciliation
Service, Federal Mine Safety and Health Review Commission,
Institute of Museum and Library Services, Medicaid and CHIP
Payment and Access Commission, Medicare Payment Advisory
Commission, National Council on Disability, National Labor
Relations Board, National Mediation Board, Occupational Safety
and Health Review Commission, Railroad Retirement Board, and
Social Security Administration for the fiscal year ending
September 30, 2026, and for other purposes.
INDEX TO BILL AND REPORT
Page number
Bill Report
List of Abbreviations......................................
5
Summary of Estimates and Appropriation.....................
7
General Summary of the Bill................................
7
Bill Wide Requirements.....................................
8
Title I--Department of Labor:
Employment and Training Administration............. 2
10
Training and Employment Services........... 2
11
Job Corps.................................. 8
14
Community Service Employment for Older
Americans..............................
16
Federal Unemployment Benefits and
Allowances............................. 9
16
State Unemployment Insurance and Employment
Service
Operations............................. 10
16
Advances to the Unemployment Trust Fund and
Other Funds............................ 16
18
Program Administration..................... 17
19
Veterans' Employment and Training.................. 17
21
Employee Benefits Security Administration.......... 20
22
Pension Benefit Guaranty Corporation............... 21
22
Office of Workers' Compensation Programs........... 22
22
Salaries and Expenses...................... 22
22
Special Benefits........................... 22
23
Energy Employees Occupational Illness
Compensation Fund...................... 25
23
Special Benefits for Disabled Coal Miners.. 25
23
Black Lung Disability Trust Fund........... 26
23
Wage and Hour Division............................. 26
24
Office of Federal Contract Compliance Programs.....
24
Office of Labor-Management Standards............... 27
25
Occupational Safety and Health Administration...... 27
25
Mine Safety and Health Administration.............. 30
26
Bureau of Labor Statistics......................... 31
27
Office of Disability Employment Policy............. 32
28
Departmental Management............................ 33
29
General Provisions................................. 34
32
Title II--Department of Health and Human Services:
Health Resources and Services Administration....... 49
34
Primary Health Care........................ 49
35
Health Workforce........................... 50
38
Maternal and Child Health.................. 54
47
Ryan White HIV/AIDS Program................ 54
53
Health Systems............................. 55
54
Rural Health............................... 56
56
HRSA-Wide Activities and Program Support... 57
60
Vaccine Injury Compensation Program........ 58
62
Centers for Disease Control and Prevention......... 59
63
Immunization and Respiratory Diseases...... 59
63
Viral Hepatitis, Sexually Transmitted
Disease, and
Tuberculosis Prevention................ 59
64
Emerging and Zoonotic Infectious Diseases.. 59
65
Chronic Disease Prevention and Health
Promotion.............................. 60
69
Birth Defects, Developmental Disabilities,
Disabilities and Health................ 60
74
Public Health Scientific Services.......... 60
76
Environmental Health....................... 60
78
Injury Prevention and Control.............. 61
79
National Institute for Occupational Safety
and Health............................. 61
81
Energy Employees Occupational Illness
Compensation
Program................................ 61
84
Global Health.............................. 61
85
Public Health Preparedness and Response.... 62
85
CDC-Wide Activities and Program Support.... 63
86
Buildings and Facilities................... 64
90
National Institutes of Health...................... 65
91
National Cancer Institute.................. 65
92
National Heart, Lung, and Blood Institute.. 66
97
National Institute of Dental and
Craniofacial Research.................. 66
100
National Institute of Diabetes and
Digestive and Kidney
Diseases............................... 66
100
National Institute of Neurological
Disorders and Stroke................... 66
101
National Institute of Allergy and
Infectious Diseases.................... 67
105
National Institute of General Medical
Sciences............................... 67
108
Eunice Kennedy Shriver National Institute
of Child Health and Human Development.. 67
110
National Eye Institute..................... 67
113
National Institute on Environmental Health
and Sciences........................... 68
113
National Institute on Aging................ 68
114
National Institute of Arthritis and
Musculoskeletal and Skin Diseases...... 68
115
National Institute on Deafness and Other
Communication Disorders................ 68
115
National Institute of Nursing Research..... 68
115
National Institute on Alcohol Abuse and
Alcoholism............................. 69
116
National Institute on Drug Abuse........... 69
116
National Institute of Mental Health........ 69
118
National Human Genome Research Institute... 69
119
National Institute of Biomedical Imaging
and Bioengineering..................... 69
120
National Center for Complementary and
Integrative Health..................... 69
120
National Institute on Minority Health and
Health Disparities..................... 70
120
John E. Fogarty International Center....... 70
121
National Library of Medicine............... 70
122
National Center for Advancing Translational
Sciences............................... 70
122
Office of the Director..................... 71
123
Buildings and Facilities................... 72
137
NIH Innovation Account, Cures Act.......... 72
137
Advanced Research Projects Agency for
Health................................. 73
137
Substance Abuse and Mental Health Services
Administration................................. 73
139
Mental Health.............................. 73
141
Substance Abuse Treatment.................. 75
149
Substance Abuse Prevention................. 76
154
Health Surveillance and Program Support.... 76
157
Agency for Healthcare Research and Quality.........
158
Centers for Medicare & Medicaid Services........... 77
158
Grants to States for Medicaid.............. 77
158
Payments to the Health Care Trust Funds.... 78
158
Program Management......................... 78
159
Health Care Fraud and Abuse Control Account 80
170
Administration for Children and Families........... 81
171
Payments to States for Child Support
Enforcement and
Family Support Programs................ 81
171
Low Income Home Energy Assistance.......... 82
171
Refugee and Entrant Assistance............. 83
171
Promoting Safe and Stable Families......... 84
175
Child Care and Development Block Grant..... 85
176
Social Services Block Grant................ 86
176
Children and Families Services Programs.... 86
177
Payments for Foster Care and Permanency.... 89
183
Administration for Community Living................ 90
184
Administration for Strategic Preparedness and
Response....................................... 93
191
Research, Development, and Procurement..... 93
194
Operations, Preparedness, and Emergency
Response............................... 95
199
Office of the Secretary............................ 95
202
General Departmental Management............ 95
202
Medicare Hearings and Appeals.............. 98
220
Office of the National Coordinator for
Health Information Technology.......... 98
220
Office of Inspector General................ 99
222
Office for Civil Rights.................... 99
221
General Provisions................................. 100
223
Title III--Department of Education:
Office of Elementary and Secondary Education....... 131
227
Education for the Disadvantaged............ 131
227
Impact Aid................................. 132
230
School Improvement Programs................ 133
231
Safe Schools and Citizenship Education..... 135
233
Indian Education........................... 135
236
Innovation and Improvement................. 136
237
Office of English Language Acquisition.............
241
Office of Special Education and Rehabilitative
Services....................................... 138
241
Special Education.......................... 138
241
Rehabilitation Services.................... 142
244
Special Institutions for Persons with
Disabilities........................... 143
246
American Printing House for the Blind.... 143
246
National Technical Institute for the Deaf 143
247
Gallaudet University..................... 143
247
Office of Career, Technical, and Adult Education... 144
248
Office of Postsecondary Education.................. 144
249
Higher Education........................... 144
249
Howard University.......................... 146
255
College Housing and Academic Facilities
Loans.................................. 146
256
Historically Black College and University
Capital Financing Program Account...... 146
256
Office of Federal Student Aid...................... 147
256
Student Financial Assistance............... 147
258
Student Aid Administration................. 147
260
Institute of Education Sciences.................... 148
261
Departmental Management............................ 148
264
General Provisions................................. 149
268
Title IV--Related Agencies:
America First Corps................................ 158
270
Committee for Purchase from People Who Are Blind or
Severely Disabled.............................. 163
272
Corporation for Public Broadcasting................
273
Federal Mediation and Conciliation Service......... 164
273
Federal Mine Safety and Health Review Commission... 165
273
Institute of Museum and Library Services........... 165
274
Medicaid and CHIP Payment and Access Commission.... 165
274
Medicare Payment Advisory Commission............... 165
275
National Council on Disability..................... 166
275
National Labor Relations Board..................... 166
275
National Mediation Board........................... 167
276
Occupational Safety and Health Review Commission... 167
276
Railroad Retirement Board.......................... 167
276
Social Security Administration..................... 169
277
Title V--General Provisions................................ 175
282
House of Representatives Report Requirements...............
284
List of Abbreviations
The following is a list of commonly used abbreviations and
acronyms that appear in this report.
ACL--Administration for Community Living
AFC--America First Corps
AHRQ--Agency for Healthcare Research and Quality
ASPR--Administration for Strategic Preparedness and Response
BARDA--Biomedical Advanced Research and Development
Authority
CBRN--Chemical, Biological, Radiological, and Nuclear
CCBHC--Certified Community Behavioral Health Clinics
CDC--Centers for Disease Control and Prevention
CHIP--Children's Health Insurance Program
CMS--Centers for Medicare and Medicaid Services
CTSA--Clinical and Translational Science Awards
CPB--Corporation for Public Broadcasting
DHS--Department of Homeland Security
DOD--Department of Defense
DOE--Department of Energy
DOL--Department of Labor
EBSA--Employee Benefits Security Administration
ESEA--Elementary and Secondary Education Act
ETA--Employment and Training Administration
FDA--Food and Drug Administration
FIC--Fogarty International Center
FMSHRC--Federal Mine Safety and Health Review Commission
FTE--Full-time Equivalent
FVPSA--Family Violence Prevention and Senior Act
GAO--Government Accountability Office
GLS--Garrett Lee Smith Memorial Act
HBCUs--Historically Black Colleges and Universities
HCFAC--Health Care Fraud and Abuse Control
HELP--Health, Education, Labor, and Pensions
HHS--Health and Human Services
HRSA--Health Resources and Services Administration
HIPSA--Health Professional Shortage Area
IC--Institute and Center
IDEA--Individuals with Disabilities Education Act
IHE--Institutions of Higher Education
IMLS--Institute of Museum and Library Services
LEA--Local Educational Agency
MACPAC--Medicaid and CHIP Payment and Access Commission
MCM--Medical Countermeasures
MedPAC--Medicare Payment Advisory Commission
MHBG--Community Mental Health Services Block Grant
MSHA--Mine Safety and Health Administration
NCATS--National Center for Advancing Translational Sciences
NCES--National Center for Education Statistics
NCI--National Cancer Institute
NEI--National Eye Institute
NHGRI--National Human Genome Research Institute
NHLBI--National Heart, Lung, and Blood Institute
NIA--National Institute on Aging
NIAAA--National Institute on Alcohol Abuse and Alcoholism
NIAID--National Institute of Allergy and Infectious Diseases
NIAMS--National Institute of Arthritis and Musculoskeletal
and Skin Diseases
NIBIB--National Institute of Biomedical Imaging and
Bio-engineering
NICHD--Eunice Kennedy Shriver National Institute of Child
Health and Human Development
NIDA--National Institute on Drug Abuse
NIDCD--National Institute on Deafness and Other
Communication Disorders
NIDCR--National Institute of Dental and Craniofacial Research
NIDDK--National Institute of Diabetes and Digestive and
Kidney Disease
NIDRR--National Institute on Disability and Rehabilitation
Research
NIEHS--National Institute of Environmental Health Sciences
NIGMS--National Institute of General Medical Sciences
NIH--National Institutes of Health
NIMH--National Institute of Mental Health
NIMHD--National Institute on Minority Health and Health
Disparities
NINDS--National Institute of Neurological Disorders and
Stroke
NINR--National Institute of Nursing Research
NLM--National Library of Medicine
NLRB--National Labor Relations Board
NSF--National Science Foundation
NTID--National Technical Institute for the Deaf
OAA--Older Americans Act
OAR--Office of AIDS Research
OCR--Office for Civil Rights
ODEP--Office of Disability Employment Policy
OFCCP--Office of Federal Contract Compliance Programs
OIG--Office of the Inspector General
OLMS--Office of Labor-Management Standards
OMB--Office of Management and Budget
OMH--Office of Minority Health
OMHA--Office of Medicare Hearings and Appeals
ONC--Office of the National Coordinator for Health
Information Technology
ORR--Office of Refugee Resettlement
ORWH--Office of Research on Women's Health
OSHA--Occupational Safety and Health Administration
OWCP--Office of Workers' Compensation Programs
OWH--Office of Women's Health
PBGC--Pension Benefit Guaranty Corporation
PHS--Public Health Service
PPHF--Prevention and Public Health Fund
PRNS--Programs of Regional and National Significance
RSA--Rehabilitation Services Administration
SAMHSA--Substance Abuse and Mental Health Services
Administration
SEA--State Educational Agency
SPRANS--Special Projects of Regional and National
Significance
SSA--Social Security Administration
SSI--Supplemental Security Income
STEM--Science, Technology, Engineering, and Mathematics
SUPTRS--Substance Use Prevention, Treatment, and Recovery
Services
TANF--Temporary Assistance for Needy Families
UAC--Unaccompanied Alien Children
UI--Unemployment Insurance
USAID--U.S. Agency for International Development
VETS--Veterans' Employment and Training Services
VISTA--Volunteers in Service to America
WANTO--Women in Apprenticeship and Non-Traditional
Occupations
WHD--Wage and Hour Division
WIA--Workforce Investment Act
WIOA--Workforce Innovation and Opportunity Act
Summary of Estimates and Appropriations
The following table compares on a summary basis the
appropriations, including trust funds for fiscal year 2026, the
budget request for fiscal year 2026, and the Committee
recommendation for fiscal year 2026 in the accompanying bill.
2026 LABOR, HHS, EDUCATION BILL
[Discretionary funding in thousands of dollars]
----------------------------------------------------------------------------------------------------------------
Fiscal Year-- 2026 Committee compared to--
Budget Activity -------------------------------------------------------------------------------
2025 Enacted 2026 Budget 2026 Committee 2025 Enacted 2026 Budget
----------------------------------------------------------------------------------------------------------------
Department of Labor............. $13,319,015 $9,627,086 $9,580,713 -$3,738,302 -$46,373
Department of Health and Human 114,965,801 83,067,660 108,066,863 -6,898,938 +24,999,203
Services.......................
Department of Education......... 78,736,810 66,702,839 66,681,178 -12,055,632 -21,661
Related Agencies................ 16,918,955 14,840,697 16,280,246 -638,709 +1,439,549
Total, Program Level........ 223,940,581 174,238,282 200,609,000 -23,331,581 +26,370,718
----------------------------------------------------------------------------------------------------------------
General Summary of the Bill
For fiscal year 2026, the Committee recommends a total of
$184,491,000,000 in current year discretionary funding--the
302(b) allocation--and $200,609,000,000 in overall programmatic
funding, including offsets and adjustments. This discretionary
amount represents 26 percent of total non-defense spending and
11 percent of total discretionary spending.
The Committee notes that the President's budget request
includes a number of important proposals to reform and
reorganize the Federal government. The Committee applauds these
efforts to improve efficiency while reducing waste, fraud, and
abuse. Such reforms are long overdue. The Committee notes that
the authorizing committees of jurisdiction have not yet had the
opportunity to consider these reorganizational proposals.
Accordingly, the Committee's bill and report reflect the
current organizational structure of the agencies funded herein.
The Committee looks forward to working with the authorizing
committees of jurisdiction as they act on the proposed
organizational reforms submitted by the Office of Management
and Budget.
Bill Wide Requirements
In cases where this report directs the submission of a
report, that report is to be submitted to the Committee on
Appropriations of the House of Representatives. Where this
report refers to the Committee or the Committee on
Appropriations, unless otherwise noted, this reference is to
the House of Representatives Subcommittee on Labor, Health and
Human Services, Education, and Related Agencies.
Each department and agency funded in this Act shall follow
the directives set forth in this Act and the accompanying
report and shall not reallocate resources or reorganize
activities except as provided herein. Funds for individual
programs and activities are displayed in the detailed table at
the end of report accompanying this Act. Funding levels that
are not displayed in the detailed table are identified within
this report. Any action to eliminate or consolidate programs,
projects, and activities should be pursued through a proposal
in the President's Budget so it can be considered by the
Committee.
Budget Submission.--As part of the President's Budget
Request, each department is directed to provide the Committee
in electronic format, a table that corresponds with every
program line found in the detailed table at the end of this
report. Such a table shall include a column for the most
recently enacted appropriation, the current year, and the
budget year, assuming current law. In addition, the Committee
continues to expect delivery of all congressional
justifications and budget summary documents no later than the
day of the President's Budget Appendix publication online. The
department shall notify the Committee 24 hours in advance of
any anticipated delay.
Congressional Reports.--Each department or agency is
directed to provide the Committee, within 30 days from the date
of enactment of this Act, and quarterly thereafter, a summary
describing each requested report to the Committee along with
related actions completed in the current and prior quarters and
planned actions to be completed in future quarters. Such a
summary shall be cumulative for all fiscal years for which any
report remains outstanding.
Customer Experience.--The Committee continues to support
efforts to improve agency customer experience. The Committee
urges all agencies funded by this Act to develop standards to
improve customer experience and incorporate the standards into
the performance plans required under 31 U.S.C. 1115. The
Committee requests an update from all agencies funded by this
Act to report on their implementation plans regarding this
subject in the fiscal year 2027 congressional justification.
Grant Continuation Cost Estimates.--As part of the fiscal
year 2027 congressional justification, each department or
agency funded in this Act with discretionary budget authority
for competitively awarded grants shall include the expected
cost of continuation awards for each competitively awarded
grant and any amount the department or agency would seek to
issue a new competitive funding opportunity announcement for
such grant in fiscal year 2027. In addition, the department
shall include the anticipated number of awards and average
anticipated award for such year.
Grant Oversight.--The new Administration has identified
numerous discrepancies within existing grant programs
throughout the bill. In response to these issues the Committee
directs, within 30 days of enactment of this Act, and every 30
days thereafter until November 30, 2026, to brief the Committee
on the status of all formula and competitive grants. Each
briefing is to include a summary of competitive and formula
awards made in the prior 30 days, Notices of Funding
Opportunities (NOFOs) the respective department anticipates
issuing within the next 30 days, and a summary of Notices of
Funding Opportunities issued in the preceding 30 days. As
applicable per grant program, award and NOFO summaries are to
indicate whether such awards are continuation awards,
supplemental grant awards, and/or new competitions and if such
amounts are forward funded. NOFO summaries are to include new
competitive criteria, changes from the prior year, expected
number of awards, expected amount per award, and status of
review panels.
National Academy of Sciences, Engineering, and Medicine.--
The Committee remains concerned with the lack of objective
nonpartisan research methods, including inaccurate references
to data and removal of panel participants, demonstrated by the
National Academy of Sciences, Engineering, and Medicine
(NASEM). The Committee urges agencies to use caution when
entering into new agreements with NASEM and to consider
alternative means for obtaining objective scientific review.
Agencies are directed to ensure all contracts are executed with
the highest standards of scientific rigor in an objective,
nonpartisan manner. The full spectrum of scientific views
should be represented on a research committee, council, or
panel membership without conflict of interest or ideology.
Performance Reporting.--As part of the congressional
justification for fiscal year 2026, each department or agency
funded by this Act is directed to include the percentage of the
Senior Executive Service for each performance level (5--
outstanding, 4--exceeds fully successful, 3--fully successful,
2--minimally satisfactory, or 1--unsatisfactory). In addition,
the department or agency shall include in such justification
the total amount spent on performance awards for the Senior
Executive Service for the most recent fiscal year for which
data is available.
Questions for the Record.--The Committee notes the
inclusion of section 526 of this Act, which requires each
department and agency to provide answers to questions submitted
for the record within 45 business days of receipt. The
Committee expects each department and agency to notify the
Committees at least 7 days in advance if they do not anticipate
meeting this statutory requirement.
TITLE I--DEPARTMENT OF LABOR
Appropriation, fiscal year 2025....................... $13,319,015,000
Budget request, fiscal year 2026...................... 9,627,086,000
Committee Recommendation.............................. 9,580,713,000
Change from enacted level......................... -3,738,302,000
Change from budget request........................ -46,373,000
This bill provides $9.6 billion in discretionary budget
authority for the Department of Labor, a reduction of 28
percent from the fiscal year 2025 enacted level. The Department
of Labor comprises $9.6 billion, or 5 percent of the total
302(b) allocation for this subcommittee.
Employment and Training Administration
Appropriation, fiscal year 2025....................... $10,270,657,000
Budget request, fiscal year 2026...................... 6,749,333,000
Committee Recommendation.............................. 6,672,600,000
Change from enacted level......................... -3,598,057,000
Change from budget request........................ -76,733,000
The ETA administers Federal job training grant programs and
Trade Adjustment Assistance and provides funding for the
administration and oversight of the State Unemployment
Insurance and Employment Service system.
Competitive Grantmaking Transparency.--The Committee is
concerned by DOL's historic lack of transparency in the
evaluation and awarding of competitive grants. The Committee
directs DOL to provide the Committee with grant scores for each
applicant for competitive funding evaluated; this is to include
all aspects of scoring included in the Funding Opportunity
Announcement and in DOL's award of funds.
Prioritizing High Wage Industries.--The Committee is
concerned that under the previous Administration, DOL
grantmaking has been ineffective in targeting high-wage, high-
growth occupations to the detriment of workers and jobseekers.
The Committee directs DOL to prioritize grant applications in
industries and occupations that exceed the average earnings of
a high school graduate based on the Bureau of Labor Statistics
(BLS) Occupational Employment and Wage Statistics when making
competitive grant awards and when not inconsistent with
authorizing statutes.
Upskilling Workers in Industrial Sectors.--The Committee
acknowledges in today's technology-driven industrial
environment, workers are expected to continuously upskill,
particularly in industries where generations of technology
outpace generations of workers. Immersive technology can equip
the workforce with the skills and knowledge necessary for the
future of work. The committee encourages the Department of
Labor to assess the ways in which use of immersive technology
can be leveraged to train and upskill workers in industrial
sectors including but not limited to energy, manufacturing,
construction, mining, and automotive assembly.
Workforce Development in Innovative Skilled Fields.--The
Committee recognizes the growing need for highly-skilled
mechanics and technicians in the automotive field to prepare
for advances in technology. Therefore, the Committee encourages
DOL, in collaboration with the Department of Education, to work
with industry partners, workforce groups, and nonprofit experts
to better support pathways for mechanics and technicians in
innovative automotive fields. Specifically, the Committee
encourages the Department to examine their support for advanced
training programs for established career mechanics and to
examine needs related to the operation and repair of
transportation fleets and motorized equipment.
TRAINING AND EMPLOYMENT SERVICES
Appropriation, fiscal year 2025....................... $3,895,587,000
Budget request, fiscal year 2026...................... 2,965,905,000
Committee Recommendation.............................. 1,882,412,000
Change from enacted level......................... -2,013,175,000
Change from budget request........................ -1,083,493,000
Training and Employment Services provides funding for
Federal job training programs authorized primarily by the
Workforce Innovation and Opportunity Act of 2014 (WIOA). The
Committee appreciates the potential value of the
Administration's proposed streamlining of ETA program. While
the Committee regrets that the pace of the budget cycle
precludes their consideration by the respective authorizing
committees of jurisdiction, the Committee looks forward to
continuing to partner with the Administration to improve the
skills of American youth, workers, and job seekers.
Adult Employment and Training Activities
The Committee provides $712,000,000 in advance funding for
adult training, which is the same as the fiscal year 2024
enacted level. The Committee provides no funding for fiscal
year 2025 for this program.
The Committee has included a provision reducing the funding
available for fiscal year 2025 by $712,000,000.
Youth Employment and Training Activities
The Committee provides no funding for Youth Employment and
Training Activities. The Committee notes the absence of
evidence that the program improves employment and educational
outcomes for program participants and that the Department has
failed to implement the program in a manner consistent with the
changes enacted in the now expired WIOA. This program is
largely duplicative of the Perkins Career and Technical
Education, 21st Century Community Learning Centers, and Student
Support and Academic Enrichment programs.
Dislocated Worker Employment and Training Activities
For Dislocated Worker Employment and Training Activities,
the Committee provides $1,421,412,000. Of the total provided
for Dislocated Worker Employment and Training Activities,
$1,095,553,000 is designated for State grants that provide core
and intensive services, training, and supportive services for
dislocated workers. In addition, States use these funds for
rapid response assistance to help workers affected by mass
layoffs and plant closures. The remaining amount is available
for the Dislocated Workers National Reserve (DWNR). DWNR
supports national emergency grants, technical assistance, and
demonstration projects as authorized by WIOA. Within this
total. The Committee provides $860,000,000 in advanced
appropriations for fiscal year 2027.
Dislocated Worker National Reserve Grantee Performance
Reporting.--Consistent with the requirements of 29 U.S.C. 3141,
the Committee directs DOL to require that all grantees
receiving awards funded through DWNR report on the employment,
earnings, and credential attainment outcomes of program
participants. The Committee further directs DOL to include
program participant outcomes disaggregated by grantee on its
website.
Dislocated Worker National Reserve Disaster Response.--To
better ensure DOL is positioned to provide support to
communities affected by natural disasters and given the
availability of dedicated funding for Treatment, Recovery, and
Workforce Support within the Substance Abuse and Mental Health
Services Administration, the Committee provides no funding for
the purposes of Training and Guidance Letter No. 04-18.
Within the total for Dislocated Worker Employment and
Training Activities, the Committee provides the following
amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity Committee
------------------------------------------------------------------------
Dislocated Worker Assistance National Reserve........ $325,859,000
Workforce Opportunity for Rural Communities (non- 55,000,000
add)............................................
Community College Grants (non-add)............... 65,000,000
Cybersecurity Grants (non-add)................... 25,000,000
Career Pathways for Youth (non-add).............. 10,000,000
------------------------------------------------------------------------
Workforce Opportunity for Rural Communities.--Within the
funds provided for DWNR, the Committee provides $55,000,000 for
the Workforce Opportunity for Rural Communities (WORC) program,
an increase of $5,000,000, to provide enhanced worker training
in the Appalachian, Delta, and Northern Border regions. The
Committee directs DOL to ensure that this funding increase is
used to support multigenerational workforce training pipelines
developed in collaboration with institutions of higher
education and workforce development system partner agencies in
regions with a WORC program.
Strengthening Community College Training Grants.--From
within the amounts provided for DWNR, the Committee provides
$65,000,000 for the Strengthening Community College Training
Grants.
Cybersecurity and Software Development Employment
Opportunities.--The Committee remains concerned about the high,
unmet demand for cybersecurity and software development skills
in both the DOD and the private sector. Of the total provided
for the DWNR, the Committee directs $25,000,000 for competitive
grants to institutions of higher education as defined in 20
U.S.C. 1001, State Workforce Agencies, local workforce
development boards, and employer associations for the purpose
of a targeted highly skilled job training grant to help
increase training capacity to meet this demand. For purposes of
making awards under this program, DOL is directed to prioritize
applicants located in States with the greatest number of
Federally recognized Tribes and with preexisting DOD
partnerships. DOL is directed to provide the Committee with a
briefing on this initiative within 120 days of the enactment of
this Act.
Career Pathways for Youth.--Multiple career pathways should
be available to young people. The Committee continues to
recognize the need for early workforce readiness, employment,
and training opportunities that help youth develop career-
specific skills for employability, such as responsibility,
organization, time management, and workplace safety. The
Committee provides $10,000,000 to utilize the demonstration
grant authority under DWNR for grants for this program.
Native American Programs
For Native American programs, the Committee provides
$65,000,000, an increase of $5,000,000, for these programs.
Migrant and Seasonal Farmworkers
The Committee provides no fiscal year 2026 funding for this
program.
YouthBuild
For the YouthBuild program, the Committee provides
$105,000,000. WIOA reformed the YouthBuild program to
prioritize the employment and educational outcomes of program
participants. While the Committee recognizes the challenges DOL
has had in overseeing grant awards, the Committee notes with
concern that in making awards under this program under the
previous administration, DOL prioritized the administrative
capacity of new grantees rather than their demonstrated
efficacy in securing employment and earnings outcomes for young
adults.
Reintegration of Ex-Offenders
The Committee provides no fiscal year 2026 funding for this
program.
Workforce Data Quality Initiative
The Committee provides $6,000,000 for the Workforce Data
Quality Initiative.
Apprenticeship Programs
The Committee provides $285,000,000 for apprenticeship
grants including $100,000,000 for apprenticeship State grants.
The Committee notes the modest increase in the number of
apprentices generated by considerable and sustained
congressional investment.
No later than 180 days after the enactment of this Act, the
Department is directed to publicly disclose on its website
grantees receiving funding, the number of apprentices
attributable to each grantee, and the respective employment and
earnings outcomes of program participants as required under 29
U.S.C. 3141. The Committee further directs DOL to provide a
briefing on its implementation of this directive within 90 days
of the enactment of this Act.
Apprenticeship Degree.--The Committee encourages DOL to
support apprenticeship degree programs where institutions of
higher education integrate the awarding of affordable college
degrees with the hallmarks of registered apprenticeships. The
Committee further encourages DOL to prioritize funding for
apprenticeship degrees in future Funding Opportunity
Announcements.
Cyber Workforce.--The Committee encourages DOL to continue
to prioritize efforts and grants centered on launching,
developing, expanding, and promoting registered apprenticeship
programs in cybersecurity, as well as related collaboration
with cyber industry and workforce intermediaries.
Defense Industrial Base-Focused Apprenticeship Programs.--
The Committee encourages DOL to prioritize increased funding
for existing training programs in advance manufacturing,
defense technology, and other high-demand industries supporting
the defense industrial base. The Committee further encourages
DOL to continue facilitating partnerships between industry,
academia, and government agencies to establish and promote
pathway programs that would grow the defense industrial base
workforce.
Degree Apprenticeships.--The Committee encourages DOL to
support the integration of academic programing and on-the-job
training including paid work experience, related instruction,
and industry involvement. The rapid expansion and adoption of
teacher and educator apprenticeships is an example of how
apprenticeships can align education and workforce development.
The Committee encourages the Department to collaborate with the
Department of Education in supporting the establishment of
apprenticeship degree programs at 4-year institutions of higher
education to align workforce development efforts and post-
secondary education in industries such as advanced
manufacturing, information technology, healthcare, and energy.
Parents of Dependent Children.--The Committee encourages
DOL to provide grantees guidance related to coordinating with
community-based providers of wrap around services to support
parents of dependent children enrolled in registered
apprenticeship and pre-apprenticeship programs.
Technology-Related Fields.--The Committee recognizes the
growing need to invest in registered apprenticeship programs
that prepare workers to meet the demands of an evolving labor
market. The Committee encourages the Department to prioritize
grant applications in new, emerging, and in-demand industry
sectors and occupations, including in technology-related
fields.
Wastewater Apprenticeships.--The Committee directs DOL to
make $20,000,000 in grant funding available to establish,
implement, expand, and administer registered apprenticeship
programs consistent with the National Guideline Standards of
Apprenticeship for Water and Wastewater System Operations
Specialists to address nationwide shortages of qualified
drinking water and wastewater operators, especially in rural
America.
JOB CORPS
Appropriation, fiscal year 2025....................... $1,760,155,000
Budget request, fiscal year 2026...................... 176,370,000
Committee Recommendation.............................. 880,078,000
Change from enacted level......................... -880,077,000
Change from budget request........................ +703,708,000
Job Corps is a residential education and vocational
training program that helps young people ages 16 through 24
improve the quality of their lives through vocational and
academic training.
The Committee has concerns with the historical oversight of
job placement contracts. The DOL Office of Inspector General
(OIG) found evidence that contractors helped only 6 percent of
the sampled participants find work. The others found jobs on
their own, or there was not enough evidence to show the
contractors helped them. The OIG estimated that nearly
$71,000,000 went to contractors for services they could not
show they provided.
Industry-Standard Training.--The Committee supports the
Department's intention to make investments in Job Corps
facilities to ``support high-quality training that meets
existing industry standards.''
Job Corps Competitiveness.--The Committee recognizes the
benefits of well-run, successful Job Corps programs in
providing vocational education to the youth of the United
States. On the other hand, underperforming Job Corps programs
have been weighing the appropriation down and undermining the
potential value of the program. Within the funds appropriated,
the Committee directs the Department of Labor to direct
appropriated funds to the top 50 percent of Job Corps programs
based on the 2023 graduation rate.
Job Corps Slot Utilization.--The Committee is concerned
with the persistent under-utilization of Job Corps centers. The
Committee requests a briefing regarding Job Corps application
and enrollment data to evaluate the relative efficacy of
different investments in producing Job Corps-eligible
applicants and arrivals.
Job Corps Programing.--The Committee is concerned that the
relative lack of success is due to instructional content that
does not reflect job-site best practices or the jobs of today's
economy. To better ensure a variety of high-quality programs
are available to Job Corps students, the Committee directs DOL
to limit grants, contracts, or cooperative agreements for
purposes of instructional content to no more than $10,000,000.
Job Corps Pilot Programs.--The Committee provides
$8,000,000 in funding for the expansion of pilot programs that
leverage partnerships with industry to improve job relevancy
and placement to provide Job Corps students programing aligned
with cybersecurity industry-recognized credentials,
Maximizing Employer Partnerships.--The Committee encourages
DOL to fully leverage section 29 U.S.C. 3208 to maximize the
resources available to campuses to develop these partnerships
and meet employers' needs.
Outcome-Focused Metrics and Budgeting.--The Committee
encourages DOL to strengthen Job Corps by incorporating
performance-based budgeting and outcome-focused metrics that
demonstrate program effectiveness in preparing young people for
the workforce. The Committee further urges DOL to identify
opportunities for greater efficiency, cost savings, and
improved contract oversight.
Supporting Continuous Campus Improvement.--The Committee
encourages DOL to develop a process involving Job Corps youth
service providers for setting achievable campus performance
expectations to more effectively drive continuous improvement
in student outcomes.
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS
Appropriation, fiscal year 2025....................... $400,950,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. - - -
Change from enacted level......................... -400,950,000
Change from budget request........................ - - -
The Committee provides no funding for the Community Service
Employment for Older Americans program, also known as the
Senior Community Service Employment Program (SCSEP). The
Committee notes that the last comprehensive evaluation of SCSEP
found that the program led to unsubsidized employment for less
than half of program participants available for employment with
worse outcomes for participants with a disability, older
adults, and participants with lower levels of education.
Moreover, the largest recipients of SCSEP grants are
organizations based in the Washington, D.C. area rather than
direct service providers.
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
Appropriation, fiscal year 2025....................... $33,900,000
Budget request, fiscal year 2026...................... 50,300,000
Committee Recommendation.............................. 50,300,000
Change from enacted level......................... +16,400,000
Change from budget request........................ - - -
The Committee provides no funding for the Trade Adjustment
Assistance program in the absence of reauthorization. Funding
included under this section is for the administration of
benefits to individuals whose petitions were approved before
July 1, 2022.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS
Appropriation, fiscal year 2025....................... $4,007,150,000
Budget request, fiscal year 2026...................... 3,421,838,000
Committee Recommendation.............................. 3,724,890,000
Change from enacted level......................... -282,260,000
Change from budget request........................ +303,052,200
The total includes $3,650,584,000 from the Employment
Security Administration Account in the Unemployment Trust Fund
and $74,306,000 from the General Fund of the Treasury. These
funds are used to support the administration of Federal and
State unemployment compensation laws.
Unemployment Insurance Compensation
In addition, the Committee provides contingency funding for
increased workloads that States may face in the administration
of unemployment insurance (UI). The Committee includes bill
language so that, during fiscal year 2026, for every 100,000
increase in the total average weekly insured unemployment
(AWIU) above 2,124,000, an additional $28,600,000 is made
available to States from the Unemployment Trust Fund.
If additional funds are provided to States under the AWIU
contingency authority, the Department is directed to provide
notification to the Committee of the current projected AWIU
level for the fiscal year, when funds were provided to States,
and how much additional funding was provided in total and to
each State within 15 days of funding being provided. If
additional funds are provided on a quarterly basis, the
Department is directed to provide this information to the
Committee on a quarterly basis.
The Committee provides $116,000,000 funding for the
Reemployment Services and Eligibility Assessments (RESEA)
program. The Committee supports the intent of the program to
provide more intensive services to individuals most likely to
use all their unemployment insurance benefits; however, the
Committee is concerned that the program has not achieved the
cost savings projected by the Congressional Budget Office (CBO)
and does not provide additional funding pursuant to the
Balanced Budget and Emergency Deficit Control Act.
While CBO once estimated that such funding generates
reductions in UI benefit exhaustion, the Committee notes that
single State evaluations of the program prior to it being made
permanent in 2018 produced mixed results with some States
successfully assisting job seekers to work and others failing
to do so. While a worthy policy objective, the absence of a
limitation on State administrative expenses and inability to
effectively target services to individuals in greatest need of
assistance have undermined the ability to achieve the
programmatic savings CBO misguidedly predicted. The Committee
directs DOL, within 180 days of the enactment of this Act, to
publicly release a report detailing the Department's
methodology in determining that services provided regardless of
an individual's likelihood to exhaust benefits generates an
approximate savings of three dollars for every one spent.
Unemployment Insurance Integrity Center of Excellence
The Committee provides $9,000,000 for the continued support
of Unemployment Insurance Integrity Center of Excellence.
Unemployment Insurance National Activities
The Committee provides $18,000,000 for UI national
activities. This funding is intended to help modernize
information technology systems and support States in
administering the UI program.
Employment Service
The Committee provides $675,052,000 for the Employment
Service allotment to States. The Committee also provides
$17,500,000 for Employment Service National Activities.
Disability Employment.--The Committee notes the continued
underemployment of individuals with disabilities and encourages
the Department, in consultation with the Social Security
Administration, to provide State agencies responsible for
reviewing Work Opportunity Tax Credit certification requests
additional information regarding the Ticket to Work program.
Foreign Labor Certification
The Committee provides $62,528,000, an increase of
$2,000,000, for the Federal administration of the Foreign Labor
Certification program and $23,282,000 for grants to States.
De Minimis Exemption From Adverse Effect Wage Rate.--The
Committee recognizes that the House of Representatives
Agriculture Committee's bipartisan Ag Labor Working Group
unanimously supported this change in the wage calculation. The
Committee notes that current law requires the highest wage rate
to be paid for all work regardless of how much time a worker
may spend doing the higher rate labor. This overly strict
calculation is driving up costs in the H-2A program and acting
as a barrier to entry to this critical program for employers
and employees. As such, the Committee directs the Secretary to
utilize a primary duties evaluation when setting the Adverse
Effect Wage Rate pursuant to 20 C.F.R. 655.120(b) and shall not
require or enforce a wage under the Occupational Employment and
Wage Statistics program without the agricultural labor or
services required exceeding 50 percent of the duties of the six
Standard Occupational Classifications surveyed by the United
States Department of Agriculture's (USDA) Farm Labor Reports or
Farm Labor Survey.
Skilled Health Professionals.--The Committee directs DOL to
evaluate the H-1B program to consider necessary revisions to
the Schedule A Shortage Occupation list to respond to regional
health care workforce challenges.
Timely Processing of Permanent Labor Certification
Applications.--The Committee strongly encourages the Department
to take appropriate actions using existing authority and
resources to improve the processing of Permanent Labor
Certification Applications, including Prevailing Wage
Determinations filed through Foreign Labor Application Gateway
system. Historically, processing took less than 6 months, but
it currently takes well over a year. Within 90 days of
enactment, the Department is directed to provide the Committee
with a report detailing efforts being taken to improve
processing timeframes by using existing authority and
resources, including automating the self-attestation process to
speedily approve submissions, while flagging potential bad
actors for further investigation and audits.
U.S. Defense Industrial Base.--The Committee notes that the
DOL has not updated the Schedule A Shortage Occupation list to
include more than two occupations since 2005. The Committee
directs DOL to evaluate the H-1B program to better prioritize
occupations including STEM and other non-STEM occupations that
are critical to the U.S. defense industrial base. Additionally,
the Committee directs DOL to evaluate the wage disparity
between American workers in these occupations and workers in
these occupations brought in under both the Schedule A Shortage
Occupation list and the H-1B visa program, and evaluate what
effect these programs have on U.S. citizens competing for STEM
and other similar occupations. The Committee requests an update
on this effort within 90 days of the enactment of the Act.
One-Stop Career Centers/Labor Market Information
The Committee provides $52,893,000 for One-Stop Career
Centers and Labor Market Information.
ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS
The Committee recommends such sums as necessary for
Advances to the Unemployment Trust Fund and Other Funds. The
funds are made available to accounts authorized under Federal
and State unemployment insurance laws and the Black Lung
Disability Trust Fund when the balances in such accounts are
insufficient.
PROGRAM ADMINISTRATION
Appropriation, fiscal year 2025....................... $172,915,000
Budget request, fiscal year 2026...................... 134,920,000
Committee Recommendation.............................. 134,920,000
Change from enacted level......................... -37,995,000
Change from budget request........................ - - -
The Committee provides $83,979,000 from the General Fund of
the Treasury and $50,941,000 from the Employment Security
Administration Account in the Unemployment Trust Fund.
Application and Approval Transparency.--The Committee
directs DOL, within 180 days of enactment of this Act, to
publicly release a report on the number of Registered
Apprenticeship program applicants, approvals, and the average
time between application submittal and approval. The Committee
further directs DOL to disaggregate this data by applicant
industry classification; whether a sponsoring organization is
an employer, employer-association, or an alternative
intermediary; and, in the event an application was not
approved, the reason for DOL's decision.
Mixed Earners Unemployment Compensation.--The Committee
notes a report (Report No. 19-24-005-03-315) issued on October
26, 2023, by the DOL OIG that described that, under the
enacting law and agreements between the Department and the
State workforce agencies (SWA), SWAs are entitled to the
reimbursement of 100 percent of the cost of eligible benefits
paid under the Mixed Earners Unemployment Compensation (MEUC)
program. Funds for this program, like most pandemic
unemployment insurance programs, were appropriated by Congress
without fiscal year limitation. Because of this, ETA continues
to set aside pandemic funds to reimburse SWAs for eligible MEUC
claims. ETA must reimburse States until all eligible claims
from the program period have been administered--even if this
requires ETA to do so years after the conclusion of the program
period in September 2021. However, paying pandemic-related
claims, long after the pandemic has ended and the U.S. economy
has recovered, is counterproductive to the original intent of
the funds--even if claimants are eligible under the program
period. DOL-OIG recommended the Assistant Secretary for
Employment and Training perform an assessment of previous
emergency UI programs and the pandemic-related UI programs to
determine an appropriate historically based time limit for
States' acceptance of emergency program benefit claims after
the expiration of the UI programs' eligibility periods and
consider making a legislative proposal to Congress to use the
determined time limit on future emergency programs. The
Committee remains concerned that these funds cannot be
sufficiently reprogrammed to support other critical needs and
encourages the Department to timely address the DOL-OIG
recommendation to prevent similar issues during the next
emergency.
Office of Apprenticeship.--The Committee notes that for
purposes of performance reporting, previous DOL budget requests
attributed the total number of Registered Apprenticeships to
the Apprenticeship Grants program. The Committee has concerns
regarding the expediency and consistency of the Office of
Apprenticeship's review of program applications and that
Registered Apprenticeships DOL has attributed to the grant
program are due to private sector investment. As part of the
Fiscal Year 2027 budget submission, the Committee directs DOL
to include the number of Registered Apprenticeship program
applicants, approvals, the average time between application
submittal and approval, and the average time between
application and initial notification that an application was
not approved.
Skilled Trades Workforce Development.--The Committee
encourages the Department of Labor to support the development
of coordinated State and regional outreach plans, in
coordination with Registered Apprenticeship programs, to
educate young Americans about the earning potential, career
pathways, benefits, and accessibility of careers in the skilled
trades.
Unemployment Insurance Fraud Detection.--For more than 20
years, the DOL's Office of Inspector General has reported on
DOL's challenge to reduce improper payments in the UI program,
which has experienced some of the highest improper payment
rates across the Federal government. The Committee is concerned
that ETA currently does not have direct access to State UI
claims data, nor does it have the capability to analyze such
data, which would allow it to better identify fraud and other
improper payments as well as other trends or emerging issues,
such as timeliness. The Committee notes a report (Report No.
19-23-012-03-315), issued on September 25, 2023, by the OIG,
that recommended the Assistant Secretary of ETA expedite OIG-
related amendments to 20 C.F.R. 603.6(a) to make ongoing
disclosures of UI information to DOL-OIG mandatory by expressly
adding OIG (including its agents and contractors) to the list
of required disclosures that are necessary for the proper
oversight of the UI program without distinction as to purpose
(e.g., audits vs. investigations). The Committee directs DOL to
take such measures as necessary to make ongoing disclosures of
UI information available to OIG for purposes of audit of
investigation. The Committee directs DOL to provide a briefing
on its implementation of this directive within 90 days of
enactment of this Act.
Unused Pandemic-Related Federal Funding.--The Committee
remains concerned about the risk of unused pandemic-related
Federal funding in State UI accounts not being returned to the
Treasury. The Committee notes a report (Report No. 19-23-010-
03-315) issued by the DOL-OIG on September 21, 2023,
recommended in part that the ETA determine the proper
disposition of excess funds and take necessary actions,
including the recovery of questioned costs. Approximately $844
million of Emergency Unemployment Relief for Governmental
Entities and Nonprofit Organizations funds (19 percent of the
total $4.5 billion allocated) remained unused in 32 States'
unemployment insurance trust funds. The Committee remains
concerned that these funds have yet to be returned to the
Treasury and encourages the Department of Labor to timely
address the DOL-OIG recommendation.
VETERANS' EMPLOYMENT AND TRAINING SERVICE
Appropriation, fiscal year 2025....................... $335,341,000
Budget request, fiscal year 2026...................... 342,341,000
Committee Recommendation.............................. 342,341,000
Change from enacted level......................... +7,000,000
Change from budget request........................ - - -
The Committee provides $65,500,000 from the General Fund of
the Treasury and $276,841,000 from the Employment Security
Administration Account in the Unemployment Trust Fund.
The Veterans Employment and Training Service (VETS) program
serves America's veterans and separating service members by
preparing them for meaningful careers, providing employment
resources and expertise, and protecting their employment
rights.
Within the total for VETS, the Committee provides the
following amounts:
------------------------------------------------------------------------
Budget Activity FY 2026 Committee
------------------------------------------------------------------------
Jobs for Veterans State Grants....................... $185,000,000
Transition Assistance Program........................ 34,379,000
Federal Administration............................... 54,048,000
Veterans Employment and Training Institute........... 3,414,000
Homeless Veterans Reintegration Program.............. 65,500,000
------------------------------------------------------------------------
The Transition Assistance Program (TAP) for separating
service members and their spouses provides a mandatory one-day
employment workshop, as well as two 2-day career track
workshops on employment preparation and vocational training, as
part of TAP to assist service members' transition to civilian
employment. TAP Employment Workshops are provided on military
installations, both domestically and abroad.
The Committee provides $500,000 to support the Honoring
Investments in Recruiting and Employing American Military
Veterans Act of 2017 (HIRE Vets) Medallion program.
Off-Base Transition Training.--The Committee continues to
support the implementation of the Off-Base Transition Training
pilot program and encourages the Department of Labor to
collaborate with the Department of Veterans Affairs to offer
resources on benefit eligibility.
Transition Assistance Program.--The Department of Labor
plays an important role in educating veterans about many of
their benefits through the Transition Assistance Program,
including providing job assistance training, business ownership
courses, financial planning resources, and basic understandings
of many other benefits. Despite these efforts, the Committee is
concerned with the growing number of veterans and separating
service members who are unaware of many of the service-
connected benefits that are available to them once they
transition back to civilian life. The Committee directs the
Department of Labor to include in the fiscal year 2027
congressional justification the estimated cost of modifying the
Transition Assistance Program to include a once-a-year workshop
for all service members, regardless of their enlistment status.
Employee Benefits Security Administration
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $191,100,000
Budget request, fiscal year 2026...................... 181,100,000
Committee Recommendation.............................. 181,100,000
Change from enacted level......................... -10,000,000
Change from budget request........................ - - -
The Employee Benefits Security Administration (EBSA)
assures the security of retirement, health, and other
workplace-related benefits of working Americans.
Pension Benefit Guaranty Corporation
PENSION BENEFIT GUARANTY CORPORATION FUND
Appropriation, fiscal year 2025....................... $512,900,000
Budget request, fiscal year 2026...................... 494,264,000
Committee Recommendation.............................. 494,264,000
Change from enacted level......................... -18,636,000
Change from budget request........................ - - -
Congress established the Pension Benefit Guaranty
Corporation (PBGC) to insure Americans' defined-benefit pension
plans. It operates a single-employer program and a
multiemployer insurance program, financed through premiums,
investment income, and assets from terminated plans.
Delphi Salaried Plan Employees.--In 2009, the PBGC
terminated certain Delphi pension plans, including the Delphi
Retirement Program for Salaried Employees. The Committee notes
that some participants of the Delphi salaried pension plan
received less than their full benefit. PBGC paid benefits are
subject to statutory limitations. The Committee also notes
ongoing legislative efforts to restore full benefits to the
affected participants.
Office of Workers' Compensation Programs
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $122,705,000
Budget request, fiscal year 2026...................... 110,000,000
Committee Recommendation.............................. 110,000,000
Change from enacted level......................... -12,705,000
Change from budget request........................ - - -
The Office of Workers' Compensation Programs (OWCP)
administers the Federal Employees' Compensation Act, the
Longshore and Harbor Workers' Compensation Act, the Energy
Employees Occupational Illness Compensation Program Act, and
the Black Lung Benefits Act. These programs provide eligible
injured and disabled workers and their survivors with
compensation, medical benefits, and services including
rehabilitation, supervision of medical care, and technical and
advisory counseling.
The Committee provides $107,823,000 in General Funds from
the Treasury and $2,177,000 from the Special Fund established
by the Longshore and Harbor Workers' Compensation Act.
SPECIAL BENEFITS
Appropriation, fiscal year 2025....................... $726,670,000
Budget request, fiscal year 2026...................... 1,298,385,000
Committee Recommendation.............................. 1,298,385,000
Change from enacted level......................... +571,715,000
Change from budget request........................ - - -
These funds provide mandatory benefits under the Federal
Employees' Compensation Act and the Longshore and Harbor
Workers' Compensation Act.
ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL ILLNESS
COMPENSATION FUND
Appropriation, fiscal year 2025....................... $66,966,000
Budget request, fiscal year 2026...................... 68,148,000
Committee Recommendation.............................. 68,148,000
Change from enacted level......................... +1,182,000
Change from budget request........................ - - -
These funds provide mandatory benefits to eligible
employees or survivors of employees of the Department of Energy
(DOE); its contractors and subcontractors; companies that
provided beryllium to DOE; atomic weapons employees who suffer
from a radiation-related cancer, beryllium-related disease, or
chronic silicosis because of their work in producing or testing
nuclear weapons; and uranium workers covered under the
Radiation Exposure Compensation Act.
SPECIAL BENEFITS FOR DISABLED COAL MINERS
Appropriation, fiscal year 2025....................... $30,367,000
Budget request, fiscal year 2026...................... 30,485,000
Committee Recommendation.............................. 30,485,000
Change from enacted level......................... +118,000
Change from budget request........................ - - -
These funds provide mandatory benefits to coal miners
disabled by black lung disease, to their survivors and eligible
dependents, and for necessary administrative costs.
The Committee provides $5,900,000 as an advance
appropriation for the first quarter of fiscal year 2027. These
funds ensure uninterrupted payments to beneficiaries.
BLACK LUNG DISABILITY TRUST FUND
Appropriation, fiscal year 2025....................... $485,706,000
Budget request, fiscal year 2026...................... 477,295,000
Committee Recommendation.............................. 477,295,000
Change from enacted level......................... -8,411,000
Change from budget request........................ - - -
The Black Lung Disability Trust Fund pays black lung
compensation, medical and survivor benefits, and administrative
expenses when no mine operator can be assigned liability for
such benefits, or when mine employment ceased prior to 1970.
The Black Lung Disability Trust Fund is financed by an excise
tax on coal, reimbursements from responsible mine operators,
and short-term advances from the U.S. Treasury. The Emergency
Economic Stabilization Act of 2008 authorized a restructuring
of the Black Lung Disability Trust Fund debt and required that
annual operating surpluses be used to pay down the debt until
all remaining obligations are retired.
Black Lung Benefits Claims Processing.--The Committee is
concerned with lengthy delays in the processing of Black Lung
Benefits Act claims, particularly where the Department has not
yet identified the liable mine operator or the liable mine
operator's ability to pay the claim is in question. Delays
impede access to necessary medical care while claims are
pending. The Committee supports efforts by the Secretary to
resolve these claims expediently to ensure miners can receive
the benefits and medical care they need. The Committee directs
DOL to provide a quarterly report on the Department's efforts
to improve the speed and quality of black lung claims
processing.
Wage and Hour Division
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $260,000,000
Budget request, fiscal year 2026...................... 235,000,000
Committee Recommendation.............................. 235,000,000
Change from enacted level......................... -25,000,000
Change from budget request........................ - - -
The Wage and Hour Division (WHD) enforces Federal minimum
wage, overtime pay, recordkeeping, and child labor requirements
of the Fair Labor Standards Act. WHD also has enforcement and
other administrative responsibilities related to the Migrant
and Seasonal Agricultural Worker Protection Act, the Employee
Polygraph Protection Act, the Family and Medical Leave Act, the
Davis Bacon Act, and the Service Contract Act.
Federal Contractors.--The Committee is concerned that the
Minimum Wage for Federal Contracts notice published by the
Department in the Federal Register on September 30, 2022 (87
Fed. Reg. 59468) disproportionately affects entities operating
seasonal recreational services and equipment rental to the
public on Federal property or lands.
Office of Federal Contract Compliance Programs
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $110,976,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. - - -
Change from enacted level......................... -110,976,000
Change from budget request........................ - - -
The Committee does not provide funding for OFCCP,
consistent with the fiscal year 2026 budget proposal. The
Committee notes the U.S. Equal Employment Opportunity
Commission (EEOC) has the legal responsibility for enforcing
Federal laws that make it illegal to discriminate against a job
applicant or an employee because of the person's race, color,
religion, sex (including pregnancy, childbirth, or related
conditions), national origin, age (40 or older), disability or
genetic information. The EEOC investigates and responds to
instances of potential discrimination related to all types of
work situations including hiring, firing, promotions,
harassment, training, wages, and benefits.
Office of Labor-Management Standards
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $48,515,000
Budget request, fiscal year 2026...................... 48,515,000
Committee Recommendation.............................. 48,515,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Office of Labor Management Standards administers the
Labor-Management Reporting and Disclosure Act, which
establishes safeguards for union democracy and union financial
integrity, and requires public disclosure reporting by unions,
union officers, employees of unions, labor relations
consultants, employers, and surety companies.
Occupational Safety and Health Administration
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $639,359,000
Budget request, fiscal year 2026...................... 582,381,000
Committee Recommendation.............................. 582,381,000
Change from enacted level......................... -56,978,000
Change from budget request........................ - - -
The Occupational Safety and Health Administration (OSHA)
administers the Occupational Safety and Health Act of 1970, by
setting and enforcing health and safety standards for
workplaces and conducting training, outreach, education, and
compliance assistance.
Within the total for OSHA, the Committee provides the
following amounts:
------------------------------------------------------------------------
Budget Activity FY 2026 Committee
------------------------------------------------------------------------
Safety and Health Standards.......................... $16,000,000
Federal Enforcement.................................. 219,343,000
Whistleblower Programs............................... 25,000,000
State Programs....................................... 115,200,000
Technical Support.................................... 23,500,000
Federal Compliance Assistance........................ 78,262,000
State Consultation Grants............................ 60,476,000
Training Grants...................................... - - -
Safety and Health Statistics......................... 34,500,000
Executive Direction and Administration............... 10,100,000
------------------------------------------------------------------------
Non-Mandatory Guidance Concerning Opioid Overdose Reversal
Medication in the Workplace.--Though drug overdose deaths have
decreased for the first time in decades, the Committee is still
extremely concerned about the tens of thousands of deaths that
still happen annually. These deaths occur everywhere including
in the workplace, which accounts for nearly 10 percent of all
occupational injury deaths in 2023. Fortunately, overdose
reversal medication such as naloxone can assist and treat
individuals who experience an overdose. The Committee requests
that within 180 days of passage of this Act, the Occupational
Safety and Health Administration issue nonmandatory guidance to
employers on how to acquire and maintain opioid overdose
reversal medication. The nonmandatory guidance should also
provide employers with how they can offer voluntary training to
employees on the usage of such medication. The Committee
further recommends that this information be made available on
the Administration's website for all to access.
Mine Safety and Health Administration
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $387,816,000
Budget request, fiscal year 2026...................... 348,207,000
Committee Recommendation.............................. 348,207,000
Change from enacted level......................... -39,609,000
Change from budget request........................ - - -
The Mine Safety and Health Administration (MSHA) enforces
the Federal Mine Safety and Health Act of 1977 and the Mine
Improvement and New Emergency Response Act of 2006 in
underground and surface coalmines and metal/non-metal mines.
Within the total for MSHA, the Committee provides the
following amounts:
------------------------------------------------------------------------
Budget Activity FY 2026 Committee
------------------------------------------------------------------------
Mine Safety and Health Enforcement................... $252,307,000
Standards and Regulations Development................ 3,700,000
Assessments.......................................... 7,000,000
Educational Policy and Development................... 25,000,000
Technical Support.................................... 31,200,000
Program Evaluation and Information Resources......... 15,500,000
Program Administration............................... 13,500,000
------------------------------------------------------------------------
Resources and Activities.--The Committee notes significant
worker dislocations and mine closures because of economic
conditions throughout the mining industry, and particularly in
coal mining. The Committee reiterates its support for the
ongoing effort to bring MSHA enforcement into proportion by
redistributing resources and activities to the areas where mine
production is currently occurring and where MSHA identifies the
most significant safety hazards.
Respirable Crystalline Silica.--The Committee shares MSHA's
commitment to ensure the safety and health of our nation's
miners. The Committee is aware of concerns regarding the final
rule, ``Lowering Miners' Exposure to Respirable Crystalline
Silica and Improving Respiratory Protection,'' published in the
Federal Register on April 18, 2024. These concerns relate to
the rule's feasibility, proportionality, and practicality,
differences between the coal and metal/nonmetal mining sectors,
and the lack of adequate notice of the inclusion of provisions
such as an immediate notification requirement. The Committee
directs MSHA to provide a briefing within 120 days of enactment
of this Act that includes: an assessment of the technical and
operational feasibility for operators to achieve compliance
with the rule's exposure limits and reporting requirements, an
evaluation of the accuracy of laboratory analyses supporting
enforcement, and information on how MSHA may apply
proportionality and flexibility in enforcement actions,
including consideration of sector-specific and operational
variability. As part of MSHA's evaluation of this rule and
respirable crystalline silica protections, the Committee
encourages MSHA to incorporate feasibility, proportionality,
and practicality.
Bureau of Labor Statistics
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $703,952,000
Budget request, fiscal year 2026...................... 68,000,000
Committee Recommendation.............................. 713,952,000
Change from enacted level......................... +10,000,000
Change from budget request........................ +645,952,000
The Bureau of Labor Statistics (BLS) is an independent
national statistical agency that collects, processes, analyzes,
and disseminates essential economic data to the Congress,
Federal agencies, State and local governments, businesses, and
the public. Its principal surveys include the Consumer Price
Index and the monthly unemployment series. The Committee
appreciates the potential value of the Administration's
proposed consolidation of Federal statistical agencies. While
the Committee regrets that the pace of the budget cycle
precludes their consideration by the respective authorizing
committees of jurisdiction, the Committee looks forward to
continuing to partner with the Administration to identify
potential efficiencies in the data collection process while
preserving the high-quality of BLS's statistical analysis.
The Committee recommendation includes $645,952,000 from the
General Fund of the Treasury and $68,000,000 from the
Employment Security Administration Account in the Unemployment
Trust Fund.
Within the total for BLS, the Committee provides the
following amounts:
------------------------------------------------------------------------
Budget Activity FY 2026 Committee
------------------------------------------------------------------------
Employment and Unemployment Statistics............... $254,150,000
Labor Market Information............................. 68,000,000
Prices and Cost of Living............................ 249,436,000
Compensation and Working Conditions.................. 92,354,000
Productivity and Technology.......................... 12,360,000
Executive Direction and Staff Services............... 37,652,000
------------------------------------------------------------------------
Declining Statistical Survey Response Rates.--The Committee
notes a report (Report No. 17-24-001-11-001) issued on October
26, 2023, by the OIG that describes how the BLS addresses
challenges posed by declining statistical survey response
rates, and the impact of the declining response rates on the
reliability and costs of economic information developed by BLS.
The OIG recommended, among other things, that BLS, based on the
nonresponse bias study or imputation assessment, establish, as
applicable, a threshold at which the Consumer Price Index and
Import and Export Price Index must publicly disclose the number
of imputations used. The OIG also recommended that BLS update
program policies and procedures to include the established
threshold, and document how to publicly disclose when the
threshold is met. The Committee remains concerned that BLS may
not have guidelines that require a sufficient degree of
transparency and urges that all DOL-OIG recommendations be
sufficiently addressed.
Different-Cell Imputation.--The Committee recognizes the
challenges BLS faces in collecting regional inflation data and
the importance of maintaining high quality reference data. The
Committee has concerns that methodological variance increase
uncertainty and has the potential to degrade the public's
confidence in BLS data.
Military Spouse Employment.--The Committee recognizes the
need for comprehensive data measuring employment among military
spouses over time. The Committee encourages BLS, in
collaboration with DOD, to assess the potential for measuring
labor market outcomes and characteristics of military spouses
with existing survey data and explore options for modifying
such surveys to capture this population.
Standard Occupational Classification 29-1051.--The
Committee is aware that BLS uses a single Standard Occupational
Classification (SOC) code (29-1051) that reflects a traditional
definition of pharmacist job functions. However, the single SOC
does not reflect as many as 46,000 pharmacists working in
nontraditional roles. The Committee encourages BLS to
collaborate with HRSA's National Center for Health Workforce
Analysis, the American Pharmacists Association, and the
American Association of Colleges of Pharmacy to publicly issue
a report on the changes necessary for the SOC codes to
accurately account for the complete pharmacist labor force and
workforce projections.
Survey on Employer Provided Training.--The Committee
directs BLS to include, as part of the fiscal year 2027
congressional justification, a cost estimate of a survey to
better understand the incidence and nature of training provided
to employees by employers.
Office of Disability Employment Policy
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $43,000,000
Budget request, fiscal year 2026...................... 33,810,000
Committee Recommendation.............................. 37,000,000
Change from enacted level......................... -6,000,000
Change from budget request........................ +3,190,000
The Office of Disability Employment Policy provides policy
guidance and leadership to eliminate employment barriers to
people with disabilities.
Office of Inspector General
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $97,028,000
Budget request, fiscal year 2026...................... 91,028,000
Committee Recommendation.............................. 99,028,000
Change from enacted level......................... +2,000,000
Change from budget request........................ +8,000,000
The Office of Inspector General conducts audits of
Department programs and operations to determine that they
comply with the applicable laws and regulations, that they use
resources effectively, and that they are achieving their
intended results.
The recommendation includes $93,187,000 from the General
Fund of the Treasury and $5,841,000 from the Employment
Security Administration Account in the Unemployment Trust Fund.
Fraud Reduction.--The Committee continues to recognize the
outstanding UI program oversight work performed by the OIG. The
DOL-OIG has shown that access to UI data is vital to hold
fraudsters accountable and perform oversight audits to ensure
efficient program operation and the preservation of precious
taxpayer dollars. Between April 1, 2020, and March 31, 2024,
the OIG's efforts to combat UI fraud resulted in more than
1,700 indictments/initial charges; 1,150 convictions; 26,000
months of incarceration ordered; and $1,000,000,000 in
investigative monetary results. Further, OIG's audit work
resulted in the issuance of 50 audit reports including 150
recommendations, more than $75,000,000,000 in funds put to
better use, and more than $277,000,000 in questioned costs
related to DOL's pandemic-related programs and operations. The
Committee directs DOL to ensure that the OIG has timely access
to UI claim and wage data, including access to wage records,
for any authorized purpose under the Inspector General Act of
1978. The Committee directs DOL to report to Congress no later
than 180 days after enactment of this Act, on the steps it has
taken to ensure that OIG has access to UI and wage records for
all oversight activities authorized by the Inspector General
Act of 1978.
Departmental Management
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $393,197,000
Budget request, fiscal year 2026...................... 300,830,000
Committee Recommendation.............................. 230,620,000
Change from enacted level......................... -162,577,000
Change from budget request........................ -70,210,000
The Departmental Management appropriation provides funds
for the staff responsible for Departmental operations,
management, and policy development.
The Committee recommendation includes $230,312,000 from the
General Fund of the Treasury and $308,000 from the Employment
Security Administration Account in the Unemployment Trust Fund.
Within the total for Departmental Management, the Committee
provides the following amounts:
------------------------------------------------------------------------
Budget Activity FY 2026 Committee
------------------------------------------------------------------------
Program Direction and Support........................ $30,250,000
Departmental Evaluation.............................. 4,281,000
Legal Services....................................... 119,935,000
International Labor Affairs.......................... - - -
Administration and Management........................ 28,450,000
Adjudication......................................... 35,000,000
Women's Bureau....................................... - - -
Civil Rights Activities.............................. 6,880,000
Chief Financial Officer.............................. 5,516,000
------------------------------------------------------------------------
Bill Wide Requirements.--The Committee notes the inclusion
of a bill wide requirements section of this report. This
section contains requirements which apply to all agencies
funded by this Act.
Bureau of International Labor Affairs.--The Committee
provides no funding for the Bureau of International Labor
Affairs.
Chief Evaluation Officer.--The Committee notes with concern
the lack of program evaluations performed by the Chief
Evaluation Officer that evaluate programs based on the
employment and labor market outcomes of program participants.
Collaborations Between Manufacturers and Educational
Institutions.--The Committee encourages the Department to
develop pilot programs that facilitate education and training
programs in the field of advanced manufacturing.
Confidential Threat Briefing.--The Committee directs DOL
to, within 180 days of the enactment of this Act, brief the
Committees in a classified setting on the current threat
landscape as relates to Department personnel covered by section
113 of this Act.
Coronavirus Aid, Relief, and Economic Security Act Program
Implementation.--The Committee continues to be concerned that
DOL and States struggled to implement the three key Coronavirus
Aid, Relief, and Economic Security Act UI programs (Pandemic
Unemployment Assistance, Pandemic Emergency Unemployment
Compensation, and Federal Pandemic Unemployment Compensation),
which received a total of $392 billion as of January 2, 2021. A
report (Report No. 19-21-004-03-315) issued on May 28, 2021, by
OIG, found that DOL's guidance and oversight did not ensure
States implemented the programs and paid benefits promptly;
performed required and recommended improper payment detection
and recovery activities; and reported accurate and complete
program activities. OIG recommended, among other things, that
DOL continue to work with States to develop, operate, and
maintain a modular set of technological capabilities to
modernize the delivery of UI benefits that is sufficient to
manage and process sudden spikes in claims volume during
emergencies or high unemployment. The Committee encourages that
all OIG recommendations be sufficiently addressed to mitigate
recurrence of the issues identified.
Energy Production and Critical Manufacturing Workforce.--
The Committee recognizes a need to address workforce shortages
in energy production and critical manufacturing. To address
this need, the Committee encourages the Department of Labor to
conduct a workforce analysis on these industries. The Committee
recommends the study to include information on growth over the
last 10 years, existing entry-level occupations, prerequisites
for occupational entry, salary data, career growth
opportunities, barriers that prevent individuals from acquiring
employment in new occupations and career paths in such
industries, and how digital technology advancements are
impacting these industries. The Department is encouraged to
publicly release such analysis within 180 days of the enactment
of this Act.
Excess Personal Property.--The Committee directs DOL to
include in the fiscal year 2027 congressional justification
information the value and recipient of excess personal property
provided to apprenticeship programs under section 112 of this
Act.
Health Care Professions.--The Committee encourages DOL to
support efforts that connect unemployed workers with
credentials in health care with employers that have acute
workforce needs.
Interstate and Locality Paid Leave Requirements.--The
Committee recognizes that the patchwork of State and local paid
leave requirements creates difficulty for employers and
employees navigating mandatory paid family and medical leave
programs with varying characteristics and requirements. The
Committee directs DOL to produce and publicly release a report
detailing these paid leave programs, including whether and how
they coordinate with employer-provided leave; the actuarial
value of such programs, accounting for differences in
programmatic features such as eligibility of employees, wage
replacement rate, and duration of benefits; and the comparative
equivalence of such programs by jurisdiction. The Committee
directs DOL to provide such report within 180 days of the
enactment of this Act.
Investments in Impoverished Areas.--The Committee directs
DOL to update the report provided to the Committee in response
to a House Report 117-403 directive to include persistent
poverty percentages for competitions in fiscal year 2023 once
those data are available.
Office of Immigration Policy.--The Committee recognizes
that employment visas are an important critical tool for
American employers to have a timely, qualified, and stable
workforce and commends the establishment of the Office of
Immigration Policy to carry out the Department's
responsibilities under the Immigration and Nationality Act,
including oversight, strategic planning, and management of
foreign labor certifications--a mandatory piece of the foreign
labor process. The Committee encourages the Department to
continue to utilize all statutory and regulatory authorities to
expeditiously manage and process foreign labor certifications.
Skilled Trades Workforce Development Outreach
Coordination.--The Committee encourages DOL to support the
development of coordinated State and regional outreach plans to
educate young Americans about the earning potential, career
pathways, benefits, and accessibility of careers in the skilled
trades.
Workforce Impacts Related to Vehicles From Foreign Entities
of Concern.--The Committee is concerned about the potential
impacts on U.S. workers from highly subsidized electric
vehicles and parts built by automakers from foreign entities of
concern. The Committee is also concerned by potential trade
practices inconsistent with the requirements of United States-
Mexico-Canada Agreement by these entities. Therefore, within
180 days of enactment of this Act, the Committee directs the
Department to submit a report analyzing the potential risks to
U.S. workers of highly-subsidized electric vehicles and parts
manufactured by automakers from foreign entities of concern.
IT MODERNIZATION
Appropriation, fiscal year 2025....................... $29,269,000
Budget request, fiscal year 2026...................... 6,889,000
Committee Recommendation.............................. 29,269,000
Change from enacted level......................... - - -
Change from budget request........................ +22,380,000
Information Technology (IT) Modernization provides a
dedicated source of funding for Department-wide IT
modernization projects together with funding through the
Department's Working Capital Fund.
General Provisions
Sec. 101. The Committee continues a provision to prohibit
the use of Job Corps funds for the salary of an individual at a
rate more than Executive Level II.
(TRANSFER OF FUNDS)
Sec. 102. The Committee continues a provision regarding
transfer authority.
Sec. 103. The Committee continues a prohibition on use of
funds to purchase goods that are in any part produced by
indentured children.
Sec. 104. The Committee continues a provision related to
grants made from funds available to the Department under the
American Competitiveness and Workforce Improvement Act.
Sec. 105. The Committee continues a provision to prohibit
recipients of funds provided to the Employment and Training
Administration from using such funds for the compensation of
any individual at a rate more than Executive Level II.
(TRANSFER OF FUNDS)
Sec. 106. The Committee continues a provision providing the
Secretary with the authority to transfer funds made available
to the Employment and Training Administration to Program
Administration for technical assistance and program integrity
activities.
(TRANSFER OF FUNDS)
Sec. 107. The Committee modifies a provision allowing up to
0.75 percent of discretionary appropriations provided in this
Act for specific Department of Labor agencies to be used by the
Office of the Chief Evaluation Officer for evaluation purposes
consistent with the terms and conditions in this Act applicable
to such office.
Sec. 108. The Committee continues a provision relating to
the Fair Labor Standards Act and certain insurance personnel
conducting post-disaster activity.
Sec. 109. The Committee continues a provision relating to
flexibility of H-2B nonimmigrant crossings.
Sec. 110. The Committee continues a provision related to
the prevailing wage in the H-2B program.
Sec. 111. The Committee continues a provision related to
workers in the H-2B program.
Sec. 112. The Committee modifies a provision relating to
surplus property and apprenticeship programs.
Sec. 113. The Committee modifies a provision relating to
the Secretary's security detail.
Sec. 114. The Committee continues a provision relating to
the Treasure Island and Gary Job Corps Centers.
Sec. 115. The Committee continues a provision relating to
Job Corps.
Sec. 116. The Committee includes a new provision related to
Adverse Effect Wage Rate determination.
Sec. 117. The Committee includes a new provision related to
H-2A rulemaking.
Sec. 118. The Committee includes a new prohibition related
to final rule entitled ``Employee or Independent Contractor
Classification Under the Fair Labor Standards Act.''
Sec. 119. The Committee includes a new provision related to
the Job Corps program.
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
Appropriation, fiscal year 2025................ $114,965,801,000
Budget request, fiscal year 2026............... 83,067,660,000
Committee Recommendation....................... 108,066,863,000
Change from enacted level.................. -6,898,938,000
Change from budget request................. +24,999,203,000
The Department of Health and Human Services (HHS)
anticipates exceeding $1.8 trillion in total spending,
constituting over 6 percent of the United States' gross
domestic product. Over 90 percent of this expenditure is
mandatory, with discretionary funding, overseen by the
Committee on Appropriations, comprising only 9 percent.
This bill provides just over $108 billion in discretionary
budget authority for HHS, a reduction of 6 percent over fiscal
year 2025 enacted level. HHS comprises 54 percent of the total
302(b) allocation for this subcommittee.
The Committee supports the efforts of the Secretary of
Health and Human Services to reform and reorganize the
Department. The Secretary has made a number of important
proposals to reorganize the Department to eliminate silos
within and among subagencies and make the Department more
efficient and responsive to the needs of the American people.
The Committee notes that the authorizing committees of
jurisdiction have not yet had the opportunity to fully consider
and act on the Department's proposals. Accordingly, the
Committee's bill and report reflect the current organizational
structure of the Department. The Committee looks forward to
working with the authorizing committees of jurisdiction as they
review the Department's request to reorganize. The Committee
strongly supports and shares the Secretary's goal to end the
chronic disease epidemic and Make America Healthy Again.
Health Resources and Services Administration
Appropriation, fiscal year 2025................ $8,286,229,000
Budget request, fiscal year 2026............... 6,371,802,000
Committee Recommendation....................... 7,405,460,000
Change from enacted level.................. -880,769,000
Change from budget request................. +1,033,658,000
The Health Resources and Services Administration (HRSA)
supports programs that provide health services to
disadvantaged, medically underserved, and special populations;
decrease infant mortality rates; assist in the education of
health professionals; and provide technical assistance
regarding the utilization of health resources and facilities.
The Committee notes that the Department proposes to
incorporate HRSA into a new Administration for a Healthy
America. The Committee looks forward to working with the
authorizing committees of jurisdiction as they consider the
Department's proposal.
The Committee's recommendation for HRSA includes
$7,133,398,000 in discretionary budget authority and
$272,062,000 in mandatory funding.
PRIMARY HEALTH CARE
Appropriation, fiscal year 2025....................... $1,858,772,000
Budget request, fiscal year 2026...................... 1,858,772,000
Committee Recommendation.............................. 1,858,772,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
Health Centers
Health Centers deliver affordable, accessible, quality, and
cost-effective primary health care to millions of people across
the country regardless of their ability to pay. The Health
Center Program supports community health centers, health
centers for the homeless, health centers for residents of
public housing, and migrant health centers. HRSA reports that
in 2023, more than 31 million people relied on HRSA-funded
health centers for care, including 1 in 8 children, more than
9.7 million rural residents, and over 400,000 veterans.
Within the amount provided, the Committee includes bill
language providing up to $120,000,000 for the Federal Tort
Claims Act program.
Further, within the total provided for the Health Centers
program, the Committee provides no less than the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2026 Committee
------------------------------------------------------------------------
Addressing Intimate Partner Violence and Project $2,000,000
Catalyst............................................
Alcee L. Hastings Program for Advanced Cancer 10,000,000
Screening...........................................
Early Childhood Development.......................... 30,000,000
Native Hawaiian Health Care.......................... 27,000,000
Papa Ola Lokahi (non-add)........................ 10,000,000
School Based Health Centers.......................... 55,000,000
------------------------------------------------------------------------
Alcee L. Hastings Program for Advanced Cancer Screening in
Underserved Communities.--The Committee commends the work of
HRSA in effectively implementing the Alcee L. Hastings Program
for Advanced Cancer Screening in Underserved Communities. This
innovative program focuses on HRSA-funded health centers to
leverage Cancer Center trained and supervised outreach
specialists and patient navigators to conduct patient outreach,
patient education, case management, and other patient support
services in underserved communities served by health centers to
promote early detection and prevention of cancer, connect
patients to screening services, and provide direct assistance
with accessing high quality cancer care and treatment as
needed. This program is progressing as intended with health
centers reporting progress toward stated goals. The grant
funding has made it possible for health centers to improve
access to and affordability of cancer screening, referral for
care, and treatment; to enhance patient experience; and to
recruit, train, and engage cancer-focused professionals. Within
the total funding for health centers, the Committee provides
robust funding to continue supporting screening initiatives in
breast, cervical, colorectal, and lung cancer; prioritize new
grantees in States where the total number of estimated new
cancer cases and deaths due to cancer are highest; and to
support grantees that can expand existing projects that embrace
additional cancers, and that also work to secure appropriate
follow up screening and access to care for individuals with
abnormal screening results.
Autonomous Artificial Intelligence and Diabetic
Retinopathy.--The Committee encourages HRSA to consider the
establishment, expansion, or maintenance of efforts at
Federally Qualified Health Centers (FQHC) to bring specialty
eyecare services to patients using FDA-cleared autonomous
artificial intelligence technology that diagnoses diabetic
retinopathy. HRSA is further encouraged to focus on supporting
efforts at FQHCs where a majority of patients with diabetes
face challenges adhering to medical recommendations to receive
annual comprehensive diabetic eye exams. HRSA is also
encouraged to evaluate the utilization of FDA-cleared
autonomous AI within FQHCs and, in consultation with physician
specialty professional organizations, promote patient and
provider education on successful patient referral pathways from
FQHCs to specialty care.
Base Grant Adjustments.--The Committee recognizes that
health center costs have increased significantly and that it
has been nearly a decade since the last base grant adjustment.
The Committee encourages HRSA to consider the needs of existing
health centers in relation to their current base grants when
allocating available health center funding.
Community Health Center Infrastructure.--The Committee
recognizes that Community Health Centers (CHCs) deliver
essential care to millions of Americans, regardless of their
ability to pay. In many rural and socioeconomically
disadvantaged areas--including colonias along the U.S.-Mexico
border--CHCs are often the only source of care and serve as a
vital safety net for families facing persistent poverty and
limited access to health infrastructure. Despite their vital
role, many CHCs face serious infrastructure challenges,
including aging or inadequate facilities that restrict their
ability to meet growing patient demand or expand services. The
Committee directs the Secretary of HHS, in coordination with
the Secretaries of Housing and Urban Development and
Agriculture, to develop a coordinated strategy to address these
deficiencies by identifying relevant Federal programs and
supporting technical assistance for facility improvements. The
strategy should prioritize CHCs serving rural areas, Tribal
lands, and border communities such as colonias. The Committee
further directs HHS to submit a report on this strategy to the
Committees on Appropriations of the House of Representatives
and the Senate within 180 days of enactment of this Act.
Expanded Service Grants for Individuals with an
Intellectual or Developmental Disability.--The Committee
supports efforts to expand service grants to health centers for
the planning and delivery of services to individuals with an
intellectual or developmental disability, including for
innovative programs that provide outreach and comprehensive
primary health services and additional health services as
defined in section 330(b) of the Public Health Service (PHS)
Act (42 U.S.C. 254b), including dental care.
Federally Qualified Health Center Look Alike
Participation.-- The Committee notes that certain health
centers throughout the country are ineligible to apply for
supplemental funding awards because of their status as a FQHC
Look-Alike (LAL). The Committee requests a briefing from HRSA
within 180 days of the enactment of this Act on the impact of
allowing FQHC LALs to apply for supplemental funding
opportunities under section 330 of the PHS Act and the ways in
which the FQHC LAL program could be better utilized as a
pipeline into the section 330 Health Center Program.
Health Center Collaboration.--The Committee supports health
centers entering partnerships that close care gaps in medically
underserved areas. The Committee encourages HRSA to examine how
to support existing health center partnerships and incentivize
more collaboration in underserved communities.
Integration of Behavioral Health Care in Community Health
Centers.--CHCs play a critical role in providing essential
health care services to communities across the United States.
Fewer than nine percent of CHC patients received mental health
services, and fewer than one percent of CHC patients received
substance use services in 2023. Both mental health and
substance use disorder treatment are key drivers of physical
and behavioral health. Integrating mental health and substance
use disorder treatment as primary services provided by CHCs is
an efficient way to meet growing demand for treatment,
particularly in rural areas. Additionally, integration of these
services would eliminate cost barriers as CHCs would no longer
need to submit a formal request to HRSA to add these services.
The Committee directs HRSA to provide an update to the
committees of jurisdiction within 180 days of the enactment of
the Act on efforts and obstacles to including mental health and
substance use disorder treatment as required primary services
in CHCs.
Native Hawaiian Health Care.--The Committee continues
$27,000,000 for the Native Hawaiian Health Care Program. Of the
total amount appropriated for the Native Hawaiian Health Care
Program, no less than $10,000,000 shall be provided to Papa Ola
Lokahi for administrative purposes authorized under 42 U.S.C.
11706, including expanded research and surveillance related to
the health status of Native Hawaiians and strengthening the
capacity of the Native Hawaiian Health Care Systems.
Parental Consent.--The Committee directs HRSA to ensure
grantees comply with all Federal and State laws for parental
and legal guardian approval for medical decisions involving
minors. Grantees should not provide materials encouraging
health care providers to hide a minor patient's perceived
sexual orientation or any effort that deviates from the
patient's biological sex from the patient's parent or guardian.
Technical assistance and guidance documentation should be
consistent with all Federal and State law regarding parental
consent. Moreover, grantees should not be providing any
guidance to health care practitioners for ways to bypass
parental consent or how to keep medically relevant information
from a patient's medical record.
School-Based Health Centers.--The Committee continues
funding for school-based health centers authorized under
section 330 of the PHS Act (42 U.S.C. 254b).
Technical Assistance.--The Committee believes funding for
the training and technical assistance available for health
centers through national and State cooperative agreements and
grants is critical to the successful operation and expansion of
the health centers program. Funds are available within the
amount provided to enhance technical assistance and training
activities and further quality improvement initiatives that
improve health outcomes and continue the development of and
support for health center-controlled networks so that new and
existing centers can improve patient access to quality health
services.
Testing for Hepatitis C.--The Committee recognizes the
value of point of care testing for the hepatitis C virus and
supports efforts by HRSA to adopt practices and policies to
test for the hepatitis C virus. The Committee further
encourages HRSA to ensure that health centers have access to
and utilize available point of care diagnostic tests to
adequately test the populations they serve.
Type 1 Diabetes.--Health centers remain a major source of
primary health care for millions of Americans. Therefore, the
Committee supports ways to increase type 1 diabetes (T1D)
screenings at health centers, particularly among high-risk
populations. HHS has reported increased incidents of diabetic
ketoacidosis (DKA) at diagnosis, with rates over 40 percent
among youth in some years. Further, misdiagnosis with type 2
diabetes is a leading risk factor for adults entering DKA at
diagnosis. A 2020 study from Diabetes Care showed that charges
associated with DKA admissions totaled over $6,700,000,000 in
2017. The Committee directs HRSA to provide a report to the
Committees on Appropriations of the House of Representatives
and the Senate within one year of the enactment of this Act
addressing the steps needed to increase screening efforts for
T1D at health centers and to make such report available on the
agency's website. The report should assess the feasibility and
estimated cost of expanding screening efforts among targeted
populations and include a plan and timeline to implement such
efforts. When developing the report, HRSA should consult with
the National Institute of Diabetes and Digestive and Kidney
Diseases, patient advocacy organizations, and other T1D
stakeholders.
Free Clinics Medical Malpractice
Within the amount provided, the Committee includes bill
language providing up to $1,000,000 for payment of claims under
the FTCA to be made available for free clinic health
professionals as authorized by section 224(o) of the PHS Act.
This appropriation extends FTCA coverage to medical volunteers
in free clinics to expand access to healthcare services for
low-income individuals in medically underserved areas.
HEALTH WORKFORCE
Appropriation, fiscal year 2025....................... $1,404,376,000
Budget request, fiscal year 2026...................... 394,620,000
Committee Recommendation.............................. 1,366,933,000
Change from enacted level......................... -37,443,000
Change from budget request........................ +972,313,000
The Bureau of Health Workforce (BHW) strengthens the health
care workforce by connecting skilled health care providers to
communities in need through grant, scholarship, and loan
repayment programs. These programs are designed to help
underserved communities recruit and retain health care
providers.
Community-Based Clinical Rotations for Medical Students.--
An estimated 80 percent of patient care is now provided in a
range of community-based settings rather than academic
hospitals where clinical training has traditionally occurred.
Research shows that providing outpatient training opportunities
in underserved areas--either in conjunction with or outside of
inpatient training programs--encourages long-term, sustainable
physician practice in high-need areas. The Committee recognizes
that prioritizing community-based clinical training in rural
and underserved areas leads to more physicians staying to
practice in these communities. Within the funding provided, the
Committee encourages HRSA to support opportunities for medical
schools to partner with FQHCs, Rural Health Clinics, or other
healthcare facilities located in medically underserved
communities to increase medical school clinical rotations in
rural and underserved areas.
Graduate Education Pipeline in Underserved Areas.--The
Committee understands the role of programs that assist students
in enrolling and completing in graduate and professional
programs that supply health professionals to underserved
communities. Many Health Professional Shortage Areas (HPSAs)
and Medically Underserved Areas (MUAs) rely on a stable
pipeline of health workforce graduates from these institutions.
The Committee encourages HRSA to assess health workforce
availability in HPSA and MUA regions. The Committee requests
that HRSA submit a report within 180 days of enactment of this
Act identifying strategies to ensure continued access to
graduate education programs that serve as essential pipelines
to primary care, behavioral health, dental, and allied health
professions in shortage areas.
Health Professions Shortages and Health Workforce
Enhancement.--The Committee notes the success of online,
personalized career-training and certification programs to
address the shortage of registered Medical Assistants and
related health professionals in communities across the country.
The Committee encourages HRSA to look to successful programs
and connect with stakeholders to identify opportunities and
barriers for collaboration, and to encourage and advance
similar collaborations in a coordinated fashion moving forward.
Health Professions Workforce.--The Committee recognizes the
critical shortages in healthcare professions, particularly
affecting rural communities. The Committee directs HHS to
conduct a comprehensive study documenting successful programs
utilizing skills-based training platforms and public-private
partnerships that enhance healthcare workforce development
through online learning platforms. The report should focus on
professions that are most critical in terms of dealing with
chronic disease management and high-volume specialty care in
this environment. Such professions include primary care
physicians, cardiologists, endocrinologists, orthopedists, and
behavioral health professionals. Further, such report should
focus on scalable solutions to balance the high numbers of
patients with specialized care that are in high demand and
include recommendations for expanding effective workforce
development initiatives. The Department shall submit this
report to the Committees on Appropriations of the House of
Representatives and the Senate within one year of the enactment
of this Act.
Health Workforce Shortages.--The Committee appreciates
HRSA's efforts to tackle health care workforce shortages across
the country. The Committee supports the expansion of the
physician, nursing, and pharmacy workforce to meet the growing
health needs of the American people. The Committee encourages
HRSA to consider ways to expand these efforts and requests
information on the steps the agency is taking to address health
professions shortages in the fiscal year 2027 congressional
justification.
Primary Care Physician Shortages.--The Committee encourages
HHS to continue its efforts to provide a comprehensive review
of national trends affecting the recruitment and retention of
primary care physicians. Such ongoing analysis should evaluate
the effectiveness of existing Federal policies and programs,
including loan repayment initiatives, reimbursement models, and
training programs serving rural and low-income populations.
Such analysis should also examine geographic and demographic
factors contributing to physician shortages. The Committee
requests an update on such efforts in the fiscal year 2027
congressional justification.
National Health Service Corps
The Committee includes $130,000,000, for the National
Health Service Corps (NHSC) to support competitive awards to
health care providers dedicated to working in underserved
communities in urban, rural, and Tribal areas.
State Loan Repayment Program.--The Committee appreciates
that the State Loan Repayment Program (SLRP) allows States to
determine how to address healthcare provider shortages.
However, the Committee is concerned that many States may not be
focusing on the full range of healthcare providers in shortage,
including in nursing, pharmacy, dentistry, and behavioral
healthcare. The Committee requests HRSA include in the fiscal
year 2027 congressional justification information regarding the
steps the agency is taking to address health professions
shortages, including efforts to ensure the SLRP is supporting
all health care professions in shortage, including in nursing,
pharmacy, dentistry, and behavioral healthcare. The update
should include: (1) information, by State, on what professions
are benefiting from the SLRP and how many individuals in each
profession have received funding; and (2) how many individuals
applied, broken down by profession and State. In addition, the
update should provide information on how HRSA can expand
efforts to include health professionals who do not typically
benefit from HRSA workforce programs, such as pharmacists, in
its educational, training, and loan repayment programs.
Tribal Set-Aside.--The Committee includes a set-aside of 15
percent within the total funding provided for NHSC to support
awards to participating individuals that provide health
services in Indian Health Service facilities, Tribally-operated
health programs, and Urban Indian Health programs.
Health Professions Education and Training
The Committee recommends $508,304,000 for the health
professions education and training programs authorized under
title VII of the PHS Act.
Centers of Excellence
The Committee recommends $25,422,000 for the Centers of
Excellence Program. The Centers of Excellence program provides
innovative resources and education centers to recruit, train,
and retain students and faculty at health professions schools.
Health Careers Opportunity Program
The Committee recommends $15,000,000 for the Health Careers
Opportunity Program (HCOP). The purpose of this grant program
is to assist students from disadvantaged backgrounds to enter
and successfully complete health profession schools. National
HCOP Academies prepare students to meet the admissions
requirements for the next level of their education and receive
a health professions degree or certificate.
Faculty Loan Repayment
The Committee includes $2,310,000 for the Faculty Loan
Repayment program. This program provides loan repayment to
health professions graduates from disadvantaged backgrounds who
serve as faculty at eligible health professions academic
institutions.
Scholarships for Disadvantaged Students
The Committee includes $55,014,000 for Scholarships for
Disadvantaged Students (SDS). The SDS program provides grants
to health professions and nursing schools to provide
scholarships to students from disadvantaged backgrounds who
have financial need.
Midwifery Training.--Within the total for SDS, the
Committee includes $5,000,000 to continue grants awarded for
the purpose of educating midwives to address the national
shortage of maternity care providers.
Primary Care Training and Enhancement
The Committee includes $49,924,000 for Primary Care
Training and Enhancement programs. These programs support the
primary care workforce by providing enhanced training for
future primary care clinicians and faculty and promoting
primary care practice, particularly in rural and underserved
areas.
Community-Based Clinical Rotations for Medical Students.--
The Committee recognizes that patient care is frequently
provided in a range of community-based settings and that
providing outpatient training opportunities in underserved
areas encourages long-term, sustainable physician practice in
high-need areas. The Committee encourages HRSA to evaluate and
facilitate opportunities for medical schools to partner with
FQHCs, Rural Health Clinics, or other healthcare facilities
located in medically underserved communities to increase
medical school clinical rotations in rural and underserved
areas.
Oral Health Training
The Committee includes $43,673,000 for Oral Health
Training. The Oral Health Training programs increase access to
high-quality dental health services in rural and other
underserved communities by increasing the number of oral health
care providers working in underserved areas and improving
training programs for these providers.
Within the funds provided, the Committee includes no less
than $13,500,000 for general dentistry programs, no less than
$13,500,000 for pediatric dentistry programs, and no less than
$15,000,000 for State oral health workforce grants. The
Committee directs HRSA to provide continuation funding for
section 748 post-doctoral training grants, predoctoral dental
grants, and dental faculty loan repayment grants.
The Committee continues to support awards with a preference
for pediatric dentistry faculty supervising dental students or
residents and providing clinical services in dental schools,
hospitals, and community-based affiliated sites.
State Oral Health Workforce Improvement Grant Program.--The
Committee commends HRSA for its ongoing efforts to address the
nation's health workforce. The oral health workforce
development program offers States the opportunity to address
their unique workforce and access to care needs.
Pediatric Specialty Loan Repayment Program
The Committee includes $10,000,000 for the pediatric
specialty loan repayment program (PSLRP) authorized by section
775 of the PHS Act.
The Committee is concerned that the 2023 and 2024 PSLRP
application processes did not adequately reflect the way
pediatric subspecialty care is provided. The Committee is also
concerned that pediatric medical subspecialists, pediatric
surgical specialists, and child and adolescent psychiatrists,
were underrepresented in the initial awards of the program
despite the intent of the program when it was created. The
Committee directs HRSA to work with stakeholders to ensure that
the program's application process includes clinical hour
requirements and site eligibility criteria that are consistent
with actual pediatric specialty practice and reflects the
regionalization of pediatric specialty care. The Committee also
directs HRSA to develop award criteria that ensure that more
applicants with significant medical school debt can benefit
from the program. The Committee requests an update on these
efforts in the fiscal year 2027 congressional justification.
Interdisciplinary Community-Based Linkages
Area Health Education Centers
The Committee includes $47,000,000 for the Area Health
Education Centers program. This program links university health
science centers with community health service delivery systems
to provide education and training networks.
Simulation-Based Clinical Education.--Within the total, the
Committee provides $3,000,000 for AHEC recipients to continue
to provide experiential learning opportunities through
simulation labs designed to educate and train health care
professionals serving rural, medically underserved communities.
HRSA shall include as an allowable use the purchase of
simulation training equipment.
Geriatrics Programs
The Committee includes $48,245,000 for the Geriatrics
Workforce Enhancement Program and the Geriatrics Academic
Career Awards Program. These programs support training to
integrate geriatrics into primary care delivery and develop
academic-primary care-community based partnerships to address
gaps in health care for older adults.
Mental and Behavioral Health Programs
The Committee consolidates activities previously funded
under Mental and Behavioral Health programs into Behavioral
Health Workforce Education and Training.
Behavioral Health Workforce Education and Training
The Committee includes $158,053,000 for the Behavioral
Health Workforce Education and Training (BHWET) program. This
program establishes and expands internships or field placement
programs in behavioral health, serving populations in rural and
medically underserved areas.
Within the total for BHWET, the Committee recommends no
less than the following amounts:
------------------------------------------------------------------------
Budget Activity FY 2026 Committee
------------------------------------------------------------------------
Graduate Psychology Education........................ $25,000,000
Mental and Substance Use Disorder Workforce Training 34,700,000
Demonstration.......................................
Addiction Medicine Fellowship (non-add).......... 25,000,000
Peer Support Specialists............................. 15,000,000
------------------------------------------------------------------------
Community-Based Settings.--The Committee encourages HRSA to
work with grantees to use BHWET funds to support individuals
providing care in community-based settings while completing
clinical training requirements for licensure. This flexibility
would allow for improved access to behavioral health services
in rural and underserved communities across America.
Graduate Psychology Education.--The interprofessional
Graduate Psychology Education program increases the number of
health service psychologists trained to provide integrated
services to high-need, underserved populations in rural and
urban communities. The Committee notes data from CDC
demonstrating a rise in mental health issues for youth and
adolescents and urges HRSA to strengthen investments in the
training of health service psychologists to help address this
population.
Mental and Substance Use Disorder Workforce Training
Demonstration.--This program makes grants to institutions,
including but not limited to medical schools and FQHCs, to
support training for medical residents and fellows in
psychiatry and addiction medicine, as well as nurse
practitioners, physician assistants, health service
psychologists, counselors, nurses, and social workers trained
to provide mental health and substance use disorder services in
underserved and rural community-based settings, including such
settings that serve pediatric populations, as authorized under
section 760 of the PHS Act.
The Addiction Medicine Fellowship program provides
fellowships to train addiction medicine physicians and
addiction psychiatrists who work in underserved, community-
based settings that integrate primary care with mental health
disorder and SUD prevention and treatment services. One major
cause of the existing treatment gap is that physicians in
traditional medical settings lack the necessary training and
overall confidence to provide comprehensive assessments of
adolescents with SUD and subsequent evidence-based treatment.
The fellowship opportunities funded by this program provide
advanced training opportunities to a wide range of specialists,
including those in family medicine, internal medicine,
psychiatry, and emergency medicine.
Peer Support Specialists.--The Committee supports community
based experiential training for students preparing to become
peer support specialists and other types of behavioral health-
related paraprofessionals. The Committee includes a $1,000,000
increase for this activity.
Substance Use Disorder Treatment and Recovery (STAR) Loan
Repayment Program
The Committee includes $40,000,000 for this program. This
program addresses shortages in the SUD workforce by providing
for the repayment of education loans for individuals working in
a full-time SUD treatment job that involves direct patient care
in either a Mental Health HPSA or a county where the overdose
death rate exceeds the national average.
National Center for Health Workforce Analysis
The Committee includes $5,663,000 for the National Center
for Health Workforce Analysis (NCHWA), consistent with the
fiscal year 2026 budget request. NCHWA is the primary Federal
entity that collects, analyzes, and reports on data and
information regarding the U.S. health workforce. NCHWA also
evaluates the effectiveness of HRSA's workforce investment
programs.
Real-Time Data to Improve U.S. Healthcare Workforce.--The
Committee encourages HRSA to develop a data dashboard for all
Graduate Medical Education (GME) training position participants
that includes real-time information on residency applications,
interviewee demographics, and residency fulfillment rates.
NCHWA has projected shortages across a wide range of health
care occupations, particularly in rural areas. As a result,
HRSA has increased its focus on rural residency training,
including through the Rural Residency Planning and Development
Program. The Committee encourages HRSA to expand these efforts
to meet locally identified needs by providing support for
medical residency program feasibility and sustainability
assessment activities including regional data landscape
analyses in rural communities to address inequities in location
and discipline. The Committee recognizes the benefit of using
real-time information to assess whether such programs are
leading to improved physician supply in medically underserved
areas.
Public Health and Preventive Medicine Training Programs
The Committee includes $8,000,000 for the Preventive
Medicine Residency program. This program provides awards for
residents to obtain enhanced experiential activities with a
focus on residents having longitudinal clinical rotations in
FQHCs in rural or medically underserved communities.
Consistent with the fiscal year 2026 budget request, the
Committee does not prioritize available funding for the Public
Health Training Centers program.
Nursing Workforce Development
The Committee recommends $258,629,000 for the Nursing
Workforce Development programs authorized under title VIII of
the PHS Act.
Nursing Workforce Center Expansion Program.--The Committee
supports efforts to provide support within available resources
to help States establish, expand, or maintain State-based
centers for nursing. Nursing Workforce Centers are hubs within
a State that advance nursing education, practice, leadership,
and workforce development at the State and local levels.
Currently, there are 39 Nursing Workforce Centers that rely on
a mix of funding from nurse licensure fees, State governments,
foundation grants, membership fees, and service fees. Many
report insufficient funding and lack of technical capabilities
as major barriers to fully supporting their State's nursing
workforce needs. Additional resources would help States collect
localized and granular workforce research data, conduct
strategic nursing workforce planning and program development,
support programs to decrease workplace violence against nurses,
develop programs to increase the recruitment and retention of
nurses, and coordinate nurse leadership development programs.
The Committee encourages HRSA to work with Congress and
stakeholders to examine ways to establish new or enhance
existing State-based nursing workforce centers to advance
training.
Nursing Workforce Development.--The Committee recognizes
the critical importance of addressing healthcare workforce
shortages in underserved communities, particularly in States
that face significant challenges in maternal health outcomes
and nursing shortages. The Committee encourages HRSA to
prioritize funding for projects at Historically Black Colleges
and Universities (HBCU) that establish career pathways from
entry-level certifications to advanced nursing credentials in
areas with documented healthcare staffing shortages. The
Committee further encourages HRSA to prioritize investments in
healthcare training infrastructure at HBCUs with existing
clinical programs that can be rapidly scaled to meet critical
regional nursing shortages.
Nursing Workforce Shortages.--The Bureau of Labor
Statistics projects 203,200 openings for nurses in the United
States each year through 2031. With an aging population with
greater health care needs, an aging clinical and faculty
workforce, and a decline in the number of students in entry-
level nursing programs, the Committee believes action must be
taken to alleviate this crisis and ensure an ample, well-
trained nursing workforce for the future. The Committee
supports efforts to expand the nursing workforce at all levels
to meet the growing health needs of our population. The
Committee encourages efforts to expand the number of nursing
faculty and clinical preceptor sites to educate students at all
levels.
Advanced Nursing Education and Nurse Practitioner Optional
Fellowship Program
The Committee includes $89,581,000 for the Advanced Nursing
Education Workforce (ANEW) program and an additional $7,000,000
for the Nurse Practitioner Optional Fellowship program within
ANEW. The ANEW program supports traineeships and faculty and
curriculum development to increase the number of qualified
nurses in the primary care workforce.
Certified Nurse Midwives.--The Committee continues
$8,000,000 for Certified Nurse Midwives within Advanced Nursing
Education.
Sexual Assault Nurse Examiners (SANE).--The Committee
continues $15,000,000 for this activity. The Committee
encourages HRSA to prioritize rural, Tribal, and underserved
communities, and urban areas without full-time coverage for
this program. This program shall provide training and
supervision to nurses with the purpose of increasing sexual
assault forensic nurse capacity in rural areas, and in support
of population-specific programs and hospitals including, but
not limited to, underserved or historically underfunded
communities. Entities receiving these funds shall promote best
practices in forensic nursing throughout a region, while
continuing to research and develop the highest standards of
care. The Committee notes that the ANEW program will recompete
in fiscal year 2027. The Committee requests that HRSA provide
information in the fiscal year 2027 congressional justification
on the feasibility of establishing regional SANE training
programs within the ANEW program that would establish a level
of excellence in forensic nursing and prepare current and
future sexual assault nurse examiners/forensic nurse examiners
to be profession-ready and meet the applicable State
certification and licensure requirements.
Nurse Practitioner Optional Fellowship Program.--The
funding provided for this activity supports grants within the
Advanced Nursing Education Nurse Practitioner Residency and
Fellowship Program to establish, expand, or maintain optional
community-based nurse practitioner fellowship programs with a
preference for those in FQHCs, for practicing postgraduate
nurse practitioners in primary care or behavioral health.
Nurse Education, Practice, Quality, and Retention
The Committee includes $69,413,000 for the Nurse Education,
Practice, Quality, and Retention (NEPQR) programs. These
programs support academic, service, and continuing education
projects to enhance nursing education, improve the quality of
care, increase nurse retention, and strengthen the nursing
workforce.
Experiential Learning.--Within the total for NEPQR, the
Committee continues no less than $10,750,000 for grants to
enhance nurse education through the expansion of experiential
learning opportunities. The Committee directs HRSA to ensure
that these grants include as an allowable use the purchase of
simulation training equipment.
Nursing Workforce Diversity
Consistent with the fiscal year 2026 budget request, the
Committee does not prioritize available funding for this
program.
Nurse Corps Scholarship and Loan Repayment
The Committee includes $92,635,000 for Nurse Corps,
consistent with the fiscal year 2026 budget request. This
program supports scholarships and loan repayment assistance for
nurses and nursing students committed to working in communities
with inadequate access to care.
Nursing Faculty Loan Program
Consistent with the fiscal year 2026 budget request, the
Committee does not prioritize available funding for this
program.
Children's Hospitals Graduate Medical Education
The Committee includes $395,000,000 for the Children's
Hospitals Graduate Medical Education (GME) program. This
program helps eligible hospitals maintain GME programs, which
support the training of residents to care for the pediatric
population and enhance the supply of primary care and pediatric
medical and surgical subspecialties. The program trains over
half of all general pediatrics residents and pediatric
subspecialty residents and fellows.
Medical Student Education
The Committee includes $75,000,000 for the Medical Student
Education program to support colleges of medicine at public
universities located in the top quartile of States projected to
have a primary care provider shortage.
The Committee directs HRSA to give priority to applications
from academic institutions located in States with the greatest
number of Federally recognized Tribes. The Committee also
directs HRSA to give priority to applications from public
universities with a demonstrated public-private partnership.
National Practitioner Data Bank
The Committee includes $33,500,000 for the National
Practitioner Data Bank (NPDB). As mandated by the Health Care
Quality Improvement Act (Public Law 99-660), the NPDB is
financed by the collection of user fees. The NPDB collects
certain adverse information, medical malpractice payment
history, and information related to healthcare fraud and abuse.
The data bank is available to healthcare agencies and
organizations that make licensing and employment decisions.
MATERNAL AND CHILD HEALTH
Appropriation, fiscal year 2025....................... $1,170,430,000
Budget request, fiscal year 2026...................... 896,846,000
Committee Recommendation.............................. 985,481,000
Change from enacted level......................... -184,949,000
Change from budget request........................ +88,635,000
The mission of the Maternal and Child Health Bureau is to
improve the physical and mental health, safety, and well-being
of the nation's women, infants, children, adolescents, and
their families.
Maternal and Child Health Services Block Grant
The Committee recommends $603,584,000 for the maternal and
child health (MCH) services block grant, consistent with the
fiscal year 2026 budget request. States use these funds to
improve access to care for mothers, children, and their
families; reduce infant mortality; provide pre- and post-natal
care; support screening and health assessments for children;
and provide systems of care for children with special health
care needs.
Community Integrated Service Systems.--The Committee
recommends $10,276,000 for community integrated service system,
which is the same as the fiscal year 2026 budget request. These
grants help States and communities build a comprehensive,
integrated system of care to improve access and outcomes for
all children, including children with special health care
needs.
Reducing Maternal Mortality.--The Committee is concerned
with the persistent rate of maternal mortality in the United
States. In 2023, the maternal mortality rate was 18.6 deaths
per 100,000 live births making the U.S. an outlier among
similarly developed countries. The Committee is encouraged by
the initial success of the Healthy Start Blood Pressure Cuff
Kit pilot and recommends an expansion of information provided
to pregnant women. The Committee recommends HRSA build on the
Healthy Start Blood Pressure Cuff Kit pilot by administering
maternity care kits to pregnant women which may include (i) a
blood pressure cuff; (ii) a factsheet of urgent maternal health
warning signs, (iii) Maternal Mental Health Hotline (833 TLC
MAMA) materials; (iv) 988 hotline information; (v) prenatal
vitamins; (vi) Safe sleep guidance; and (vii) pregnancy-safe
seatbelt use and car seat safety information. The Committee
requests an update in the fiscal year 2027 budget justification
regarding the steps being taken to provide these resources.
Self-Measured Blood Pressure Monitoring.--The Committee
notes the promise of the Healthy Start blood pressure
monitoring pilot, including the distribution of cuff kits to 15
sites in 12 States. The Committee would like to see more States
benefit from this project and urges continued support and
expansion of this effort to the extent practicable. The self-
measured blood pressure monitoring pilot works to identify
preeclampsia during pregnancy at an earlier stage in high-risk
communities by distributing blood pressure cuffs and patient
information. Preeclampsia, the most dangerous form of
hypertension, is a pregnancy complication that affects as many
as one in twelve pregnancies and can be easily monitored.
MCH Block Grant--Special Projects of Regional and National
Significance
The Committee recommends $163,667,000 for special projects
of regional and national significance (SPRANS), which fully
funds the fiscal year 2026 budget request. The Committee
continues bill language identifying a specific amount for
SPRANS. Within that amount, the Committee provides no less than
the following within SPRANS:
------------------------------------------------------------------------
FY 2026
Budget Activity Committee
------------------------------------------------------------------------
Early Childhood Development Grants................... $10,250,000
Epilepsy............................................. 3,642,000
Fetal Alcohol Syndrome............................... 1,000,000
Fetal Infant and Child Death Review.................. 5,000,000
Hereditary Hemorrhagic Telangiectasia................ 2,000,000
Infant-Toddler Court Teams........................... 20,000,000
Minority Serving Institutions........................ 10,000,000
Newborn Essentials Support Toolkits.................. 5,000,000
Oral Health.......................................... 5,250,000
Regional Pediatric Prevention Network................ 25,000,000
Sickle Cell Disease.................................. 7,000,000
State Maternal Health Innovation Grants.............. 55,000,000
------------------------------------------------------------------------
Infant Toddler Court Teams.--The Committee includes
$20,000,000 for research-based Infant-Toddler Court Teams to
change child welfare practices to improve well-being for
infants, toddlers, and their families. The Committee directs
HRSA to allocate funding to ensure continuation of existing
grantees, technical assistance, and support other expansion
activities.
Newborn Essentials Support Toolkits.--The Committee
provides $5,000,000 to continue the work of the Newborn Supply
Kit program. The Committee directs HRSA to make grants or enter
into cooperative agreements with eligible entities,
particularly those that have a multi-state reach, to procure
supply kits for new mothers and partner with local eligible
entities to distribute the supply kits. Eligible entities for
this program shall include hospitals, health centers,
community-based organizations, or other organizations serving
mothers and infants. Such supply kits shall be composed of
essential goods to help mothers recover from childbirth and
care for newborn infants such as diapers, wipes, blankets,
infant thermometers, postpartum supplies, breastfeeding
supplies, information on the Maternal Mental Health Hotline,
information on the National Breastfeeding Helpline, educational
material on breastfeeding, information about programs providing
support to postpartum women and children, evidence-based
education material on the use of low-dose aspirin (to address
hypertension, preeclampsia, and preterm birth), and a blood
pressure monitor. The Committee directs HRSA to ensure, to the
maximum extent practicable, the geographical diversity of the
recipients of such kits, emphasizing geographic areas with the
greatest need, such as maternal care deserts, rural
communities, and communities with the highest maternal
mortality rates.
Oral Health and Primary Care Integration.--Within the total
provided for oral health within SPRANS, the Committee includes
$250,000 to continue demonstration projects to increase the
implementation of oral health and primary care practice
integration. The projects should model the core clinical oral
health competencies for non-dental providers that HRSA
published and initially tested in its 2014 report,
``Integration of Oral Health and Primary Care Practice.'' The
Committee encourages the Chief Dental Officer to continue to
direct the design, monitoring, oversight, and implementation of
these projects.
Regional Pediatric Prevention Network.--The Committee
includes $25,000,000 for the pediatric prevention network and
directs HRSA to continue funding the network's current
structure of two awards consisting of at least five children's
hospitals (centers) each. Funding shall be equally distributed
among the ten centers. HRSA is directed to prioritize
applications from networks with the demonstrated capacity and
experience to coordinate among the Nation's pediatric hospitals
and their communities to prepare for and coordinate research-
informed responses to future pandemics. Such centers shall be
located in geographically diverse areas of the country to
ensure a regional approach to the network.
Sickle Cell Disease Treatment Demonstration Program
The Committee includes $8,205,000 for this program, which
is the same as the fiscal year 2026 budget request. The sickle
cell disease treatment demonstration program helps individuals
with sickle cell disease (SCD) access quality, coordinated,
comprehensive care by building comprehensive sickle cell
disease care teams that extend specialty care from centrally
based SCD experts in hospitals, clinics, or university health
centers to the communities where people live.
Autism and Other Developmental Disabilities
The Committee recommends $57,344,000 for autism and other
developmental disabilities programs. These programs seek to
improve the health and well-being of children and adolescents
with autism spectrum disorder and other developmental
disabilities and to advance best practices for the early
identification and treatment of autism and related
developmental disabilities.
Leadership Education in Neurodevelopmental and Related
Disabilities.--The Committee provides no less than $38,245,000
for the Leadership Education in Neurodevelopmental and Related
Disabilities (LEND) program to allow the existing 60 LEND sites
to maintain their capacity to train interdisciplinary
professionals to screen, diagnose, and provide evidence-based
interventions to individuals with autism spectrum disorder and
other developmental disabilities. The LEND program is essential
to increasing the number of professionals with advanced
interdisciplinary training in a broad array of professional
disciplines to train professionals to improve the evaluation,
diagnosis, and treatment of people with autism and other
developmental disabilities. The funding provides the LENDs with
support needed to address the critical shortage of
professionals, increase the number of trainees, serve
underrepresented communities, and fulfill the expanded
statutory mandate to serve persons with autism and
developmental disabilities across the lifespan.
Heritable Disorders in Newborns and Children
The Committee provides $20,883,000 for the Heritable
Disorders program. This program assists States to improve and
expand their newborn screening programs and to promote parental
and provider education.
Duchenne and Becker Muscular Dystrophy.--The Committee is
aware that the Department is still considering whether to
recommend Duchenne for inclusion on the Recommended Uniform
Screening Panel (RUSP) for newborn screening. The Committee
recognizes the importance of Federal guidance and support in
State decision making around the detection of chronic illnesses
at birth. The Committee urges HHS to promptly consider the
outstanding review of available evidence for Duchenne and
requests a plan regarding the new process for future
recommendations for conditions for newborn screening.
Metachromatic Leukodystrophy.--Metachromatic leukodystrophy
(MLD) is an ultra-rare, rapidly progressive, irreversible and
ultimately fatal neurometabolic disease that affects
approximately one in 100,000 live births. It is caused by an
error in the gene responsible for encoding the enzyme
arylsulfatase A (ARSA) leading to neurological damage and
developmental regression. The Committee notes that a gene
therapy for early-onset MLD was approved in March 2024,
offering a potentially curative option for eligible children.
However, timely diagnosis is critical for treatment to be
effective. A nomination to add MLD to the RUSP was subsequently
submitted in June 2024 to the Department. The Committee
requests an update on the status of the MLD nomination for the
RUSP in the fiscal year 2027 congressional justification.
Healthy Start
The Committee notes that mandatory funding available for
the Maternal, Infant, and Early Childhood Home Visiting
(MIECHV) program continues to increase and will exceed
$600,000,000 in fiscal year 2026. The MIECHV program supports
pregnant women and parents with young children who live in
communities that face greater risk and barriers to achieving
positive maternal and child health outcomes. Therefore,
consistent with the fiscal year 2026 budget request, the
Committee does not recommend separate discretionary funding for
the Healthy Start program.
Early Hearing Detection and Intervention
The Committee includes $18,818,000 for the early hearing
detection and intervention program. This program awards grants
to 53 States and territories to support Statewide systems of
newborn hearing screening and early intervention programs.
Emergency Medical Services for Children
The Committee includes $24,334,000 for emergency medical
services for children. Funding is available to every State's
emergency medical services office to improve the quality of
emergency care for children and to support research on and
dissemination of best practices.
Screening and Treatment for Maternal Mental Health and
Substance Use Disorders
The Committee provides $13,500,000 for the Screening and
Treatment for Maternal Mental Health and Substance Use
Disorders (MMHSUD) program. The program helps expand health
care providers' capacity to screen, assess, treat, and refer
pregnant and postpartum women for maternal mental health and
substance use disorders. The Committee continues to support the
MMHSUD program, which was reauthorized in the Consolidated
Appropriations Act, 2023 (P.L. 117-328).
According to Maternal Mortality Review Committee data,
suicide and overdose are the leading causes of maternal
mortality, accounting for 22 percent of pregnancy-related
deaths. Maternal mental health (MMH) conditions impact one in
five pregnant or postpartum women. The MMHSUD program provides
grants to States to improve access to care and expand the
workforce by training health care providers to screen, assess,
and treat MMH conditions and substance use disorders and
provide specialized psychiatric consultation to providers.
According to HRSA, almost 50 percent of the providers who used
the psychiatric consultation line were in a rural or
underserved area. The program supports women in rural and
underserved areas who lack access to mental health care,
especially for the millions of women living in a maternity care
desert.
Each MMHSUD program is funded up to $750,000 with 13 States
currently receiving funding. The additional funding for this
program will allow for three more programs to receive funding
to support mothers and babies in their States. The Committee
encourages HRSA to work to expand grants to Tribes and Tribal
organizations to address MMH conditions and substance use
disorders. The Committee requests an update in the fiscal year
2027 congressional justification on efforts by the agency to
provide grants for Tribes and Tribal organizations to support
maternal mental health and substance use disorders in these
communities.
Pediatric Mental Health Care Access
The Committee includes $13,000,000 for the pediatric mental
health care access program, which is equal to the fiscal year
2026 budget request. This program supports expanded access to
behavioral health services in pediatric primary care by
supporting the development of pediatric mental health care
telehealth access programs.
Innovation for Maternal Health
The Committee includes $15,300,000 for the Innovation for
Maternal Health program, which is equal to the fiscal year 2026
budget request. The Innovation for Maternal Health program
authorizes the establishment or continuation of a program to
identify, develop, or disseminate best practices to improve
maternal health care quality and outcomes, improve maternal and
infant health, and eliminate preventable maternal mortality and
severe maternal morbidity, among other activities. This funding
supports capacity building, technical assistance, and continued
implementation of the Alliance for Innovation on Maternal
Health Program's patient safety bundles to all States,
territories, and Tribal organizations. Patient safety bundles
are a set of targeted and evidence-informed best practices
that, when implemented, improve patient outcomes and reduce
maternal mortality and severe maternal morbidity.
Maternal Mental Health Hotline
The Committee includes $8,000,000 for the Maternal Mental
Health Hotline. The Maternal Mental Health Hotline supports the
four million women who give birth each year. Maternal mental
health conditions impact one in five pregnant and postpartum
women and one in three high-risk populations including service
members, military spouses, and rural women. The Hotline
provides 24-hour voice and text support services for pregnant
and postpartum mothers. Since its launch on Mother's Day in
2022, the Hotline has served over 64,000 women and families
across the United States with average response times of less
than 30 seconds. The most common reasons for calling include
feeling overwhelmed, depression, and anxiety. The Committee
directs HRSA to promote public awareness of the Hotline to
communities at higher risk of developing a maternal mental
health condition including military members, veterans, military
spouses, and rural communities. The Committee directs HRSA to
submit a report to the Committees on Appropriations of the
House of Representatives and the Senate within 180 days of the
enactment of this Act detailing actions HRSA has taken to
increase Hotline awareness.
Poison Control Centers
The Committee includes $28,846,000 for Poison Control
Centers. The Poison Control Centers program supports a national
network of centers that prevent and treat poison exposures by
providing cost effective, quality health care advice to the
public and health care providers.
Integrated Services for Pregnant and Postpartum Women
The Committee includes $10,000,000 for integrated services
for pregnant and postpartum women, the same as the fiscal year
2026 budget request. The Integrated Services for Pregnant and
Postpartum Women program helps States, Indian Tribes, and
Tribal organizations establish or operate innovative programs
to effectively deliver care for pregnant and postpartum women
while considering their social, behavioral, and health care
needs.
RYAN WHITE HIV/AIDS PROGRAM
Appropriation, fiscal year 2025....................... $2,571,041,000
Budget request, fiscal year 2026...................... 2,497,535,000
Committee Recommendation.............................. 2,045,630,000
Change from enacted level......................... -525,411,000
Change from budget request........................ -451,905,000
The Ryan White Human Immunodeficiency Virus/Acquired
Immunodeficiency Syndrome (HIV/AIDS) program funds activities
to address the care and treatment of persons living with HIV/
AIDS who need assistance to obtain treatment. The program
provides grants to States and eligible metropolitan areas to
improve the quality, availability, and coordination of health
care and support services, including access to HIV-related
medications.
Within the total for the Ryan White HIV/AIDS program, the
Committee provides the following amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity Committee
------------------------------------------------------------------------
Emergency Assistance................................. $680,752,000
Comprehensive Care Programs.......................... 1,364,878,000
AIDS Drug Assistance Program (non-add)........... 900,313,000
------------------------------------------------------------------------
Ryan White Formula Funding.--The Committee is concerned
that the Ryan White Part A funding formula, which is calculated
based on jurisdiction of diagnosis, disadvantages jurisdictions
that experience increasing population sizes due to new incoming
residents. When HRSA last studied this issue in 2019, it found
jurisdictions were over- and under-represented in the funding
formula by up to 50 percent. The Committee urges HRSA to renew
its analysis on discrepancies between where Ryan White patients
are diagnosed and where they currently reside. The Committee
requests an update in the fiscal year 2027 congressional
justification on these findings and potential courses of action
and considerations for a residence-based formula.
HEALTH SYSTEMS
Appropriation, fiscal year 2025....................... $122,009,000
Budget request, fiscal year 2026...................... 110,887,000
Committee Recommendation.............................. 122,887,000
Change from enacted level......................... +878,000
Change from budget request........................ +12,000,000
The Health Systems Bureau supports national activities that
enhance health care delivery in the U.S., including maintaining
a national system to allocate and distribute donor organs to
individuals awaiting transplant; building an inventory of cord
blood units; and maintaining a national system for the
recruitment of bone marrow donors.
Organ Transplantation
The Committee includes $55,049,000 for the Organ
Transplantation program, which is a $1,000,000 increase over
the fiscal year 2024 level.
Advisory Committee on Organ Transplantation.--As part of
the effort to modernize the Organ Procurement and
Transplantation Network (OPTN) and the structures and systems
that support it, the Committee urges HRSA to appoint members
to, and reconvene, the Advisory Committee on Organ
Transplantation (ACOT) so that the agency has important
external expertise to inform its work. The Committee urges HRSA
to hold at least one meeting of the ACOT in fiscal year 2026.
Living Organ Donation Reimbursement Program.--Within the
funding provided, the Committee includes a $1,000,000 increase
for the living organ donation reimbursement program. This
program reduces financial disincentives to living organ
donation by providing reimbursement to living organ donors for
many expenses related to donating an organ (e.g., travel, lost
wages, and child care). Research suggests that many of these
donors could not have donated without this program.
OPTN Next Generation Technology.--The Committee supports
HRSA's OPTN Modernization Initiative, with particular interest
in the efforts to develop and implement a technology solution
to fully modernize the OPTN so more individuals can be matched
with life-saving organs. The Committee understands that because
of outdated technology and a lack of dynamic algorithms, the
current matching system is inefficient, and therefore critical
time is lost in the effort to identify and match an available
organ to the most appropriate candidate, causing some organs to
go unused. The Committee urges HRSA to prioritize the
development of a modern, dynamic organ candidate matching
technology system that better serves donor families and
recipients, performs efficiently, allows for timely, systematic
updates in allocation policy, and supports clinical innovation.
Organ Procurement and Transplantation Network Modernization
Initiative.--The Committee recognizes the importance of the
OPTN Modernization Initiative, launched in March 2023, to
strengthen accountability and the performance of the nation's
organ transplant system. The Committee is extremely concerned
by recent reports of cases involving patients with neurological
signs incompatible with organ donation. Such reports raise
serious ethical and legal questions. The Committee is
encouraged by the Secretary's recent announcement that HRSA is
mandating strict corrective actions for the entities involved.
The Committee directs HRSA to provide a briefing to the
Committees on Appropriations of the House of Representatives
and the Senate within 30 days of enactment of this Act and
every 90 days thereafter on HRSA's spend plan, progress toward
its stated objectives, and actions the Department has taken or
plans to take to improve oversight, protect patient safety,
increase public and stakeholder trust in the organ allocation
process, and track and evaluate the effectiveness and impact of
the modernization initiative.
Organ Transportation Working Group.--The Committee supports
the recommendations made by the Federal Aviation
Administration's (FAA) Organ Transportation Working Group to
identify best practices for transporting organs in the cabin of
airplanes. This initiative is critical for patients awaiting
organ transplants, as transporting organs in the cabin can
reduce transit time, minimize temperature fluctuations, and
increase the viability of life-saving organs during critical
transportation windows. As part of the report, FAA developed 20
recommendations, including five for HRSA: (1) establish a forum
for continuous discussion and communications across the
transplant community and aviation industry stakeholder groups;
(2) establish standardized data definitions, data types, and
reporting protocols for data collection in the organ transport
community; (3) add granularity in data reporting by collecting
transportation methods and success/failure rates in addition to
timing in schedule; (4) develop a centralized data management
system to collect data from OPTN members, couriers, and other
relevant stakeholders; and (5) share relevant incident reports
with TSA and airlines. The Committee supports these
recommendations and directs HRSA to provide an update to the
Committees on Appropriations of the House of Representatives
and the Senate within 60 days of enactment of this Act on how
HRSA will implement these recommendations. In addition, the
Committee directs HRSA to provide the Committees with an update
on implementation with 180 days of enactment of this Act and
post such update on a publicly available website.
National Cord Blood Inventory
The Committee includes $19,266,000 for the national cord
blood inventory (NCBI) program. The NCBI program supports cord
blood banks to build a genetically and ethnically diverse
inventory of the highest quality cord blood units for
transplantation.
C.W. Bill Young Cell Transplantation
The Committee includes $33,009,000 for the C.W. Bill Young
Cell Transplantation program, equal to the fiscal year 2026
budget request. This program supports coordinating the
procurement of bone marrow and umbilical cord blood units for
transplantation.
Hansen's Disease Program
The Committee includes $13,706,000 for the Hansen's disease
program and $1,857,000 for payments to Hawaii for treatment of
Hansen's disease, equal to the fiscal year 2026 budget request.
These programs support outpatient and short-term
residential care, as well as outreach and education, and
research in Baton Rouge, Louisiana; 11 outpatient clinic
programs in the continental United States and Puerto Rico; and
medical care and treatment of persons with Hansen's disease
throughout the Hawaiian Islands.
RURAL HEALTH
Appropriation, fiscal year 2025....................... $364,607,000
Budget request, fiscal year 2026...................... 283,830,000
Committee Recommendation.............................. 515,407,000
Change from enacted level......................... +150,800,000
Change from budget request........................ +231,577,000
The Federal Office of Rural Health Policy's (FORHP)
programs provide funding to improve access, quality, and
coordination of care in rural communities; for research on
rural health issues; for technical assistance and recruitment
of health care providers; for screening activities for
individuals affected by the mining, transport, and processing
of uranium; and for the outreach and treatment of coal miners
and others with occupation-related respiratory and pulmonary
impairments.
Rural Healthcare.--While current spending for all rural
health discretionary programs is relatively small, it plays a
critical role in solidifying the fragile healthcare
infrastructure in rural communities. The Committee supports
programs seeking to address the severe health care crisis
escalating in rural America and preventing any additional rural
hospitals from closing. Health care workforce shortages
continue to plague rural communities, and, while health care
innovations, such as telehealth technologies, show promise in
rural areas, the Committee believes that action needs to be
taken to address the workforce shortages in rural communities.
The Committee continues to support HRSA's efforts to implement
programs and policies to improve rural health outcomes,
strengthen care delivery, and address the immediate issues
facing rural communities.
Supporting Rural Hospitals Glycemic Management Standards.--
The Committee recognizes the critical role of advanced
technology in improving patient safety and health outcomes in
rural hospitals, particularly for managing diabetes-related
conditions. To support compliance with the mandatory CMS
electronic clinical quality measures on hospital harm related
to hyperglycemia and hypoglycemia, the Committee encourages
HRSA to allow rural hospitals to utilize existing HRSA grant
programs for the purchase and implementation of FDA-approved
insulin management technology. This includes continuous glucose
monitoring systems, automated insulin delivery systems, and
associated software solutions designed to prevent adverse
events related to blood glucose levels. The Committee urges
HRSA to issue guidance clarifying that these technologies are
an allowable use of grant funds when consistent with relevant
statutory authorities, provided they align with program goals
to improve patient care, enhance safety, and reduce the burden
on providers.
Trauma Care in Rural Areas.--The Committee notes the access
challenges to trauma care in rural areas. The Committee
supports efforts by HRSA to address this access gap and
requests an update on this topic in the fiscal year 2027
congressional justification.
Rural Health Outreach Programs
The Committee includes $110,975,000 for rural health
outreach programs. These programs support projects that
demonstrate new and innovative modes of outreach in rural
areas, such as integration and coordination of health services.
Within the total for Rural Health Outreach Programs, the
Committee provides no less than the following amounts for
Regional Grant Programs:
------------------------------------------------------------------------
FY 2026
Budget Activity Committee
------------------------------------------------------------------------
Appalachian Region Healthcare Support Program........ $2,500,000
Delta States......................................... 31,000,000
Delta States Rural Development Network Grants 12,000,000
(non-add).......................................
Delta Region Maternal Care Coordination Program 2,250,000
(non-add).......................................
Delta Region Community Health Systems Development 15,000,000
Program (non-add)...............................
Rural Northern Border Region Healthcare Support 4,000,000
Program.............................................
------------------------------------------------------------------------
Delta States.--These programs seek to strengthen healthcare
delivery in rural areas of the Delta region. The Delta States
region consists of Alabama, Arkansas, Illinois, Kentucky,
Louisiana, Mississippi, Missouri, and Tennessee. Within the
funds provided for Rural Health Outreach Programs, the
Committee includes an increase of $2,000,000 over the fiscal
year 2024 enacted level to support the Delta States programs.
Within the total for the Delta Region Community Health Systems
Development Program, the Committee includes funding to continue
the Delta Health Systems Implementation Program.
Rural Maternity and Obstetrics Management Strategies.--
Within the funds provided for Rural Health Outreach Programs,
the Committee includes no less than $14,000,000 for rural
maternity and obstetrics management strategies (RMOMS). RMOMS
supports grants to improve access to and continuity of maternal
and obstetrics care in rural communities by increasing the
delivery of and access to preconception, pregnancy, labor and
delivery, and postpartum services, as well as developing
sustainable financing models for the provision of maternal and
obstetrics care.
Rural Health Policy Development
The Committee includes $14,076,000 for Rural Health Policy
Development. Funding supports FORHP's activities to analyze,
advise the Secretary, and provide information to the public
regarding issues that affect the availability, access to, and
quality of health care in rural areas.
Rural Hospital Facilities.--The Committee notes that
hospital closures present unique challenges for rural
communities as they seek to repurpose facilities to serve
community needs. Within the funding provided for Rural Health
Policy Development, the Committee includes $2,000,000 for FORHP
to conduct a study and provide a report regarding rural
hospital facilities that have closed. Such report shall provide
an overview of the number of rural hospital facilities that
have closed, a description of the ways in which rural
communities have repurposed such facilities, an analysis of
obstacles rural communities have encountered in repurposing
such facilities, a compilation of best practices for rural
communities facing a facilities closure, an overview of Federal
resources available to assist rural communities in successfully
repurposing such facilities for community needs, and
recommendations for additional statutory authorities or
resources that could assist rural communities in repurposing
rural hospital facilities. The Committee encourages FORHP to
coordinate with the U.S. Department of Agriculture, which
administers the Community Facilities Program, the Department of
Housing and Urban Development, the Department of the Treasury,
and other relevant Federal agencies in undertaking this study.
The Committee directs HRSA to provide an interim report to the
Committees on Appropriations of the House of Representatives
and the Senate within one year of enactment of this Act and a
final report within two years of enactment of this Act.
Rural Health Research Center Program.--The Rural Health
Research Center Program funds publicly available and policy
relevant research on rural health to assist providers and
Federal, State, and local governments in addressing challenges
faced by rural communities. Access to health services in rural
areas is under extreme stress with patients forced to travel
extended distances for even basic health care, while more than
30 percent of rural hospitals are at risk of closing.
Additional research is needed on the significant and pervasive
challenges faced by rural Americans in accessing health care
related to mental health, drug and alcohol use, nutrition and
healthy eating, and chronic health management, among other
critical needs. This results in a need for additional policy
research capacity to find solutions to these important issues.
The Committee provides an increase of $1,000,000 for FORHP to
fund additional core research centers to increase the number of
studies on rural health and support policy solutions that
improve access to health care, health outcomes, and population
health.
Rural Hospital Flexibility Grants
The Committee includes $74,277,000 for Rural Hospital
Flexibility Grants. These programs help States to assist small
and critical access rural hospitals to remain economically
viable and to provide high-quality care.
Within this total, the Committee includes no less than
$5,000,000 for the Rural Emergency Hospitals Technical
Assistance Program and up to $23,442,000 for the Small Rural
Hospital Improvement Program.
State Offices of Rural Health
The Committee includes $13,000,000 for State Offices of
Rural Health. HRSA supports the establishment and operation of
State offices of rural health to strengthen the rural health
care delivery system.
Black Lung Clinics
The Committee includes $12,190,000 for Black Lung Clinics,
equal to the fiscal year 2026 budget request. This program
funds clinics that treat respiratory and pulmonary diseases of
active and retired coal miners, steel mill workers,
agricultural workers, and others with occupationally related
respiratory and pulmonary impairments.
Radiation Exposure Screening and Education Program
The Committee includes $1,889,000 for the radiation
exposure screening and education program, equal to the fiscal
year 2026 budget request. This program provides grants for the
education, prevention, and early detection of radiogenic
cancers and diseases resulting from exposure to uranium during
mining and milling at nuclear test sites.
Rural Communities Overdose Response Program
The Committee includes $145,000,000, the same as the fiscal
year 2026 budget request, for this program. Within the funding
provided, the Committee includes $10,000,000 to continue the
three Rural Centers of Excellence (Centers), as established by
P.L. 115-245 and continued through P.L. 117-328. The Committee
recognizes the success of the three Centers in reducing
substance use disorders within rural communities, through
various evidence-based treatment and recovery models. The
Committee supports HRSA's continued investment in the current
Centers and encourages HRSA to consider how the Centers can
expand their outreach into other underserved communities.
Rural Residency Planning and Development
The Committee includes $14,000,000 for the rural residency
planning and development program. This program funds physician
residency training programs that support physician workforce
expansion in rural areas. The Committee commends FORHP for its
efforts to improve and expand the physician workforce in rural
areas by developing new, sustainable rural residency programs
and supports the continuation and expansion of the program to
develop new rural residency programs, or Rural Track Programs.
Financial and Community Sustainability for At Risk Hospitals
The Committee includes $10,000,000 for this activity. First
proposed in fiscal year 2024, this program will target
technical assistance to rural hospitals severely at-risk for
imminent closure and struggling to maintain health care
services.
Small rural hospitals are often the only health care
available in rural counties, and populations most affected by
hospital closings tend to be poor, minorities, and elderly
patients with chronic health conditions. There have been 143
rural hospital closures from 2010 through January 2023, peaking
with a high of 19 in 2020 just as the pandemic hit. Closures
are happening more often in communities of color. Historically,
about half of the closures result in a complete loss of
services at those facilities.
Rural Hospital Stabilization Program
The Committee includes $20,000,000 for this program.
Launched in fiscal year 2024, this program provides support to
at-risk rural hospitals to enhance or expand service lines to
retain health care services locally and increase service volume
and revenue that will enhance hospitals' financial viability.
Rural Hospital Provider Assistance Program
The Committee includes $100,000,000 for a Rural Hospital
Provider Assistance program. The Committee is concerned that
low reimbursements for low-wage hospitals prevent them from
paying higher wages, which in turn keeps them at the low end of
the wage index, resulting in a downward spiral. The Committee
supports efforts by the Secretary and the CMS Administrator to
address this issue through the implementation of the Rural
Health Transformation Program and other regulatory relief. To
supplement such efforts, the Committee provides new funding for
HRSA to administer a formula grant program to support hospitals
at the low end of the wage index serving residents in States
with the highest poverty rates. By focusing limited resources
on areas with the greatest demonstrated need, the Committee
seeks to ensure sustained access to quality health care
providers for these communities.
FAMILY PLANNING
Appropriation, fiscal year 2025....................... $286,479,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. - - -
Change from enacted level......................... -286,479,000
Change from budget request........................ - - -
Consistent with the fiscal year 2026 budget request, the
Committee does not recommend funding for the Family Planning
program. The Family Planning program administers Title X of the
PHS Act.
HRSA-WIDE ACTIVITIES AND PROGRAM SUPPORT
Appropriation, fiscal year 2025....................... $219,588,000
Budget request, fiscal year 2026...................... 42,050,000
Committee Recommendation.............................. 223,088,000
Change from enacted level......................... +3,500,000
Change from budget request........................ +181,038,000
This account supports telehealth programs, operation of the
340B drug pricing program, and the cost of Federal staff and
related activities to coordinate, direct, and manage the
programs of HRSA. The fiscal year 2026 budget request amount
does not include additional program management funding
requested for the proposed Administration for a Healthy
America.
HRSA Chief Dental Officer.--The Committee notes with strong
concern that despite its directive to have HRSA ensure that the
Chief Dental Officer (CDO) is functioning at an executive level
with resources and staff to lead oral health programs and
initiatives across HRSA, such authority was not delegated by
the previous HRSA Administrator. The Committee urges HRSA to
restore this position with authority and resources to oversee
and lead oral health dental programs and initiatives across the
agency. The CDO is also expected to serve as the agency
representative on oral health issues to international,
national, State, and/or local government agencies,
universities, and oral health stakeholder organizations.
Oral Health Literacy.--The Committee includes $300,000 to
continue the development of an oral health awareness and
education campaign across relevant HRSA bureaus, including
Health Centers, Health Workforce, Maternal and Child Health,
Ryan White HIV/AIDS Program, and Rural Health. The Committee
directs HRSA to identify oral health literacy strategies that
are evidence-based and focused on oral health care prevention
and education, including prevention of oral disease such as
early childhood and other caries, periodontal disease, and oral
cancer. The Committee encourages HRSA to ensure that the Chief
Dental Officer plays a key role in the design, monitoring,
oversight, and implementation of this project.
Provider Relief Fund and Uninsured Program.--The Committee
directs HRSA to provide a report to the Committees on
Appropriations of the House of Representatives and the Senate
within 180 days of enactment of this Act detailing the total
amount of funds returned or recovered as a result of fraudulent
claims or improper payments through this and other HRSA
pandemic relief accounts and provide the Committees with an
update on the current status of related program integrity and
recovery efforts.
Tribal Engagement.--HRSA's core mission is to improve
health outcomes and build the health workforce. Historically,
HRSA has had low participation by Indian Tribes in several core
program areas, despite the great Tribal need in all of HRSA's
mission areas. The Committee appreciates HRSA's recent efforts
to expand Tribal engagement efforts. The Committee directs HRSA
to provide the Committees on Appropriations of the House of
Representatives and the Senate a detailed description of
funding provided to Tribal entities, grants Tribal entities are
eligible to apply for, and an action plan by HRSA on how it
will provide technical assistance to improve Tribal
participation in HRSA programs within 180 days of enactment of
this Act. Such report shall be made available on the agency's
website.
Office of Pharmacy Affairs
The Committee includes $12,238,000 for the Office of
Pharmacy Affairs, equal to the fiscal year 2026 budget request.
The Committee notes that HHS proposes to transfer the Office of
Pharmacy Affairs from HRSA to CMS. The Committee looks forward
to working with the authorizing committees of jurisdiction as
they consider the Department's proposal.
Office for the Advancement of Telehealth
The Committee includes $45,550,000 for the Office for the
Advancement of Telehealth (OAT). Funds for OAT promote the
effective use of technologies to improve access to health
services for people who are isolated from health care and to
provide distance education for health professionals.
Telehealth Accreditation.--The Committee recognizes the
strong bipartisan support for telehealth and supports efforts
to ensure telehealth programs are set up for long-term success.
The Committee supports the Department's efforts to ensure that
telehealth programs adhere to standards and evidence-based best
practices. Accreditation processes aim to improve virtual care
services through the regular review of telehealth programs to
ensure they have the tools needed to meet and maintain
established standards. Accreditation provides a recognized
marker for high quality of care and consistency, which promotes
and fosters trust and confidence among patients and providers.
To build on the Department's efforts, the Committee encourages
HHS and HRSA to utilize telehealth accreditation, where
appropriate, to ensure high quality and consistent care for
patients.
Telehealth Centers of Excellence.--Within the funds
provided for OAT, the Committee provides no less than
$8,500,000 for Telehealth Centers of Excellence. These Centers
identify best practices, serve as national training resources,
and test the efficacy of different telehealth clinical
applications. These Centers serve to promote the adoption of
telehealth programs across the country by validating
technology, establishing training protocols, and by providing a
comprehensive template for States to integrate telehealth into
their State health provider network. Funding should serve to
promote the adoption of telehealth services nationwide and help
address the access to care issue faced by rural America.
Telehealth Network Grants.--The Telehealth Network Grant
Program (TNGP) supports the use of telehealth networks to
improve health care services for medically underserved
populations in urban, rural, and frontier communities. The
Committee recognizes the importance of expanding telehealth
services in rural and underserved communities. To improve
access to care, the Committee provides an increase of no less
than $1,000,000 for TNGP within the funding provided for OAT.
The Committee encourages HRSA to prioritize funding for
initiatives incorporating AI-driven remote patient monitoring,
mobile diagnostic units, and telemedicine expansion to address
critical shortages in primary and specialty care.
Telehealth Resource Centers.--The Telehealth Resource
Centers (TRC) program provides expert and customizable
telehealth technical assistance across the country. The TRCs
provide training and support, disseminate information and
research findings, promote effective collaboration, and foster
the use of telehealth technologies to provide health care
information and education for providers who serve rural and
medically underserved areas and populations. The Committee
recognizes the essential role TRCs play in helping rural and
other under-resourced communities integrate telehealth into
care delivery and address persistent challenges related to
access, reimbursement, and technology adoption. Given the
exponential growth of telehealth utilization in recent years
and the increased demand for TRC services, the Committee
provides an increase of $500,000 for the TRC Program within the
funding provided for OAT.
VACCINE INJURY COMPENSATION PROGRAM
Appropriation, fiscal year 2025....................... $15,200,000
Budget request, fiscal year 2026...................... 15,200,000
Committee Recommendation.............................. 15,200,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Vaccine Injury Compensation Program provides
compensation for individuals with vaccine-associated injuries
or deaths. The Committee provides $15,200,000 for expenses
associated with administering the program. The Committee also
includes $272,062,000 in mandatory funding from the Vaccine
Injury Compensation Program Trust Fund for claims, the same as
the fiscal year 2026 budget request.
Centers for Disease Control and Prevention
Appropriation, fiscal year 2025....................... $9,222,090,000
Budget request, fiscal year 2026...................... 5,475,241,000
Committee Recommendation.............................. 7,480,880,000
Change from enacted level......................... -1,741,210,000
Change from budget request........................ +2,005,639,000
The Committee recommendation for the Centers for Disease
Control and Prevention (CDC) program level includes
$6,027,147,000 in discretionary budget authority, $55,358,000
in mandatory funds under the terms of the Energy Employees
Occupational Illness Compensation Program Act, and
$1,398,375,000 in transfers from the Health Fund (PPHF).
IMMUNIZATION AND RESPIRATORY DISEASES
Appropriation, fiscal year 2025....................... $919,291,000
Budget request, fiscal year 2026...................... 963,291,000
Committee Recommendation.............................. 931,291,000
Change from enacted level......................... +12,000,000
Change from budget request........................ -32,000,000
The Committee recommendation includes $231,358,000 in
discretionary budget authority and $699,933,000 in transfers
from PPHF.
Immunization cooperative agreements are awarded to State
and local public health departments for planning, developing,
and conducting childhood, adolescent, and adult immunization
programs, including enhancement of the vaccine delivery
infrastructure. CDC directly maintains a stockpile of vaccines,
supports consolidated purchase of vaccines for State and local
health agencies, conducts surveillance, supports jurisdictions
in investigating and responding to outbreaks of vaccine-
preventable diseases, and provides training and quality
improvement activities to improve healthcare providers' vaccine
storage, handling, and administration capabilities.
Within the total for Immunization and Respiratory Diseases,
the Committee recommends the following amounts:
------------------------------------------------------------------------
Budget Activity FY 2024 Enacted FY 2026 Committee
------------------------------------------------------------------------
Immunization and Other Respiratory $681,933,000 $699,933,000
Diseases (PPHF)..................
Influenza Planning and Response... 231,358,000 231,358,000
------------------------------------------------------------------------
Acute Flaccid Myelitis.--The Committee continues to support
the work of CDC to promote awareness of Acute Flaccid Myelitis
among front-line clinicians and has integrated this funding
into the Immunization and Other Respiratory Diseases funding
line.
Avian Influenza.--The Committee recognizes the potential
risk of avian influenza in egg laying hens and cattle migrating
to humans. The Committee encourages the CDC to collaborate with
USDA to support outreach and education among at-risk
agricultural communities through existing funding mechanisms.
Immunization During Pregnancy.--To increase access to
recommended immunizations, the Committee encourages CDC to
increase its efforts to educate health care providers about the
importance of immunization during pregnancy, which can provide
protection for children from 0-6 months from diseases such as
flu, pertussis (whooping cough), and respiratory syncytial
virus (RSV), when the children are at their most vulnerable.
The Committee also encourages CDC to work with Federal partners
to improve awareness and coordination among Federal partners to
increase immunization during pregnancy.
Vaccines for Children.--The Vaccines for Children (VFC)
Program provides safe, effective, and life-saving immunizations
for millions of children each year, including the hepatitis B
immunization and Nirsevimab, a monoclonal antibody that helps
prevent RSV in infants and young children. The Committee
continues to support the CDC's administration of the VFC in an
effort to prevent disease, disability, and death in the U.S.
VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND TUBERCULOSIS
PREVENTION
Appropriation, fiscal year 2025....................... $1,391,056,000
Budget request, fiscal year 2026...................... 520,000,000
Committee Recommendation.............................. 353,000,000
Change from enacted level......................... -1,038,056,000
Change from budget request........................ -167,000,000
CDC provides national leadership and support for Sexually-
Transmitted Infections (STI) prevention research and the
development, implementation, and evaluation of evidence-based
STI prevention programs serving persons affected by, or at risk
for, STI infection. Activities include surveillance,
epidemiologic and laboratory studies, and prevention
activities.
Within the total for the National Center for Viral
Hepatitis, Sexually Transmitted Diseases, and Tuberculosis
Prevention, the Committee provides the following amounts:
------------------------------------------------------------------------
Budget Activity FY 2024 Enacted FY 2026 Committee
------------------------------------------------------------------------
Sexually Transmitted Disease and - - - $300,000,000
Tuberculosis Prevention Block
Grants...........................
Domestic HIV/AIDS Prevention and $1,013,712,000 - - -
Research.........................
HIV Prevention by Health 755,631,000 - - -
Department.......................
School Health--HIV BA......... 38,081,000 - - -
Ending HIV/AIDS Initiative........ 220,000,000 - - -
Viral Hepatitis................... 43,000,000 53,000,000
Sexually Transmitted Infections... 174,310,000 - - -
Tuberculosis (TB)................. 137,034,000 - - -
Infectious Diseases and Opioids... 23,000,000 - - -
------------------------------------------------------------------------
The Committee provides $300,000,000 for consolidated
Sexually Transmitted Disease and Tuberculosis Prevention grants
to States. This funding will provide flexibility to address
local needs in addressing State specific challenges by
consolidating funding for Infectious Disease and Opioids, STIs,
and TB programs into one newly established grant program. The
committee recognizes that through the consolidated grant, CDC
will continue to offer recipients strategic direction,
technical support, and laboratory and programmatic expertise.
Viral Hepatitis.--The Committee provides $53,000,000 for
Viral Hepatitis. This funding will support health departments
conducting viral hepatitis outbreak response and surveillance,
support viral hepatitis elimination planning and implementation
in target jurisdictions, and work with health clinics and
community organizations to promote awareness and uptake of
updated national viral hepatitis testing and vaccination
recommendations.
EMERGING AND ZOONOTIC INFECTIOUS DISEASES
Appropriation, fiscal year 2025....................... $760,272,000
Budget request, fiscal year 2026...................... 870,486,000
Committee Recommendation.............................. 822,372,000
Change from enacted level......................... +62,100,000
Change from budget request........................ -48,114,000
The Committee recommendation includes $777,372,000 in
discretionary appropriations and $45,000,000 in transfers from
PPHF.
Programs funded under Emerging and Zoonotic Infectious
Diseases (EZID) support the prevention and control of
infectious diseases through surveillance, outbreak
investigation and response, research, and prevention.
Within the total for EZID, the Committee recommends the
following amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Antimicrobial Resistance $197,000,000 $197,000,000
Initiative.......................
Vector-Borne Diseases............. 63,603,000 65,603,000
Lyme Disease...................... 27,000,000 27,500,000
Prion Disease..................... 8,000,000 9,000,000
Emerging Infectious Diseases...... 197,997,000 233,997,000
Mycotic Diseases.................. 16,000,000 31,000,000
Harmful Algal Blooms.............. 3,500,000 3,500,000
Food Safety....................... 72,000,000 72,000,000
National Healthcare Safety Network 24,000,000 24,000,000
Travel and Port Health Protection. 53,772,000 63,772,000
Advanced Molecular Detection...... 40,000,000 50,000,000
Epidemiology and Lab Capacity 40,000,000 45,000,000
(PPHF)...........................
------------------------------------------------------------------------
Alpha-gal Syndrome.--The Committee appreciates the work of
the Division of Vector-Borne Diseases to prevent the
transmission of and promote health provider awareness of Alpha-
gal Syndrome (AGS). AGS is an emerging tick-borne condition and
allergy characterized by a potentially life-threatening
hypersensitivity to galactose-alpha-1,3- galactose (alpha-gal).
Its prevalence is closely associated with the range of the lone
star tick. AGS is a growing clinical and public health concern
for persons in the United States. Exploding lone star tick
populations may be driving an alarming increase in cases.
Health care provider knowledge is limited and can lead to
delayed diagnosis and inappropriate treatment.
The Committee encourages CDC to accelerate measures to
improve AGS surveillance, patient care, and public awareness
with an emphasis on healthcare provider education, in keeping
with the three public health priorities identified in the CDC
2023 report. CDC is encouraged to focus on high or growing
prevalence States. CDC may also benefit from a focused increase
in its collaboration and partnership with local governments,
health, education, community, non-profit, and faith-based
sectors in those same high-incidence communities.
Antibiotic Resistance Solutions Initiative.--The Committee
strongly encourages CDC to increase awareness of the elevated
risk of drug-resistant infections that impact patients,
especially those with cancer. The Committee urges CDC to
educate physicians and patients on infection prevention and
antibiotic stewardship in the cancer patient population.
Chronic Fatigue Syndrome.--The Committee supports CDC's
work related to provider education and public awareness for
postural orthostatic tachycardia syndrome (POTS) and other
forms of dysautonomia, common chronic conditions that impact
millions of Americans and cause severe disability. The
Committee is concerned that 28 States do not have a board-
certified autonomic specialist resulting in POTS patients
facing on average a 5-year diagnostic delay and encourages the
CDC to work with patient advocates, clinicians, and researchers
to develop an education program for health care providers to
increase access to care for POTS and similar dysautonomia
patients.
Emerging Infectious Disease.--Funding for the Emerging
Infectious Disease program includes funding previously provided
for parasitic diseases and malaria prevention through the CDC
Global Health Center but carried out through the National
Center for Emerging and Zoonotic Infectious Diseases.
Epidemiology and Laboratory Capacity.--The Committee
recognizes the importance of the Epidemiology and Laboratory
Capacity (ELC) program, which provides flexibility to State,
territorial, and local health departments to address gaps not
funded by the disease specific sections of the ELC cooperative
agreement. The ELC program provides critical foundational
support for these health departments to fund epidemiology,
surveillance, laboratory, and data science staff positions that
provide the backbone for public health programs. This funding
will allow public health departments to build their
foundational public health workforce and infrastructure and
will better prepare them to respond to emerging infectious
disease threats more quickly including vector-borne and tick-
related diseases such as alpha-gal, dengue, Lyme, malaria, West
Nile, and Zika.
Fungal Infection Disease Surveillance.--The Committee is
concerned by the spread of deadly fungal infections in the
United States in recent years and finds that the economic
burden of fungal infections in the United States is already
staggering, particularly in western States. The Committee finds
that a Federal plan with resources to address the threat of
fungal infections holds the best potential to safeguard the
health of Americans in the event of a domestic pandemic or in
foreign theaters of war, and that the Federal government's
recognition of fungal infections as a microbial threat to human
health can allow for existing planning mechanisms such as the
CDC's 2019 AR Threats Report and 2020-2025 PACCARBS National
Action Plan to better account for steps taken to respond to
fungal threats in the United States.
Harmful Algal Blooms.--The Committee notes that harmful
algal blooms (HABs) are on the rise globally, particularly
across the Great Lakes region, and encourages CDC to develop
studies to assess the health effects of exposure to cyanotoxins
in the air and water, including, but not limited to, the Great
Lakes region. The CDC has a unique role in better understanding
the intersection of public health and environmental impacts of
HABs. The Committee encourages the CDC to continue building
interagency cooperation surrounding HABs, especially the
Harmful Algal Bloom and Hypoxia Research and Control Act Task
Force and the Great Lakes Restoration Initiative. The scope of
future research may expand to include improving laboratory
methods for identifying and quantifying HAB-related toxins in
biological specimens, supporting better detection methods to
identify the origin of dissolved reactive phosphorous in
upstream river streams and ditches, clinical diagnostic methods
to identify HAB-related symptoms and illnesses, optimizing
emergency response capacities, and identifying and addressing
the impacts of harmful algal toxins on humans.
Lyme Disease.--Lyme disease can be found in at least 80
countries around the globe and is endemic in many regions. In
the U.S., Lyme disease is the most common disease transmitted
from animals to humans. After years of uncertainty, CDC
continues to note the number of reported Lyme disease cases in
the U.S. is likely far below the estimated number of actual
cases that are diagnosed and treated annually. According to
CDC, in 2023, approximately 89,000 cases of the disease were
reported, compared to estimates showing that more than 476,000
may be diagnosed and treated with Lyme disease annually in the
U.S. The Committee continues to support CDC's efforts to
improve testing and treatment related to Lyme and other vector-
borne diseases and encourages CDC to consider expanding
activities related to the development of more accurate
diagnostic tools and tests for Lyme disease and steps to
educate high risk workers and their employers regarding the
occupational risks of tickborne diseases.
Maternal Fetal Transmission of Lyme Disease.--Within 180
days of the enactment of this Act, the Committee directs CDC to
provide a report on its plans to better understand maternal-
fetal transmission of Lyme disease and gestational Lyme disease
and plans to improve education for the public and for
healthcare providers about the risks of Lyme disease during
pregnancy and adverse birth outcomes. CDC is encouraged to
identify resources required and potential obstacles to
progress.
Mycotic Diseases.--The Committee provides an increase of
$15,000,000 in Emerging Infectious Diseases for mycotic
diseases, including, surveillance and prevention, building
capacity in the State and local health departments, cooperative
agreements, education of the public and healthcare providers,
and laboratory support. The Committee continues to support the
CDC's collaboration with the Valley Fever Institute and the
Cocci Study Group. The Committee requests an update in the
fiscal year 2027 congressional justification on how this
funding is being utilized.
National Strategy for Vector-borne Disease.--The Committee
encourages the CDC to execute the Lyme and tick-borne disease
portion of the National Strategy for Vector-borne Disease. It
is also important that the CDC accelerate measures to improve
Alpha-gal Syndrome surveillance, patient care, and public
awareness with an emphasis on healthcare provider education, in
keeping with the three public health priorities identified in
the 2023 CDC report.
Prion Disease.--The Committee is concerned that Chronic
Wasting disease (CWD), a fatal condition in cervids (deer, elk,
and moose) caused by misfolded prions, has been detected in
over 36 States and all four regions of the country. Monitoring
the prevalence of prion diseases, including determining a
disease's incidence and whether it was acquired from animals or
other humans, is critical. In light of scientific observations
regarding the nationwide spread of CWD and concerns about the
potential for cross-species transmissions to humans and food
production animals, the Committee includes $9,000,000 for
surveillance efforts of human prion diseases, including
Creutzfeldt-Jakob Disease, through the National Prion Disease
Pathology Surveillance Center and CDC.
Travel and Port Health Protection.--The Committee provides
$63,772,000, an increase of $10,000,000, to support the
Traveler-Based Genomic Surveillance (TGS) program. The
Committee is aware of the expansion of the TGS program to
include multiple pathogens of public health interest collected
through aircraft wastewater, and voluntary nasal swabs from
travelers arriving at several U.S.-based international airports
and recommends the continuation of these activities through
resources made available in this bill and from previous
appropriations balances. This capability has been effective in
advancing the nation's pathogen surveillance capabilities to
provide early warning for detection, characterization,
migratory disease origin.
Southern Tick Associated Rash Illness.--The Committee
directs CDC to publicly release a report on Southern Tick
Associated Rash Illness (STARI) including its prevalence, the
tick-vector or vectors causing STARI, and the progress in
identifying the causative pathogen of STARI or any suspected
non-infectious disease-causing mechanism. The Committee directs
CDC to provide a briefing to the Committee on this topic within
180 days of the enactment of this Act.
Tick Borne Diseases External Engagement.--The Committee
strongly encourages CDC to establish a panel of expert outside
stakeholders to evaluate and review the Lyme disease
information on its website for its inclusion of a balance of
scientifically valid perspectives, primarily regarding the
state of the science for diagnostics and treatments. The stated
goals and purposes of the review and the identity of review
participants, including the balanced panel of experts,
including experienced TBD clinicians, researchers, and
educators, should be fully transparent.
Tick-Borne Disease Public Information.--The Committee
directs CDC, within 180 days of enactment of this Act, to
develop a two-year plan (to include Fiscal Years 2026 and
Fiscal Year 2027) for conducting evaluation reviews of the
information on its website for tickborne diseases (TBDs),
including any TBD overviews and information on individual TBDs,
including alpha-gal syndrome, the non-infectious allergic
disease related to a tick bite that is less understood than
other allergic conditions, and for developing educational
materials for clinicians and the public for each TBD and
tickborne condition, with priority based on disease burden,
determined by prevalence and level of disability.
The CDC is further directed, within 180 days of the
enactment of this Act, to publicly release a report on alpha-
gal syndrome, including prevalence, etiology, treatment,
outcomes, and prognosis.
Vector-Borne Diseases.--The Committee recognizes the
increased threat posed by vector-borne diseases such as Zika,
West Nile, STARI, Oropouche, alpha-gal syndrome, and dengue and
provides $65,603,000 to support CDC's ability to assist States
affected by the increased prevalence in vector-borne diseases.
CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION
Appropriation, fiscal year 2025....................... $1,433,914,000
Budget request, fiscal year 2026...................... 35,000,000
Committee Recommendation.............................. 1,159,953,000
Change from enacted level......................... -273,961,000
Change from budget request........................ +1,124,953,000
The Committee recommendation includes $742,511,000 in
discretionary appropriations and $417,442,000 in transfers from
PPHF. Programs supported within Chronic Disease Prevention and
Health Promotion provide national leadership and support for
State, Tribal, and community efforts to promote health and
well-being through the prevention and control of chronic
diseases.
Within the total provided, the Committee provides the
following amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Tobacco........................... $246,500,000 - - -
Nutrition, Physical Activity, and 58,420,000 $58,420,000
Obesity..........................
High Obesity Rate Countries 16,500,000 16,500,000
(non-add)....................
School Health..................... 19,400,000 - - -
Food Allergies (non-add)...... 2,000,000 - - -
Farm-to-School (non-add)...... 2,000,000 - - -
Health Promotion.................. 64,100,000 85,675,000
Vision and Eye Health......... 6,500,000 4,500,000
Alzheimer's Disease........... 39,500,000 39,500,000
Inflammatory Bowel Disease.... 2,000,000 3,000,000
Interstitial Cystitis......... 1,100,000 2,200,000
Chronic Kidney Disease........ 4,500,000 5,500,000
Chronic Disease Education and 4,500,000 30,975,000
Awareness....................
Prevention Research Centers....... 28,961,000 - - -
Heart Disease and Stroke (PPHF)... 155,105,000 163,130,000
Diabetes (PPHF)................... 156,129,000 163,130,000
National Diabetes Prevention 37,300,000 40,300,000
Program..........................
Cancer Prevention and Control..... 410,049,000 417,548,000
Cancer Prevention and Control - - - 331,366,000
BA...........................
Cancer Prevention and Control - - - 86,182,000
PPHF.........................
Oral Health....................... 20,250,000 23,250,000
Safe Motherhood/Infant Health..... 110,500,000 110,500,000
Epilepsy.......................... 11,500,000 11,500,000
National Lupus Registry........... 10,000,000 20,000,000
Community Grants.................. 68,950,000 30,000,000
Racial and Ethnic Approaches 44,950,000 - - -
to Community Health..........
Good Health and Wellness in 24,000,000 30,000,000
Indian Country...............
Social Determinants of Health 6,000,000 - - -
Pilot Program....................
Healthy Weight Task Force Obesity 5,000,000 5,000,000
Activities/Early Child Care
Collaboration (PPHF).............
------------------------------------------------------------------------
Alzheimer's Disease and Related Dementias.--The Committee
recognizes that conformational disorders, such as Alzheimer's
disease, Creutzfeldt-Jakob Disease, and prion diseases, may
share disease characteristics which are overlooked or mistaken
in diagnosis. The Committee encourages CDC to support broader
conformational disease prevention and awareness activities with
Alzheimer's Disease awareness and prevention funding.
Breast and Cervical Cancer Screening.--The Committee
provides $240,999,000, an increase of $5,499,000 for this
program. This includes $154,817,000 in new budget authority and
$86,182,000 in funding transferred from the PPHF. The Committee
continues to support provision of critical, lifesaving breast
and cervical cancer screening and diagnostic services. The
Committee is aware that there are still substantial barriers to
screening like geographic isolation, limited health literacy,
lack of provider recommendation and trust, inconvenient times
to access services, and physical discomfort. The Committee is
encouraged by recent progress in screening methods and programs
that aim to eliminate patient access barriers. The Committee
encourages CDC to continue efforts to reduce breast and
cervical cancer and to work to reach women who may have delayed
screening services.
The Committee is concerned with the decline in screening
rates, and the increase in diagnosis of advanced cervical
cancers, especially in rural and underserved communities.
Provided within the increase, the Committee encourages the
National Breast and Cervical Cancer Early Detection Program to
build on existing programs by finding new and innovative
outreach and education strategies to engage women to increase
screening rates. The use of navigators has proven especially
successful in reaching women with low rates of screening. The
Committee further directs CDC publicly release a report on
these activities within 180 days of the enactment of this Act.
CAROL Act Activities.--The Committee provides increased
funding for the CDC Division for Heart Disease and Stroke
Prevention to support the expansion of the national sudden
cardiac registry to capture data from all States and to expand
heart valve disease education awareness as authorized in the
CAROL Act (P.L. 117-244).
Cancer Prevention and Control.--The Committee provides
$417,548,000 for CDC cancer prevention and control activities,
a $7,499,000 increase from the fiscal year 2024 enacted level.
The Committee directs CDC to fund the following activities at
not less than the fiscal year 2024 enacted level: breast and
cervical cancer including WISEWOMEN, breast cancer awareness
for young women, cancer registries, colorectal cancer,
comprehensive cancer control, Johanna's Law, ovarian cancer,
prostate cancer, skin cancer, and the cancer survivorship
resource center. In addition, under this heading in the fiscal
year 2027 congressional justification, CDC is directed to
include a discussion of planned efforts for each of the areas
identified in the preceding sentence. Within the amounts
provided, the Committee includes increases of $5,499,000 for
Breast and Cervical Cancer programs, $500,000 for Ovarian
Cancer programs, $500,000 for Johanna's Law programs and
$1,000,000 for Prostate Cancer programs.
Cervical Cancer Outreach and Education.--The Committee is
concerned with the decline in screening rates, and the increase
in diagnosis of advanced cervical cancers, especially in rural
and underserved communities. Provided within the increase, the
Committee encourages NBCCEDP to build on existing programs by
finding new and innovative outreach and education strategies to
engage women to increase screening rates. The use of navigators
has proven especially successful in reaching women with low
rates of screening. The Committee requests a briefing on these
activities within 180 days of enactment of this Act.
Chronic Disease Education and Awareness Program.--The
Committee is pleased by the continued progress of the Chronic
Disease Education and Awareness program and notes the success
and impact of supported projects. The Committee has provided
$30,975,000 for fiscal year 2026 to support grants for chronic
diseases, including rare conditions, that lack a specific
funding line within the CDC's budget. Funding previously
allocated to excessive alcohol use, arthritis, and the
Hospitals Promoting Breast Feeding program lines is now
included in the Chronic Disease Education and Awareness
program.
Chronic Mental Health.--An estimated 2,800,000 people in
the United States are affected by schizophrenia and data show
approximately 75 percent of patients discontinue treatment
within the first 18 months. The Committee encourages CDC to
work with national partners on education, outreach, and public
awareness activities around schizophrenia.
Chronic Kidney Disease.--Chronic kidney disease (CKD)
affects more than 37 million adults in the United States, with
an additional 80 million Americans at risk of developing CKD
due to diabetes, cardiovascular disease, or other conditions.
The vast majority of adults (about 90 percent) are unaware they
have CKD until there is a need for dialysis or kidney
transplantation. Approximately 25 percent of Medicare's annual
budget is spent on care for CKD patients, however, CKD is not
detected early enough to initiate treatment regimens to reduce
death and disability. A public health approach contributes
toward better and earlier detection to allow more time for
interventions targeted to improve outcomes. The Committee
encourages continued investment to educate the public about
their risk for CKD, educate clinical professionals, and spur
innovation by entities serving the CKD community. By improving
surveillance, early detection, and treatment, the progression
of kidney disease can be slowed, and complications can be
reduced which will dramatically improve the quality of life of
patients and reduce healthcare costs.
Diabetes.--According to CDC's 2021 data from the National
Diabetes Statistics Report, approximately 2 million Americans
have type 1 diabetes (T1D), with 304,000 of these individuals
under the age of 20. The incidence of T1D has increased
significantly over the past 20 years. Millions of individuals
are at an increased risk of developing T1D because they have a
first-degree relative with the condition, and a subset of these
individuals are in the early stages of T1D.
The Committee recommends that CDC continue to update its
website to include comprehensive information about screening,
risks of DKA at diagnosis, and information about accessing
possible treatments and clinical trials to delay the onset of
T1D. CDC is encouraged to include information targeting
physicians, school health workers, parents, and adults
regarding screenings; provide information about populations
that should be prioritized for screening; and direct patients
to appropriate resources if their screening results indicate
that they are at increased risk of developing T1D. CDC is
further encouraged to enact a process to review the scientific
literature on screening for T1D and update information on its
website to reflect new information in a more timely manner.
Diabetes.--The Committee notes that according to the CDC,
Native Americans and Alaska Native adults are more likely to
have diabetes than any other racial or ethnic group, with one-
in-seven Native Americans and Alaska Native adults having
diabetes. Within the amount provided, the Committee reserves no
less than 5 percent for Indian Tribes and Tribal Organizations.
Epilepsy.--The Committee commends CDC for its ongoing
leadership of this successful program and effective community
collaborations, and encourages further efforts to eliminate
stigma, improve awareness and education, and better connect
people with epilepsy to health and community services. The
Committee recognizes the importance of data to accurately
understand the incidence, prevalence, and mortality rate of
epilepsies, along with individual and social risk factors that
influence health outcomes. The Committee appreciates CDC's
ongoing epilepsy-related surveillance and funding of
epidemiologic studies on epilepsy. The Committee encourages CDC
to enhance surveillance and epidemiologic studies of epilepsies
to generate data that can guide interventions to improve
outcomes for people with epilepsy.
Heart Disease and Stroke.--The Committee continues to
support heart valve disease education and awareness, encourages
CDC to support the implementation of the Cardiovascular
Advances in Research and Opportunities Legacy Act, and
encourages CDC to increase the programmatic emphasis on heart
valve disease education and awareness. Funding previously
allocated to the Million Hearts Initiative is now consolidated
with the Heart Disease and Stroke funding line to support core
programmatic activities.
High Obesity Rate Counties.--The Committee directs the CDC
to continue this program at no less than fiscal year 2024
level. The Committee continues to support land grant
universities in partnership with their cooperative extensions
in counties with obesity rates over 40 percent. The Committee
directs CDC to encourage grantees to work with State and local
public health departments and other partners to support
measurable outcomes through community and population-level
evidenced-based obesity intervention and prevention programs.
The Committee further directs that funded projects integrate
evidence-based policy, systems, and environmental approaches to
better understand and address the environmental and societal
implications of obesity. To ensure a more seamless integration
between grantees and public health partners, the Committee
directs that preference be given to proposals that are led by
or conducted in coordination with an academic medical center to
ensure that education and outreach efforts are aligned with
best medical practices. The Committee further encourages CDC to
consider including high childhood obesity rates in its
eligibility criteria for the High Obesity Program as well as
the preponderance of obesity by State based on the CDC
Behavioral Risk Factor Surveillance System.
Inflammatory Bowel Diseases.--The committee applauds the
ongoing work to improve health outcomes for people impacted by
Crohn's disease and ulcerative colitis, known collectively as
IBD. The Committee provides $3,000,000, an increase of
$1,000,000, to support CDC's work to improve the public health
response to IBD. This includes work to increase awareness of
IBD, improve understanding of effective treatments, and
improved early disease diagnosis. The committee directs CDC to
continue supporting this work.
Lung Cancer.--The Committee is concerned that only 16
percent of all those eligible are screened for lung cancer. To
improve screening rates, the Committee encourages the National
Comprehensive Cancer Control Program (NCCCP) to work with
States on targeted, cost-effective strategies that increase
lung cancer screening rates. Tactics might include improving
patient and provider education, increasing awareness of the
screening criteria, and leveraging patient navigators/community
health workers to reduce barriers to accessing lung cancer
screening.
National Lupus Registry.--The Committee continues to
support the National Lupus Patient Registry and the Developing
and Disseminating Strategies to Build Sustainable Lupus
Awareness, Knowledge, Skills, and Partnerships Program to
educate healthcare providers about the signs and symptoms of
lupus, to reduce time to diagnosis and ensure referrals to
appropriate specialty care and self-management tools/services.
The Committee encourages the CDC to build on this work and
focus on increasing community-clinical linkages to improve
chronic care management and patient-centered care programs,
including through partnerships with national lupus voluntary
health agencies, to address the needs of people living with
lupus. Guided by the National Public Health Agenda for Lupus,
CDC funds population registries and cohort studies to increase
public health knowledge about lupus as well as supporting
activities to improve awareness of the signs and symptoms of
Lupus. The Committee provides $20,000,000 for CDC's Lupus
activities, an increase of $10,000,000, to support both
research and awareness activities.
Oral Health.--The Committee understands the importance of
CDC's Division of Oral Health and its role in reducing oral
disease rates among vulnerable populations. Therefore, the
Committee provides $23,250,000, an increase of $3,000,000 for
the Division of Oral Health. Within the increase for the
Division of Oral Health, the Committee provides funding to
evaluate and enhance the nation's surveillance systems to
better identify oral health burden at the national, State, and
local levels. Such enhancements will make data available more
quickly, enable exploration and evaluation of methods to track
adherence to infection prevention, provide information for
dental settings to support educational efforts, and increase
awareness of the importance of oral health to overall health.
Prostate Cancer.--The Committee remains concerned about the
rise in prostate cancer deaths and supports the CDC's work to
address this trend by increasing public awareness of prostate
cancer risks, screening, and treatment in high-risk men. The
Committee supports the creation of a national education and
awareness campaign targeting high-risk men and their families.
Safe Motherhood and Infant Health.--The Committee includes
a total of $110,500,000 for this portfolio of programs to
improve the health of pregnant and postpartum women and their
infants. The Committee encourages CDC to use the funding to
support Perinatal Quality Collaboratives, and other programs
including the Sudden Unexpected Infant Death and Sudden Death
in the Young Case Registry. Consistent with the requirements of
42 U.S.C. 247b-12, the Committee directs CDC to publicly
release a report regarding current and potential strategies to
provide support to children and mothers who suffer from rare
pre-natal or postpartum complications within 180 days of the
enactment of this Act.
Triple-Negative Breast Cancers.--The committee recognizes
findings that African American women have twice the odds of
being diagnosed with Triple-Negative Breast Cancers (TNBCs).
The Committee therefore directs CDC to publicly issue a report
on current and planned future efforts to promote awareness of
TNBC diagnosis and treatment, including any findings of best
practices for the use of educational or related tools to
increase the uptake of awareness and treatment no later than
180 days after enactment of this Act.
U.S. Associated Pacific Islands.--The Committee continues
to support funding for the prevention and control of chronic
disease and associated risk factors in the U.S. affiliated
Pacific Islands, U.S. Virgin Islands, and Puerto Rico.
Vision and Eye Health.--The Committee provides $4,500,000
for activities related to vision and eye health including
glaucoma. The Committee supports national surveillance on the
prevalence and risk of vision loss and eye disease in the
Vision and Eye Health Surveillance System. Data on risk of
vision loss and existence of vision loss in the U.S. is
necessary to inform State and community partnerships that
emphasize early detection and intervention and to address
challenges in access to eye care that can prevent eye disease
from progressing to permanent vision loss.
BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND HEALTH
Appropriation, fiscal year 2025....................... $206,060,000
Budget request, fiscal year 2026...................... 157,810,000
Committee Recommendation.............................. 208,560,000
Change from enacted level......................... +2,500,000
Change from budget request........................ +50,750,000
The National Center on Birth Defects and Developmental
Disabilities (NCBDDD) account supports efforts to conduct
research on and address the causes of birth defects and
developmental disabilities, as well as reduce the complications
of blood disorders and improve the health of people with
disabilities.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Child Health and Development BA... $71,300,000 $75,300,000
Birth Defects................. 19,000,000 34,800,000
Fetal Death................... 900,000 900,000
Fetal Alcohol Syndrome........ 11,500,000 11,500,000
Autism........................ 28,100,000 28,100,000
Health and Development with 86,410,000 84,910,000
Disabilities BA..................
Special Olympics.............. 19,500,000 20,500,000
Tourette Syndrome............. 2,500,000 2,500,000
Early Hearing Detection and 10,760,000 6,760,000
Intervention.................
Muscular Dystrophy............ 8,000,000 8,000,000
Fragile X..................... 2,000,000 2,000,000
Spina Bifida.................. 7,500,000 8,000,000
Congenital Heart Defects...... 8,250,000 9,250,000
Public Health Approach to Blood 10,400,000 10,400,000
Disorders........................
Hemophilia Activities............. 3,500,000 3,500,000
Hemophilia Treatment Centers...... 5,100,000 5,100,000
Thalassemia....................... 2,100,000 2,100,000
Neonatal Abstinence Syndrome...... 4,250,000 4,250,000
Surveillance for Emerging Threats 23,000,000 23,000,000
to Mothers and Babies............
------------------------------------------------------------------------
Birth Defects and Developmental Disabilities.--Funding
previously delineated for activities related to Folic Acid,
Infant Health, and Attention Deficit and Hyperactivity Disorder
are reflected in the Child Health and Development and Health
and Development with Disabilities program lines.
Cerebral Palsy.--Cerebral palsy (CP) is the most common,
lifelong motor disability caused by an early developmental
brain injury. The mechanism and type of injury underlying CP is
still not well understood, which can include perinatal stroke,
maternal infection, genetics and/or hypoxic ischemic
encephalopathy. The Committee encourages CDC to consider
supporting efforts to expand scientific knowledge on
prevalence, risk factors, early detection, and co-morbidities
of CP in order to determine if the CP population is rising,
dropping, or staying the same.
Fetal Death.--The Committee provides continued funding to
support CDC's implementation of the recommendations of the
Stillbirth Task Force.
Blood Clots.-- The majority of blood clots are highly
preventable, but public awareness remains low. The Committee is
concerned about the significant economic and health impact of
blood clots on patients and the health care system,
particularly for pregnant women, veterans, Black Americans,
people over 50, cancer patients, and those with co-morbidities.
The Committee encourages CDC to partner with patient advocacy
organizations to ensure greater public awareness of blood
clots. As part of the fiscal year 2027 congressional
justification, the Committee directs CDC to include a cost
estimate of a nationwide public awareness campaign to recognize
the symptoms of blood clots and how to prevent them.
Fragile X and Fragile X Associated Disorders.--The
Committee commends CDC's efforts to identify and define the
population impacted by Fragile X (FX) and all conditions
associated with the gene mutations with the goal of
understanding the public health impact of these conditions. The
Committee encourages the NCBDDD to support additional
strategies to promote earlier identification of children with
FX, such as voluntary newborn screening. The Committee also
encourages the NCBDDD work to ensure populations with FX
conditions are being properly diagnosed and made aware of
available medical services. Finally, the Committee recommends
the NCBDDD support research across the lifespan of individuals
living with FX and the associated conditions and disorders.
Muscular Dystrophy.--The Committee includes $8,000,000 to
support Muscular Dystrophy research and monitoring initiatives.
The Committee encourages CDC to focus on activities that
leverage existing resources and provide the most benefit to the
Duchenne community, including active engagement with external
consortia to help address the array of issues that affect
adolescents and adults with Duchenne, including bone health,
adrenal health, cardiac health, pulmonary health, puberty,
weight management, and fertility. In States where Duchenne
newborn screening implementation efforts have begun, the CDC is
encouraged to conduct annual assessment of State implementation
efforts to include implementation barriers and laboratory
standards. Further, the Committee considers the incorporation
of existing data from prior collection efforts into the next
generation data system to be a priority. The Committee requests
a briefing within 180 days of the enactment of this Act
regarding the CDC plan for this legacy data integration.
Surveillance for Emerging Threats to Mothers and Babies.--
The Committee includes $23,000,000 to support CDC's
Surveillance for Emerging Threats to Mothers and Babies. The
program supports CDC's collaboration with State, Tribal,
territorial, and local health departments to monitor the impact
of emerging health threats on pregnant women and their babies
and inform public health and clinical decision-making to
improve the health of pregnant women and infants.
PUBLIC HEALTH SCIENTIFIC SERVICES
Appropriation, fiscal year 2025....................... $754,497,000
Budget request, fiscal year 2026...................... 771,897,000
Committee Recommendation.............................. 789,497,000
Change from enacted level......................... +35,000,000
Change from budget request........................ +17,600,000
The Committee recommendation includes $604,497,000 in
discretionary appropriations and $185,000,000 in transfers from
PPHF.
This account supports programs that provide leadership and
training for the public health workforce, support
infrastructure to modernize public health surveillance, promote
and facilitate science standards and policies, and improve
access to information on disease outbreaks and other threats.
Within the total, the Committee provides the following
amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity FY 2024 Enacted Committee
------------------------------------------------------------------------
Health Statistics................. $187,397,000 $187,397,000
Surveillance, Epidemiology, and 298,100,000 319,100,000
Informatics......................
Public Health Data Modernization 175,000,000 185,000,000
Initiative (PPHF)................
Advancing Laboratory Science...... 23,000,000 27,000,000
Public Health Workforce........... 71,000,000 71,000,000
------------------------------------------------------------------------
Advancing Laboratory Science.--The Committee appreciates
the work of the Advancing Laboratory Science program to deepen
organizational ties with commercial laboratories and provides
an increase of $4,000,000 to support these activities. Such
collaborations will better position the CDC and the nation to
respond to future pathogenic threats.
Assisted Reproductive Reporting Requirements.--The
Committee recognizes that Congress passed the Fertility Clinic
Success Rate and Certification Act in 1992, which ``mandates
that clinics performing assisted reproductive technology
annually provide data for all procedures performed to CDC and
sets forth definitions and reporting requirements.'' The
Committee acknowledges the importance of oversight to ensure
ethical assisted reproductive technology practices and to
address the long-term health outcomes and complications for
women and children. The Committee directs CDC to provide and
publicly release a report within 180 days of enactment of this
Act. This report shall address key outcomes, accrediting
information, data on health complications experienced by egg
donors and women undergoing fertility treatment, and the status
of consumer education materials as they relate to such
treatments.
CDC is further directed to include data related to the
number of fertilized eggs, blastocysts, and embryos created in
each cycle of assisted reproductive technology; the number that
perish due to natural causes in the course of in vitro
fertilization or a related procedure; the number that perish
due to preimplantation genetic diagnosis testing in the course
of in vitro fertilization or a related procedure; and the
number that are intentionally destroyed. In the event such data
are not available, CDC is directed to revise the National
Assisted Reproductive Technology Surveillance System to allow
their collection and publication in future years.
Data Modernization.--The Committee is pleased to see
progress towards the implementation of CDC's data modernization
efforts and encourages the agency to continue to invest in the
five key pillars of data modernization: (1) electronic case
reporting; (2) laboratory information management systems; (3)
syndromic surveillance; (4) electronic vital records systems,
and (5) the national notifiable disease surveillance system.
The Committee also recognizes CDC's efforts to engage with
States, Tribes, localities, and territories through data use
agreements for core data sources as well as key recommendations
from the Advisory Committee to the Director Data and
Surveillance Workgroup. The Committee directs CDC, within 180
days of the enactment of this Act, to provide a report
regarding how these efforts are advancing the agency towards
the development and implementation of enterprise-level public
health data systems.
Eating Disorders.--The Committee remains concerned that
mental health problems among youth are at an all-time high,
with eating disorders-related emergency room admissions for
youth doubling during the pandemic. For 23 years, CDC conducted
surveillance of the signs and symptoms of eating disorders
within the Youth Risk Behavioral Surveillance System (YRBSS),
but the YRBSS coordinators voted to remove the question from
the 2015 survey. The resulting gap in data collection has left
public health experts and researchers with limited data to
address current eating disorders among youth. The Committee
directs CDC to include one standard question on unhealthy
weight control practices for eating disorders for consideration
by State directors in the development of the next YRBSS survey.
Youth Premium Cigar Usage.--The Committee encourages CDC to
include one standard question on youth premium cigar usage for
consideration by State directors in the development of the next
YRBSS survey.
Surveillance, Epidemiology, and Informatics.--The
surveillance, epidemiology, and informatics programs are the
CDC's critical public health surveillance platforms programs,
including syndromic data and case reporting at the Federal,
State, and local level that provide vital information about the
nation's health. The increase provides continued support of
broad, State-based surveys used across health conditions and
risk factors, for both ongoing programs and CDC emergency
responses. These systems continuously monitor a wide range of
risk factors, providing health authorities with real-time data
to identify emerging threats and track trends over time. Early
detection of these risk factors enables timely interventions,
which can prevent diseases from spreading or becoming more
severe. Bolstering CDC's partnerships with State health
information exchanges will facilitate better use of
longitudinal health data for essential public and population
health uses, which benefits all of HHS.
National Neurological Conditions Surveillance System.--The
Committee provides $5,000,000, the same as the fiscal year 2024
enacted level to continue efforts on the two initial conditions
regarding multiple sclerosis and Parkinson's disease.
Primary Immunodeficiencies.--The Committee includes
$3,500,000 for education, awareness, and genetic sequencing
surveillance related to primary immunodeficiencies. This
program has proven effective in identifying undiagnosed
patients and linking them to centers of care.
ENVIRONMENTAL HEALTH
Appropriation, fiscal year 2025....................... $242,850,000
Budget request, fiscal year 2026...................... 152,350,000
Committee Recommendation.............................. 232,850,000
Change from enacted level......................... -10,000,000
Change from budget request........................ +80,500,000
The Committee recommendation includes $181,850,000 in
discretionary appropriations and $51,000,000 in transfers from
PPHF.
Programs supported within Environmental Health conduct
surveillance and data collection to detect and address emerging
pathogens and environmental toxins that pose significant
challenges to public health, as well as determine whether and
at what level of exposure these substances are harmful to
humans.
Within the total, the Committee provides the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2024 Enacted FY 2026 Committee
------------------------------------------------------------------------
Environmental Health Laboratory... $70,750,000 $70,750,000
Other Environmental Health 48,500,000 48,500,000
Laboratory...................
Newborn Screening Quality 21,000,000 21,000,000
Assurance Program............
Newborn Screening/Severe 1,250,000 1,250,000
Combined Immunodeficiency
Diseases.....................
Environmental Health Activities... 48,600,000 38,600,000
Safe Water.................... 8,600,000 8,600,000
Amyotrophic Lateral Sclerosis 10,000,000 10,000,000
(ALS) Registry...............
Trevor's Law.................. 3,000,000 3,000,000
Climate and Health............ 10,000,000 - - -
All Other Environmental Health 17,000,000 17,000,000
Environmental and Health Outcome 34,000,000 34,000,000
Tracking Network.................
Asthma............................ 33,500,000 33,500,000
Childhood Lead Poisoning (PPHF)... 51,000,000 51,000,000
Lead Exposure Registry............ 5,000,000 5,000,000
------------------------------------------------------------------------
Amyotrophic Lateral Sclerosis.-- The Committee recommends a
funding level of $10,000,000 for the National ALS Registry and
Biorepository at CDC to maintain the National ALS Registry and
Biorepository. The Committee encourages CDC to continue its
investment in research to reduce the incidence of Amyotrophic
Lateral Sclerosis (ALS) through prevention and risk mitigation
strategies among civilians, active military personnel and
veterans in the United States. Additionally, the Committee
directs the CDC to collaborate with the DOD and Veterans
Affairs to provide a publicly available report, to include a
strategy to develop and test risk reduction strategies that
will lower the incidence of ALS among active-duty personnel and
veterans, on the incidence and prevalence of ALS among military
veterans within 270 days of the enactment of this Act.
Asthma.--The Committee recognizes the significance of
asthma as a chronic disease with implications for public
health, productivity at work and at school, and healthcare
utilization. The Committee directs CDC to provide a briefing on
the current economic burden of asthma in the U.S. to help guide
public health efforts and resource allocation within 180 days
of the enactment of this Act. The CDC last published this data
in 2018 in a report titled, ``The Economic Burden of Asthma in
the United States, 2008-2013.'' Specifically, the Committee
directs CDC to provide a thorough assessment of the following
key aspects: prevalence, medical costs, absenteeism, and
mortality.
Climate and Health.--The Committee provides no funding for
climate and health related activities.
Pediatric Reference Intervals.--The Committee supports
CDC's work to ensure the reliable diagnosis and treatment of
children in a cost-effective manner. A 2022 CDC study found
that many reference intervals used for children do not
accurately reflect the biology of child development. The
Committee encourages CDC to develop pediatric reference
intervals and directs the CDC to include information on the
funding needed for this activity as part of the fiscal year
2027 congressional justification.
Polycystic Ovary Syndrome.--The Committee encourages CDC to
dedicate funding toward establishing standardized reference
intervals for Polycystic Ovary Syndrome (PCOS) hormone tests in
women, adolescents, and girls, particularly testosterone,
antimullerian hormone, and others. This effort aims to enhance
diagnostic precision, improve the reliability of clinical and
research data, and support earlier diagnosis and more effective
management, ultimately driving better health outcomes for those
affected by PCOS and saving healthcare costs.
INJURY PREVENTION AND CONTROL
Appropriation, fiscal year 2025....................... $761,379,000
Budget request, fiscal year 2026...................... 550,079,000
Committee Recommendation.............................. 665,329,000
Change from enacted level......................... -96,050,000
Change from budget request........................ +115,250,000
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2024 Enacted FY 2026 Committee
------------------------------------------------------------------------
Domestic Violence and Sexual $38,200,000 $38,200,000
Violence Prevention..............
Child Sexual Abuse Prevention. 3,000,000 3,000,000
Community and Youth Violence 18,100,000 - - -
Prevention.......................
Domestic Violence Community 7,500,000 7,500,000
Projects.........................
Rape Prevention................... 61,750,000 61,750,000
Suicide Prevention................ 30,000,000 30,000,000
Adverse Childhood Experiences..... 9,000,000 9,000,000
National Violent Death Reporting 24,500,000 - - -
System...........................
Traumatic Brain Injury............ 8,250,000 8,250,000
Elderly Falls..................... 3,050,000 3,050,000
Drowning.......................... 2,000,000 2,000,000
Injury Prevention Activities...... 29,950,000 - - -
Opioid Overdose Prevention and 505,579,000 505,579,000
Surveillance.....................
Injury Control Research Centers... 11,000,000 - - -
Firearm Injury and Mortality 12,500,000 - - -
Prevention Research..............
------------------------------------------------------------------------
Cannabinoid Hyperemesis Syndrome in Youth.--The Committee
is increasingly concerned by the rise in reported cases of
cannabinoid hyperemesis syndrome (CHS)--a condition associated
with prolonged, high-potency cannabis use that leads to severe
nausea and vomiting. With the growth of high-THC vaping
products and their increasing use among adolescents, the
Committee believes further study is warranted. The Committee
directs the Centers for Disease Control and Prevention, in
coordination with the Substance Abuse and Mental Health
Services Administration and the National Institute on Drug
Abuse, to conduct a study on the prevalence of CHS among youth
and assess any correlations between CHS incidence and youth use
of THC vaping products. The Committee requests an interim
report within 180 days of enactment and a final report within
one year.
Drowning Prevention.--The Committee includes $2,000,000 to
prevent fatal drownings. Drowning is the leading cause of death
among children 1-4 and the second leading cause of
unintentional death among children 5-14. The funding will allow
CDC to support proven drowning prevention programs with
national organizations working with youth at greater risk
including children who have autism spectrum disorder, to
support State drowning surveillance efforts, and to begin
implementation of a national plan on water safety.
The Committee further encourages the CDC to use drowning
prevention resources to support the implementation of the
United States National Water Safety Action Plan (USNWSAP). The
Committee commends the broad range of stakeholders who
contributed to the USNWSAP.
Firearm Research.--The Committee notes the CDC's historic
avoidance of research into the crimes and fatalities prevented
through self-defense with a firearm and therefore provides no
funding for firearm research.
National Poison Data System.--The committee urges CDC to
continue to partnership with the National Poison Data System to
support real-time monitoring of chemical exposures and public
health hazards.
Opioid Overdose Prevention Limitation on Administrative
Expenses.--The Committee supports CDC's activities to promote
effective strategies to reduce addiction and overdose deaths
but has concerns that funding for such activities is being
diverted to support administrative costs. For fiscal year 2026,
the Committee provides $54,000,000 for salaries and expenses,
level funding with fiscal year 2024. For the remainder of the
funds within the account, the Committee directs that no less
than 85 percent be provided to State, local, and Tribal health
departments or systems.
Prescription Drug Monitoring Programs.--The Committee
understands that nearly all 50 States and U.S. territories'
prescription drug monitoring programs are connected and
securely sharing critical controlled substance information for
the purposes of identifying and preventing abuse, misuse, or
diversion of prescription drugs. The Committee supports the
removal of a requirement for States to connect to a specific
data hub solution as a condition of funding. However, to adhere
to Congressional intent and ensure the success and continuity
of the program, the Committee encourages CDC to cease any
technical requirements that limit the ability of States to
optimize Federal funding and to continue to utilize the
prescription drug monitoring program data hub of their choice.
Suicide.--The Committee recognizes that suicide is a
serious public health problem requiring strategic suicide
prevention solutions, especially among disproportionately
impacted populations. The Committee further recognizes that
suicide prevention requires a strategic public health approach
that addresses multiple risk factors at the individual,
community, and societal levels. States, Tribes, and territories
are most suited to lead a comprehensive public health approach
to suicide prevention, which demands effectively coordinating
with multisector partners to take a data-driven, evidence-based
process that addresses the broad range of risk and protective
factors associated with suicide. The Committee directs the
Director to prioritize funding to State public health
departments to support the Comprehensive Suicide Prevention
program, and to increase funding to Tribes and territories to
build capacity and implement strategies to prevent suicide.
NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
Appropriation, fiscal year 2025....................... $362,800,000
Budget request, fiscal year 2026...................... 73,200,000
Committee Recommendation.............................. 312,700,000
Change from enacted level......................... -50,100,000
Change from budget request........................ +239,500,000
The National Institute for Occupational Safety and Health
(NIOSH) conducts applied research, develops criteria for
occupational safety and health standards, and provides
technical services to government, labor, and industry,
including training for the prevention of work-related diseases
and injuries. This appropriation supports surveillance, health
hazard evaluations, intramural and extramural research,
instrument and methods development, dissemination, and training
grants.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2024 Enacted FY 2026 Committee
------------------------------------------------------------------------
National Occupational Research $119,500,000 $120,500,000
Agenda...........................
Agricultural, Forestry, and 29,000,000 30,000,000
Fishing (non-add)............
Education and Research Centers.... 32,000,000 34,000,000
Personal Protective Technology.... 23,000,000 23,000,000
Mining Research................... 66,500,000 70,000,000
National Mesothelioma Registry and 1,200,000 1,200,000
Tissue Bank......................
Firefighter Cancer Registry....... 5,500,000 6,500,000
Other Occupational Safety and 103,300,000 57,500,000
Health Research..................
Total Worker Health........... 11,800,000 11,800,000
------------------------------------------------------------------------
Agricultural, Forestry, and Fishing.--The Committee
provides $30,000,000 to protect workers in this sector by
providing leadership in applied research, disease and injury
surveillance, education, and prevention.
Chronic Obstructive Pulmonary Disease (COPD).--COPD is a
highly prevalent chronic disease and is a leading cause of
death in the U.S. Although combustible tobacco use is the most
important risk factor in the U.S., there are also other causes
and about 14 percent is attributable to occupation. The
Committee notes the opportunity for CDC's implementation of the
COPD National Action Plan developed by CDC and the NHLBI. The
Committee encourages CDC, including NCCDPHP and NIOSH to
support surveillance and awareness activities on COPD through
existing funding mechanisms.
Deep Mining.--Within the funding provided for occupational
mine safety and health, the Committee encourages CDC to partner
with institutions with the relevant mining expertise to
establish new safety protocols for deep mining that continue to
foster U.S. innovation and reduce foreign reliance on critical
minerals and metals.
Environmental Exposures and Cancer in First Responders
including Firefighters.--The Committee is aware that first
responders have increased rates of cancer diagnoses and death
relative to the general population they serve. First
responders, such as firefighters, are exposed to a complex mix
of known and possible cancer-causing chemicals through
breathing hazardous substances and absorbing them through their
skin. Despite an understanding of the risks associated with
firefighter and first responders' environmental exposures,
there has been no large-scale, systematic examination of the
mechanisms by which the environmental exposures experienced by
these frontline responders can cause cancer. The Committee
encourages NIOSH/CDC to establish a Total Worker Health Center
of Excellence to examine the health and safety of first
responders, including addressing the cancer disparity among
those in the fire service to build upon existing scientific
evidence-based research to further develop new solutions and
best practices for complex occupational safety and health
problems such as the toxic exposures and higher cancer
incidence rates in this population.
Firefighter Cancer Registry.--The Committee recognizes the
inherent dangers of firefighting and the corresponding
importance of investigating traumatic and medical firefighter
line of duty deaths. The Committee includes $6,500,000 for
CDC's National Firefighter Registry for Cancer as the registry
continues to recruit and enroll participants.
Lung Cancer Screening.--The Committee is concerned that
only 16 percent of all those eligible are screened for lung
cancer using low dose chest computed tomography scans. To
improve screening rates, the Committee encourages the National
Comprehensive Cancer Control Program (NCCCP) to work with
States on targeted, cost-effective strategies that increase
lung cancer screening rates. Tactics might include improving
patient and provider education, increasing awareness of the
screening criteria, and leveraging patient navigators/community
health workers to reduce barriers to accessing lung cancer
screening. The Committee also encourages NIOSH to support
efforts to bring lung cancer screening to high-risk workers and
to explore using low-dose chest computed tomography scans to
screen for coal workers' pneumoconiosis in its Coal Workers'
Health Surveillance Program.
Education and Research Centers.--The Committee includes
$34,000,000, an increase of $1,000,000, for Education and
Research Centers (ERCs) in recognition of their important work
to improve workplace safety and health by translating
scientific discoveries into practice through effective
education, training, and outreach. The Committee applauds the
work of NIOSH to implement innovative approaches, and its
translational research. The Committee supports the education
and training of graduate and post-graduate students,
particularly in Industrial Hygiene, Occupational Health
Nursing, Occupational Medicine Residency, and Occupational
Safety. The Committee encourages the CDC to use such funding to
expand Occupational Medicine Residency programs at new or
existing ERCs.
Mine Health and Safety.--The Committee supports research
related to air pollutant exposure risks to miners in metal and
non-metal surface and underground mines. The Committee provides
increased funding for CDC to partner with western institutions
with demonstrated expertise in air pollution, familiarity with
western mining challenges, and accredited environmental
analytical laboratories to evaluate airborne pollutant exposure
risks of miners, develop novel respirable dust and crystalline
silica exposure monitoring technologies, work with mine
operators to implement exposure monitoring and mitigation
measures, train mineworkers to reduce air pollutant exposures,
and transfer the knowledge gained to other industries and parts
of the country.
Respirator Approval.--The Committee supports the work of
the National Personal Protective Technologies Laboratory's
Respirator Approval Program (RAP). This continued funding
better ensures that RAP continues its essential work in
ensuring that workers in high-risk fields have access to the
safest, most advanced respiratory protection available.
Total Worker Health.--The Committee is concerned about the
negative health impacts faced by large numbers of vehicle
mechanics and technicians across all mechanical industries. The
Committee encourages the CDC to analyze the on-the-job health
impacts of workers in these fields to better understand and
improve the health and well-being of all mechanics through
research, workplace studies and interventions. It is essential
to workers in hazardous fields, including our mechanics, shop
workers, and our nation's overall health, to create a workplace
which prioritizes worker's physical and mental health,
longevity, and safety.
World Trade Center Health Program.--The Committee remains
strongly committed to the World Trade Center Health Program
(WTCHP), which provides critical medical monitoring and
treatment to responders and survivors of the September 11th
attacks. The Committee is concerned by recent reports of access
to care issues affecting both enrollees and network providers,
particularly in the Nationwide Provider Network (NPN). These
issues include delays in processing authorizations and
reimbursements, a lack of transparency in claims resolution,
and disruptions in continuity of care stemming from
administrative inefficiencies.
The Committee is particularly troubled that these
challenges have resulted in care delays for patients suffering
from 9/11-related conditions, as well as growing
dissatisfaction and attrition among providers. These systemic
barriers undermine the WTCHP's mission and threaten the trust
built between the program and the 9/11 community. The Committee
encourages CDC to take steps to resolve these issues which may
include metrics on provider retention and enrollee complaints;
an assessment of the NPN contractor's performance and
accountability measures; and specific actions to improve care
access and provider support.
The Committee further encourages CDC to ensure that
sufficient resources are allocated to administer the WTCHP
effectively and to evaluate long-term solutions that protect
patient care continuity.
World Trade Center Health Program Eligibility.--The
Committee recognizes that thousands of potentially eligible
members of the World Trade Center Health Program (WTCHP) reside
outside the New York metropolitan area. In consideration of
migration trends, and with a greater need to provide clinical
services, in particular monitoring and treatment of WTCHP-
certified conditions and improve access to research within
regions where eligible members live, the Committee encourages
CDC to implement a competition to award an additional Clinical
Center of Excellence outside the New York metropolitan area.
ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM
Appropriation, fiscal year 2025....................... $55,358,000
Budget request, fiscal year 2026...................... 55,358,000
Committee Recommendation.............................. 55,358,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Energy Employees Occupational Illness Compensation
Program provides compensation to employees and survivors of
employees of Department of Energy facilities and private
contractors who have been diagnosed with a radiation-related
cancer, beryllium-related disease, or chronic silicosis as a
result of their work. NIOSH estimates occupational radiation
exposure for cancer cases, considers and issues determinations
for adding classes of workers to the Special Exposure Cohort,
and provides administrative support to the Advisory Board on
Radiation and Worker Health.
Dose Reconstruction Program.--Within the funds made
available by the Energy Employees Occupational Illness
Compensation Program Act, CDC is encouraged to prioritize
additional funding to the NIOSH Radiation Dose Reconstruction
Program for scientific dose reconstruction activities for
additional health physicists and continue to meet compensation
timelines and expected applications.
GLOBAL HEALTH
Appropriation, fiscal year 2025....................... $692,843,000
Budget request, fiscal year 2026...................... 293,200,000
Committee Recommendation.............................. 473,200,000
Change from enacted level......................... -219,643,000
Change from budget request........................ +180,000,000
Through its Global Health activities, CDC coordinates,
cooperates, participates with, and provides consultation to
other nations, Federal agencies, and international
organizations to prevent and contain diseases and environmental
health problems. In cooperation with ministries of health and
other appropriate organizations, CDC tracks and assesses
evolving global health issues and identifies and develops
activities to apply CDC's technical expertise.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2024 Enacted FY 2026 Committee
------------------------------------------------------------------------
Global HIV/AIDS Program........... $128,921,000 - - -
Global Tuberculosis............... 11,722,000 - - -
Polio Eradication................. 180,000,000 $180,000,000
Folic and other Vaccine 50,000,000 - - -
Preventable Diseases.............
Global Public Health Protection... 293,200,000 293,200,000
------------------------------------------------------------------------
Protecting Life in Global Health Assistance.--The Committee
remains deeply concerned over the violation of the Helms
Amendment under the previous Administration. The Helms
amendment prohibits Federal funds for abortions in foreign aid
programs. CDC has responsibility for ensuring that implementing
partners adhere to the terms and conditions of all awards made
by the agency, including oversight of funding transferred to
the agency. Within 90 days of the enactment of this Act, the
CDC is directed to brief the Committee on steps taken since the
start of fiscal year 2024 to ensure relevant grant management
officers, grant management specialists, and programmatic staff
are effective in ensuring adherence to the Helms Amendment.
Parasitic Diseases and Malaria.--The Committee provides
funding for parasitic diseases and malaria prevention related
activities through the Emerging Infectious Diseases program
line within the CDC Center for Emerging Zoonotic and Infectious
Diseases.
Soil Transmitted Helminth and Related Diseases.--The
Committee includes funding to extend the currently funded CDC
projects aimed at surveillance, source remediation, and
clinical care to reduce soil transmitted helminth infection.
PUBLIC HEALTH PREPAREDNESS AND RESPONSE
Appropriation, fiscal year 2025....................... $938,200,000
Budget request, fiscal year 2026...................... 594,000,000
Committee Recommendation.............................. 913,200,000
Change from enacted level......................... -25,000,000
Change from budget request........................ +319,200,000
The Public Health Preparedness and Response (PHPR) account
supports programs that build and strengthen national
preparedness for public health emergencies, both naturally
occurring and intentional. PHPR supports needs assessments,
response planning, training, epidemiology and surveillance, and
upgrades for laboratory capacity and communications systems.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2024 Enacted FY 2026 Committee
------------------------------------------------------------------------
State and Local Preparedness and $744,200,000 $744,200,000
Response Capability..............
Public Health Emergency 735,000,000 735,000,000
Preparedness Cooperative
Agreement....................
Academic Centers for Public 9,200,000 9,200,000
Health Preparedness..........
Ready Response Enterprise Data 55,000,000 30,000,000
Integration Platform & Center for
Forecasting Analytics............
CDC Preparedness and Response 139,000,000 139,000,000
Capability.......................
------------------------------------------------------------------------
Emergency Preparedness and Response.--The Committee
supports the CDC's efforts to provide guidance, technical
assistance, and resources, including emergency preparedness
epidemiologist and experts, to communities as they prepare for,
withstand, and recover from emergencies. For example, events
such as the Norfolk Southern train derailment in East
Palestine, Ohio and the 2024 Smokehouse Creek Fire across the
Texas Panhandle demonstrates the need to provide rural
communities support particularly through CDC's assistance
building public health emergency preparedness plans, supporting
operational coordination and maintaining and implementing
response capabilities in real-world events.
CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT
Appropriation, fiscal year 2025....................... $663,570,000
Budget request, fiscal year 2026...................... 398,570,000
Committee Recommendation.............................. 523,570,000
Change from enacted level......................... -140,000,000
Change from budget request........................ +125,000,000
This account supports the Office of the Director as well as
public health leadership and support activities at CDC.
Within the total, the Committee recommends the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2024 Enacted FY 2026 Committee
------------------------------------------------------------------------
Preventive Health and Health $160,000,000 - - -
Services Block Grant.............
Office of the Director............ 128,570,000 $128,570,000
Office of Rural Health (non- 5,000,000 6,000,000
add).........................
Infectious Disease Rapid Response 25,000,000 35,000,000
Reserve Fund.....................
Public Health Infrastructure and 350,000,000 360,000,000
Capacity.........................
------------------------------------------------------------------------
Birthing experience and Maternity Care During Public Health
Emergencies and Natural Disasters.--In the face of public
health emergencies and natural disasters, pregnant and
postpartum patients need to take special measures to ensure the
health and safety of themselves and their children. To ensure
patients and providers have accurate, evidence-based
information on maternal and infant health risks during public
health emergencies and natural disasters, with a particular
focus on reaching pregnant and postpartum individuals in
underserved communities, the Committee encourages CDC to
convene a meeting of Federal; State, local, and/or territorial
public health officials; Tribal public health officials; and
public stakeholders representing maternity care providers,
maternal and infant health focused community based
organizations, and patient voices to discuss measures to detect
maternal and infant health need and measures to facilitate
access and delivery of maternal and infant data during public
health emergencies and natural disasters.
CDC Core Capacities.--The Committee has prioritized funding
for CDC Core Capacities necessary to respond to the threats of
infectious disease across 15 accounts. These accounts include
Quarantine; Emerging Infectious Diseases; Advanced Molecular
Detection; Epi and Lab Capacity; Health Statistics; Public
Health Data Modernization; Public Health Workforce; Advancing
Laboratory Science; Surveillance, Epi, and Informatics; Global
Health Protection; Public Health Emergency Preparedness
Cooperative Agreements; Buildings and Facilities; the
Infectious Diseases Rapid Response Reserve Fund; Public Health
Infrastructure; and Emerging Infectious Diseases. As part of
the fiscal year 2027 congressional justification, CDC is
directed to provide a breakout table detailing the funding
requested for these core capacity program lines.
CDC Public Health Fellowships.--The Committee recognizes
the value of the CDC's fellowship program in improving the
technical abilities of public health professionals prior to
their permanent placement with State, local, Tribal, or
territorial public health agencies. The CDC is directed to
provide the Committee, within 180 days of enactment of this
Act, a briefing on the number of CDC fellowships, the cost of
the CDC fellowship program, and the placements of CDC fellows
and their tenure within relevant public health offices.
Disease Modeling.--The Committee encourages CDC to work
with schools of public health and other academic institutions
to engage the nation's expertise in disease modeling, public
health data analysis, research, and training to build workforce
capacity in this emerging field.
Eating Disorders and Assisted Suicide.--The Committee is
concerned with the potential practice of referring, counseling,
prescribing, or administering assisted suicide to individuals
suffering from chronic mental health conditions, including
anorexia and other eating disorders. The Committee directs the
CDC Director to submit a report within 180 days of the
enactment of this Act to the Committee on instances where
providers have referred, counseled, prescribed, or administered
assisted suicide to individuals suffering from chronic mental
health conditions, including anorexia or other eating
disorders.
Food Allergies.--The Committee recognizes the serious issue
of food allergies, which affect approximately 8 percent of
children in the U.S. The Committee includes Chronic Disease
Prevention and Health Promotion funding to support school-based
efforts to address food allergies and reduce potentially fatal
anaphylactic reactions.
Gender Dysphoria.--The Committee notes the limited medical
evidence of the long-term effects of hormone drugs and surgical
procedures to alter bodily sex traits. In the United Kingdom,
the National Health Service recently ended social, hormonal,
and surgical interventions to look like the opposite sex for
minors due to the limited evidence to support clinical decision
making for this population. The Committee directs CDC to
conduct a long-term study on the effects of drugs or surgery
used as an intervention for gender dysphoria.
Headaches.--The Committee recognizes the significant impact
of migraine and headache disorders on student health,
attendance, and academic performance. To address these
challenges, the Committee encourages the CDC to study migraine
and other headache disorders within its Healthy Schools Program
to improve awareness, education, and management of migraine and
other headache disorders in school settings, specifically to
include training for school health staff, creation of
educational materials, and implementation of environmental
strategies to mitigate headache triggers.
Human Health Risks Posed by Wildlife.--The Committee is
concerned by the CDC's lack of action to implement the GAO
recommendation that the agency comprehensively assess the risk
that imported wildlife could introduce zoonotic diseases to the
U.S. Therefore, the Committee directs CDC to develop a
comprehensive risk analysis framework for purposes of
evaluating current policies to determine whether adjustments
are required for purposes of assessing zoonotic disease risks
related to imported wildlife. The Committee further directs CDC
to provide a briefing on its implementation of this directive
within 180 days of the enactment of this Act.
Indoor Air Quality.--The Committee encourages CDC to
conduct a study on how indoor air quality impacts pathogen
transmission including how increased use of outdoor air
ventilation, high-efficiency particulate air (HEPA) filtration,
and germicidal ultraviolet (GUV) light affect such
transmission.
Infectious Disease Rapid Response Reserve Fund.--The
Committee provides funding for the Reserve Fund to ensure that
CDC is positioned to respond quickly to an imminent public
health emergency. The Committee directs CDC to provide a table
to the Committee each month, which shall include all amounts
available in the Reserve Fund for the current fiscal year and
the preceding two fiscal years, including: (1) each individual
obligation above $5,000,000; (2) with respect to each such
obligation, the notification to which it relates; and (3) the
total amount unobligated in the Reserve Fund.
Local Health Departments.--Federal funding intended for
both State and local health departments does not consistently
reach local health departments beyond those directly funded by
CDC. The Committee encourages CDC to require States to fund
local health departments when programmatically appropriate. The
Committee urges CDC to publicly track and report to the
Committee how funds provided to State health departments are
passed through to local health departments, including the
amount and date funds are made available, per grant award, by
local jurisdiction.
Obesity.--The Committee recognizes obesity as a serious
chronic disease and public health and economic issue that must
be addressed. CDC formally recognizes obesity as a disease and
recommends that it be treated as such. Evidence-based
therapies, including innovative and highly effective anti-
obesity medications (AOMs) are available with others in
development. Expanded access to intensive behavioral therapy
and AOMs, in addition to existent surgical procedures, not only
provide significant weight loss reductions but lead to improved
outcomes in over 200 obesity-related health conditions
including diabetes, coronary heart disease, and hypertension.
The Committee encourages CDC to take a comprehensive approach
in treating obesity as a chronic disease and find ways to
improve access to treatment options. The Committee also
encourages CDC to continue to collaborate with other Federal
agencies who are already treating obesity as a chronic disease
as it considers best practices to improve care for people with
obesity.
Office of Rural Health.--The Committee is encouraged by
efforts from the agency to establish the CDC Office of Rural
Health (ORH) and ORH's early initiatives. The Committee directs
the agency to ensure that the established ORH will continue to
guide CDC's rural health leadership across the entire agency.
This includes by developing purposeful public health guidance
for rural health departments, analyzing and developing
initiatives to expand the rural public health workforce,
coordinating with the Federal Office of Rural Health Policy
under HRSA, and otherwise serving as a resource and technical
assistance hub for public health in rural communities. The
Committee includes $6,000,000 for the continued efforts of this
office.
Peripheral Arterial Disease Prevalence.--Between 1995 and
2020, Peripheral Arterial Disease Prevalence (PAD) prevalence
in the United States increased from 11,300,000 to 21,000,000.
Based on the aging population, by 2030 the number of
individuals with PAD is expected to increase to 23,800,000. The
Director of CDC is encouraged, in collaboration with HRSA, CMS,
and leading clinical and patient advocacy organizations, to
establish a PAD education program.
Postural Orthostatic Tachycardia Syndrome and
Dysautonomia.--The Committee supports CDC's work related to
provider education and public awareness for postural
orthostatic tachycardia syndrome (POTS) and similar forms of
dysautonomia, common chronic conditions that impact millions of
Americans and cause severe disability. The Committee is
concerned that 28 States do not have a board-certified
autonomic specialist resulting in POTS patients facing on
average a 5-year diagnostic delay and encourages the CDC to
work with patient advocates, clinicians, and researchers to
develop an education program for health care providers to
increase access to care for POTS and similar dysautonomia
patients.
Public Health Infrastructure.--The Committee notes that the
Public Health Infrastructure (PHI) program is intended, as
described in the joint explanatory statement that created it,
to support public health departments. The Committee includes a
new program requirement that 10 percent of PHI funding be
designated specifically for Tribes and Tribal organizations.
The provision of a stable, disease agnostic funding line will
better ensure Tribes and Tribal Organizations are better
equipped to coordinate together to save lives. The Committee
notes that in the absence of this new requirement, CDC has
provided only $5,408,000 to Tribes and Tribal organizations
through the PHI program in fiscal year 2024, while providing
$21,750,000 to national professional and advocacy
organizations. The Committee is concerned that the provision of
funds to national organizations and high programmatic
assessment by the CDC has undermined the ability of the program
to effectively support State, local, Tribal, and territorial
public health organizations and again directs that no less than
70 percent of this funding be awarded to health departments.
Reporting.--The Committee is concerned that CDC abortion
surveillance reports, published annually in the CDC Morbidity
and Mortality Weekly Report, lack adequate participation by
States including incomplete submissions and even total
nonparticipation. The Committee requests a report on the extent
of data inconstancies; steps taken by CDC to improve data
completeness; and recommendations for legislative or regulatory
changes to achieve complete data.
Survey and Other Data Products.--The Committee notes the
proliferation of surveys and other data products related to
mental health within CDC and across HHS. As part of the Fiscal
Year 2027 Congressional Justification, the Committee directs
CDC, in collaboration with SAMHSA, NIH, and HRSA to include a
summary of all annual, biannual, quadrennial surveys or other
data products related to mental health.
Youth Electronic Cigarette Use.--The Committee recognizes
the growing challenge that schools undergo by increased use of
electronic cigarettes and other vaporizing equipment in their
facilities. These concerns often cause schools to lock bathroom
doors to prevent their use, but this can also pose a safety
risk. The Committee understands that there are commercially-
available off-the-shelf vape detection sensors that can provide
detect vape, smoke, THC, and sound abnormalities in areas where
cameras cannot be placed. The Committee urges CDC to clarify
that funds may be used for this technology and the Committee
encourages CDC to work with States and school districts to
increase awareness of this technology.
Youth Sports Injury Prevention Education.--Across the
country, communities continue to recognize the importance of
physical activity to maintain health, resulting in rapidly
growing youth sports activities. Research and education are
needed to examine sport and recreation injury across various
activities, demographic groups, and health care settings, in
addition to age related education for prevention and
management. The Committee encourages CDC to establish a
national public health information and education initiative
with States who have legislated child and youth sports injury
education requirements for coaches of non-school organized
youth sports activities. The Committee encourages CDC to
coordinate with respective State departments of public health
to develop public service announcements to educate volunteer
coaches and parents of children and youth (ages 5-17) on the
risks and means to prevent and manage sports related injuries.
BUILDINGS AND FACILITIES
Appropriation, fiscal year 2025....................... $40,000,000
Budget request, fiscal year 2026...................... 40,000,000
Committee Recommendation.............................. 40,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
This account supports capital projects as well as repairs
and improvements to restore, maintain, and improve CDC's assets
and facilities.
The Committee continues language to allow CDC to retain
unobligated funds in the Individual Learning Accounts from
departed employees to support the replacement of the
underground and surface coal mine safety and health research
facility.
NATIONAL INSTITUTES OF HEALTH (NIH)
Appropriation, fiscal year 2025....................... $48,301,000,000
Budget request, fiscal year 2026...................... 29,295,186,000
Committee Recommendation.............................. 47,845,000,000
Change from enacted level......................... -456,000,000
Change from budget request........................ +18,549,814,000
The mission of NIH is to seek fundamental knowledge about
the nature and behavior of living systems and the application
of that knowledge to enhance health, lengthen life, and reduce
illness and disability. NIH conducts and supports research to
understand the basic biology of human health and disease; apply
this understanding towards designing new approaches for
preventing, diagnosing, and treating disease and disability;
and ensure that these approaches are widely available.
The Committee recommendation for the National Institutes of
Health (NIH) program level is $47,845,000,000 including funding
for the Advanced Research Projects Agency for Health (ARPA-H).
The Committee provides $46,253,998,000 in discretionary
appropriations, $1,365,002,000 in PHS Act section 241
evaluation set-aside transfers, and $226,000,000 as authorized
in the 21st Century Cures Act (P.L. 114-255).
The Committee commends the innovative proposal in the
Administration's fiscal year 2026 budget request to
comprehensively reorganize the National Institutes of Health.
The structure of organizations as large, complex, and prominent
as NIH merit periodic consideration. It is important NIH
remains responsive to changing science and fosters research
collaborations across institutes and centers, so that it can
remain the world pioneer in biomedical research. In the 118th
Congress, the Committee worked in coordination with the
Committee on Energy and Commerce of the House of
Representatives to propose a reorganization of NIH for the 21st
century. This began a conversation about how to ensure the U.S.
maintains its innovative edge in basic science and biomedical
research against global competitors, to drive down duplicative
administrative costs, and to foster a holistic life stage
approach to NIH research and eliminate demographic- or disease-
specific siloes. Ultimately the legislative schedule has not
permitted such necessary coordination, and the Committee notes
that any large-scale restructuring proposal remains under the
jurisdiction of the Committee on Energy and Commerce. The
Committee recommendation for fiscal year 2026 reflects the NIH
structure under current law. The Committee looks forward to
Congress continuing to work with the Administration regarding
innovative ideas at the National Institutes of Health. The
Committee includes specific funding allocations for several
initiatives and activities detailed in the institute- and
center-specific sections below.
NATIONAL CANCER INSTITUTE
Appropriation, fiscal year 2025....................... $7,224,159,000
Budget request, fiscal year 2026...................... 4,530,833,000
Committee Recommendation.............................. 7,272,159,000
Change from enacted level......................... +48,000,000
Change from budget request........................ +2,741,326,000
Mission.--NCI leads, conducts, and supports cancer research
across the nation to advance scientific knowledge and help all
people live longer, healthier lives.
Biliary Tract Cancers (BTC).--The Committee strongly
encourages NIH to continue to support research to develop novel
treatment strategies in biliary tract cancers, and for basic
and translational research as well as clinical trials in liver
cancers, as both are needed to improve state-of-the-art cancer
immunotherapy. The Committee strongly supports research on
novel cancer vaccines and immunotherapies. Targeting recurrent
cancer neoantigens in BTC with novel cancer treatment vaccine
in combination with other drugs that work on the human immune
system could move the treatment paradigm in BTC forward and
enable combinatorial immunotherapy trials, including adoptive
cell therapies.
Breast Cancer Screening Evidence Gaps.--The United States
Preventive Services Task Force (Task Force) breast cancer
screening recommendation statement, published in April 2024,
identifies several critical research gaps that restrict the
Task Force from making evidence-based recommendations that
address multiple important areas. For example, the Task Force
notes that research is needed: to better understand whether and
how the benefits quantitatively differ for annual vs. biennial
breast cancer screening; to help clinicians and patients
understand the best strategy for breast cancer screening in
women found to have dense breasts on a screening mammogram,
such as supplemental screening; and to understand and address
the higher breast cancer mortality among Black women. Breast
cancer is the second most common cancer among women in the
U.S., and over 40,000 women are expected to die from breast
cancer in 2024. For the Task Force to fulfill its mission to
improve health through actionable preventive services
recommendations, the Committee urges the NIH to continue to
support research in the areas outlined in the Evidence Gaps
Research Taxonomy Table from the USPSTF's 2024 Breast Cancer
Screening Recommendation Statement to ensure the Task Force has
the necessary evidence to create the strongest evidence-based
recommendations for all women and further reduce breast cancer
morbidity and mortality, especially among those with the
greatest burden of disease. The Committee encourages that these
efforts should continue to prioritize the inclusion of women of
all racial and ethnic groups to investigate whether the
effectiveness of screening, diagnosis, and treatment vary by
group. The Committee requests an update on this effort in the
fiscal year 2027 congressional justification.
Cancer Centers.--The Committee recognizes the role of NIH
designated cancer centers in supporting high-quality,
interdisciplinary cancer research with the goal of reducing
cancer incidence, mortality, and morbidity. This support
facilitates coordination across a broad spectrum of research--
from basic laboratory science to clinical investigation and
population health--by strengthening the organizational capacity
of cancer centers nationwide. The Committee encourages
continued support of such efforts.
Cancer Clinical Trials.--Clinical Cancer trials are pivotal
to finding new medications and treatment options for patients.
The Committee is concerned that the lack of genomic variance in
cancer clinical trials is compromising our ability to
understand how certain cancers affect populations differently,
compounding health disparities, and hindering future innovative
treatment and therapies. The Committee provides $3,000,000 for
the National Cancer Institute for increasing trial participants
from underrepresented populations.
Childhood Cancer Data Initiative (CCDI).--The Committee
includes no less than $55,000,000 for the CCDI, which is a
$5,000,000 increase from the fiscal year 2024 enacted level.
Within this total, the Committee continues no less than
$750,000 for enhancement of the CCDI Molecular Characterization
Initiative and other efforts as applicable. The effort should
include comprehensive clinical and molecular data for each
patient to the extent possible. The dataset should include
clinical, radiographic, histopathologic, and molecular
information to the extent possible and be stored in a manner
that allows for interrogation of patient level data. The data
collected will be used to identify risk factors, aid in
prognostication and treatment recommendations, and assist with
the development of novel therapeutics for these diseases.
Childhood Cancer STAR Act.--The Committee includes no less
than $35,000,000, which is $5,000,000 above the fiscal year
2024 enacted level, for continued implementation of sections of
the Childhood Cancer Survivorship, Treatment, Access, and
Research (STAR) Act (P.L. 115-180). The funding expands
opportunities for childhood cancer research, improves efforts
to identify and track childhood cancer incidences, and enhances
the quality of life for childhood cancer survivors. While some
progress has been made in pediatric cancer research--leading to
a decline in childhood cancer deaths by almost 70 percent over
the last four decades--cancer is still the leading cause of
death by disease past infancy among children in the U.S.,
according to NCI. And while survival rates for some forms of
childhood cancer like leukemia have increased to greater than
85 percent, the median survival rate for other childhood
cancers such as diffuse intrinsic pontine glioma is less than
one year. STAR Act funding goes to critical research
infrastructure, surveillance, and survivorship programs that
fundamentally change the lives of pediatric blood cancer
patients and survivors. For example, the NCI has been able to
expand its efforts to collect cancer tissue specimens from
children with cancer for which current treatments are least
effective, making samples more available to researchers to
develop the next breakthrough. The STAR Act works to improve
the lives of childhood cancer survivors by funding critical
research to further our understanding of the complications
survivors face later in life as well as care models to improve
care as survivors transition to primary care.
Deadliest Cancers.--The Recalcitrant Cancer Research Act of
2012 (P.L. 112-239) focuses on cancers with a 5-year survival
rate below 50 percent, which account for over 40 percent of all
U.S. cancer deaths. While advances in some cancers have made it
possible to reduce the overall rate of cancer deaths over the
last several decades, there has been limited progress in
reducing mortality for these diseases. The Committee encourages
NCI to continue its focus on these cancers, which include
cancers of the brain (including glioblastoma), esophagus, liver
(including cholangiocarcinoma), lung, ovaries, pancreas,
stomach, and mesothelioma and requests an update on research
focused on each of these areas in the fiscal year 2027
congressional justification. Further, given the high mortality
rates for these cancers, the Committee is particularly
concerned about reports of increased incidence of esophageal,
liver, pancreas, and stomach cancer among young adults and
urges the NCI to continue to support much needed research to
understand the causes and risk factors leading to these
increases, as well as potential interventions.
Diffuse Intrinsic Pontine Glioma.--The Committee encourages
NCI to continue its research to better understand Diffuse
Intrinsic Pontine Glioma (DIPG) brain tumors and coordinate its
research efforts with other Federal agencies, including the
DOD, as well as private research foundations and advocacy
groups to improve the detection, treatment, and prevention of
DIPG. DIPG is a rare brain tumor that accounts for almost 80
percent of pediatric brainstem gliomas and represents 20
percent of all tumors in children. Due to its location and
highly aggressive nature, its prognosis is almost always fatal.
Early Detection, Screening, and Prevention for Liver
Cancer.--The Committee commends NCI for seeking input on how
best to address the need to prioritize early detection,
screening, and prevention sciences for primary liver cancer.
Primary liver cancer has a dismal 5-year survival rate of only
22 percent, is the third most common cause of cancer death in
the U.S., and unlike most cancers the rate of liver cancer
mortality continues to increase. Therefore, the Committee urges
NCI to use submitted expert feedback to inform a national
agenda for early detection, screening, and prevention of
primary pancreatic and liver cancers. The Committee commends
NCI for its Early Detection of Liver Cancer consortia
initiatives as a means of fostering progress and collaboration.
The Committee encourages NCI to continue such programs as well
as program projects, cooperative research, and broad agency
announcements, and other mechanisms. The Committee requests an
update on this effort in the fiscal year 2027 congressional
justification.
Functional Precision Medicine.--The Committee has a long
history of working to address refractory cancers and the lack
of treatment options currently available when standard of care
has been exhausted. The Committee is encouraged by the promise
of functional precision medicine approaches to identify
individualized treatment options more rapidly for hard-to-treat
cancers, especially with minority populations. Recent data
showing the clinical utility of combining patient-specific drug
sensitivity testing and genomic profiling to treat refractory
cancers has proven to be potentially lifesaving. The Committee
supports efforts to establish a unique clinical program across
institutes that could further validate the clinical utility and
accessibility of functional precision drug testing approaches,
to guide therapeutic interventions and accelerate collaboration
across research and clinical institutions in the nation. The
Committee requests an update on this topic in the fiscal year
2027 congressional justification.
Glioblastoma Therapeutics Network.--The Glioblastoma
Therapeutics Network is a collaborative initiative between NCI,
hospitals, and research institutions to evaluate novel
therapies for glioblastoma. The Committee recognizes its
contribution as a testing ground for assessing cutting-edge
treatments and drug combinations in clinical settings, with the
potential to transform patient outcomes, and encourages
continued support for such efforts.
Improving Native American Cancer Outcomes.--The Committee
continues to be concerned that Native Americans experience
overall cancer incidence and mortality rates that are
strikingly higher than non-Native populations. The Committee
directs NCI to continue its coordination with the NIMHD on the
Initiative for Improving Native American Cancer Outcomes.
Medical Imaging Technologies in Cancer Screening Trials.--
The Committee supports the establishment of clinical trials
conducted by the NCI to assess the potential role of blood
tests to detect cancer in the body. Medical imaging, as a means
of conducting diagnostic workup following a positive assay and
as a method for disease characterization, is essential to this
clinical trial and assessment process. Imaging is a known
necessity for a cancer diagnosis and treatment and should
continue to hold a core function in the clinical trial process.
The Committee encourages NCI to include imaging technologies
and tools in these clinical trials, as they are the essential
component of each precise cancer diagnosis and help ensure
patients receive the most effective and impactful care.
Metastatic Breast Cancer.--The Committee is aware that
clinical research is of utmost importance to those living with
metastatic breast cancer (MBC), which is breast cancer that has
spread to other organs and become incurable. An estimated
168,000 Americans live with MBC, and nearly all of the more
than 43,000 deaths from breast cancer are attributed to this
late stage of disease. Given the mortality associated with MBC
and the lack of treatment options, research offers the best
possibility of therapeutic advances and extended life for these
patients. MBC is also associated with startling health
disparities, since breast cancer mortality is about 40 percent
higher for Black women in the U.S. than Caucasian women and
breast cancer is the second most common cause of death by
cancer for Black women. The Committee encourages a continued
emphasis by NCI on research for MBC, to discover better
treatments and a cure for MBC and to address health disparities
in this population. The Committee requests an update on NCI's
activities regarding MBC in the fiscal year 2027 congressional
justification, including updates on actions NCI is taking to
achieve representation of the demographics of the U.S.
population in clinical trials.
Natural Products Research.--Research shows that derivatives
from natural products have been an important source of
clinically useful anti-cancer agents, yet not enough evidence-
based research has been done to strategically identify those
compounds that could provide potential benefits in cancer
treatment. The Committee believes that it is important to fully
explore whether and how natural products could be beneficial to
patients in reducing the toxicity of therapy or by enhancing
therapeutic efficacy as a primary or adjunctive therapy.
Therefore, the Committee encourages NCI to expand its support
of research to evaluate the potential value of natural products
in reducing adverse effects of cancer therapy and in enhancing
therapeutic efficacy through basic, translational, and clinical
trials research. NCI is encouraged to seek applicants that have
a demonstrated expertise in natural products research, can
conduct a holistic review of drugs and disease states, have
access to an annotated inventory of natural products, and that
are able to test the safety and efficacy of natural products in
communities experiencing high rates of health care disparities
in access to cancer care.
Optimal Timing and Sequencing of Cancer Immunotherapy.--The
Committee recognizes that cancer immunotherapy is improving
outcomes for an increasing number of cancer patients,
especially those for whom other treatments were ineffective.
New research suggests that more patients might benefit if
immunotherapy were used earlier in the course of their cancer,
or to prevent and intercept cancers before they start.
Therefore, the Committee urges NCI to prioritize research
focused on assessing the optimal timing for the use of cancer
immunotherapy in individual patients. Examples of such research
include studying the effectiveness of cancer immunotherapy in
premalignant conditions, early-stage cancer, and as a
neoadjuvant therapy, prior to additional treatment such as
surgery, radiation, or chemotherapy.
Pediatric Rare Cancer Therapeutic Development.--Childhood
cancers are rare and need specialized treatments, rather than
just lower-dose treatments than adults receive. Each type of
cancer requires appropriate therapeutic approaches to save a
child's life or significantly improve quality of life and
extend a child's lifespan, yet many types of childhood cancer
do not yet have effective curative treatments available. The
Committee encourages NIH to continue to examine novel systems
for identifying how rare cancers develop and progress, and to
continue to support and accelerate development and evaluation
of life-saving therapeutics for pediatric cancer patients.
Prostate Cancer.--The Committee remains concerned that
prostate cancer, the most diagnosed cancer among American men
and the second leading cause of cancer-related death, receives
a disproportionately low share of Federal cancer research
funding. While prostate cancer accounts for approximately 15
percent of all new cancer diagnoses and 11 percent of cancer
deaths among men, it receives only 8 percent of the total
Federal cancer research investment. The Committee is especially
concerned about the lack of treatment options for men with
advanced prostate cancer and the absence of modern diagnostic
and imaging technologies that are common in other hormone-
driven cancers with similar burden. To ensure that Federal
research efforts are aligned and efficient, the Committee
encourages the NCI to coordinate its research strategy with
other Federal agencies, including the DOD, and to engage with
private research foundations and advocacy organizations. The
Committee urges NCI to prioritize investments in advanced
diagnostic tools and therapeutic research to improve outcomes
for men at all stages of prostate cancer.
Site-Specific Survivorship Issues and Interventions.--The
Committee commends Office of Cancer Survivorship's (OCS)
commitment to improve the quality and length of life for
individuals diagnosed with cancer. The Committee recognizes
that advances in treatments and care have resulted in long-term
survivorship for some individuals, and some survivors who
received multi-modality cancer treatment experience late and
long-term effects. The Committee encourages OCS to include in
its research efforts a focus on site-specific, or cancer-
specific, late and long-term effects, which may yield evidence
to support improvements in survivorship care. The Committee
requests an update in the fiscal year 2027 congressional
justification on such efforts.
Theranostics.--Theranostics is a nuclear medicine technique
that combines diagnostic imaging and targeted
radiopharmaceutical therapies to precisely identify and treat
diseases like cancer. This technology allows for personalized
treatment of cancers--such as thyroid cancer, prostate cancer,
and neuroendocrine tumors--while sparing healthy tissue around
the tumor. Theranostics shows potential to advance the battle
against cancer. The Committee encourages NCI to support
research that utilizes theranostics, where appropriate, to
provide early, accurate, and effective cancer diagnosis and
treatment.
Uterine Leiomyosarcoma Research.--The Committee is aware
that increased research into uterine leiomyosarcoma, a rare and
aggressive soft tissue sarcoma with limited treatment options
and high mortality rates, could lead to improved outcomes for
patients. The Committee encourages the NIH to prioritize and
expand research on the biology, early detection, and
development of novel therapeutic approaches for uterine
leiomyosarcoma. Such investments could be for basic science,
translational, or clinical research. The Committee requests
that NIH include an update in the fiscal year 2027
congressional justification on such research efforts, including
any milestones and recommendations for future activities.
Young Adult Cancer Survivorship Research.--NCI has
supported the Childhood Cancer Survivor Study since 1994. This
study, a long-term, retrospective cohort study, has
dramatically enhanced our understanding of the side effects of
cancer treatment in children and adolescents, supported
research to find interventions for childhood cancer survivors,
and improved survival from treatment side effects. The
Committee encourages the NCI to conduct a landscape analysis of
young adult cancer survivorship research and provide the
Committee with an update on this effort in the fiscal year 2027
congressional justification.
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)
Appropriation, fiscal year 2025....................... $3,982,345,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 3,990,345,000
Change from enacted level......................... +8,000,000
Change from budget request........................ +3,990,345,000
Mission.--NHLBI provides global leadership for a research,
training, and education program to promote the prevention and
treatment of heart, lung, blood and sleep disorders and enhance
the health of all individuals so that they can live longer and
more fulfilling lives.
Chronic Lung Disease.--Chronic lung diseases are among the
leading causes of death and chronic illness in the U.S.,
including the over 15 million Americans diagnosed with COPD and
related diseases. Most chronic lung disease research to date
has focused on later stages of disease when substantial loss of
lung function and damage to lung tissue have already occurred.
There is a need for treatments that when applied early in the
course of diseases can more effectively slow the progression
and mitigate the lung tissue damage caused by chronic lung
diseases. NHLBI supports a wide array of basic and
translational research in these conditions. Increased funding
is urgently needed to improve our understanding of early
disease to identify appropriate targets to modulate disease
progression before the irreversible tissue damage has occurred.
NHLBI-funded studies such as the COPD Gene and SPIROMICS
projects are critical to this objective and have already
provided significant insight to begin to understand the biology
of early disease. The Committee encourages NHLBI to increase
support for these and other early disease research in chronic
lung disease.
Duchenne and Becker Muscular Dystrophy.--While there are
multiple approved therapies to treat Duchenne Muscular
Dystrophy (DMD), research data does not show that any of these
important treatments halt or reverse the effects of this
devastating condition. Recognizing the need for continued
research, the Committee encourages NIH to ensure that research
data produced by its grants is shared in a timely and
transparent manner to accelerate progress. The Committee
emphasizes the importance of robust data-sharing plans that
facilitate access to data for sub analyses, enabling
researchers to maximize insights, identify trends, and advance
innovation in the field. In addition, the Committee encourages
NIH to review the structure and processes of the Muscular
Dystrophy Coordinating Committee to ensure incorporation of
perspectives of DMD patient and caregiver perspectives, with a
transparent process and timeline for participation. The
Committee also encourages NIH to respond to the 2025
recommendations of the Muscular Dystrophy Coordinating
Committee and maintain a public record of progress in
implementation.
Longitudinal Studies.--The Committee encourages the NIH to
continue supporting instrumental longitudinal studies that have
created a tremendous knowledge base and data around human
health and allowed researchers to understand risk factors for
diseases such as heart attack and stroke.
Mitral Valve Prolapse Workshop.--The Committee commends
NHLBI for convening a 2024 workshop, to review the state of the
science and identify research needs and opportunities for the
treatment of individuals with mitral valve prolapse, including
individuals who are at risk of sudden cardiac arrest or sudden
cardiac death. The Committee urges NHLBI to continue engaging
with subject matter experts and stakeholders regarding research
needs and opportunities related to developing guidelines for
treatment of individuals with mitral valve prolapse.
National Chronic Obstructive Pulmonary Disease Action.--The
Committee notes NHLBI's role in crafting the National Chronic
Obstructive Pulmonary Disease Action Plan. NHLBI is encouraged
to continue this important work by supporting additional
research activities and collaborating with other public health
service agencies to facilitate implementation of the plan's
recommendations.
National Center on Sleep Disorders Research (NCSDR).--The
Committee recognizes NCSDR for facilitating and coordinating
effective sleep health and sleep disorders research across NIH
and HHS. The Committee notes that recent scientific progress,
along with improvements in care and therapy, may not be
reaching the individuals who could most benefit as time to
diagnostics for many conditions can take years if not decades.
The Committee encourages NCSDR to work with stakeholders across
HHS to better translate research findings, to encourage
increased awareness of breakthroughs and to further public
health efforts to link patients to care.
Sickle Cell Disease and Sickle Cell Trait.--The Committee
encourages NIH to further its clinical research in Sickle Cell
Disease (SCD) and Sickle Cell Trait, which includes promising
approaches to eradicate the disease, save lives, and
dramatically reduce the substantial health care complications
and costs associated with SCD for both children and adults. The
NIH is encouraged to consider programs both domestically and
globally to evaluate the effectiveness of screening
technologies for infants and children with the sickle cell
trait and disease and to develop different innovative
technologies and medicines to treat and cure SCD.
Valvular Heart Disease Research.--Heart-valve disease
occurs if one or more of an individual's valves malfunctions,
and many people in the U.S. can have heart valve defects or
disease but no symptoms. While the condition remains stable for
some individuals and does not cause significant or life-
threatening problems, unfortunately more than 25,000 people die
each year in the U.S. from this disease, primarily due to
underdiagnosis and undertreatment. The Committee commends the
NHLBI for its work in advancing treatments for those with
valvular heart disease. The Committee encourages the agency to
expand these initiatives to include research that uses advanced
technological imaging and precision medicine to generate data
on valvular disease, identifies individuals who are at high
risk of sudden cardiac death as a result of valvular disease,
develops prediction models for high-risk patients, and enables
interventions and treatment plans to keep these patients
healthy throughout life. For these efforts the Committee
includes $23,000,000, an increase of $3,000,000 from the fiscal
year 2024 enacted level, in funding to the NHLBI for this
activity.
Wildland Fire Smoke.--The Committee is concerned that
public health experts do not yet fully understand the risk
posed by exposure to wildland fire smoke, particularly acute
and chronic smoke exposure to patients with existing pulmonary
and cardiac disease. The Committee encourages NHLBI to support
research to understand the risk smoke exposure has for patients
with underlying health conditions and any interventions that
can be implemented to mitigate adverse health effects.
NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR)
Appropriation, fiscal year 2025....................... $520,163,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 525,163,000
Change from enacted level......................... +5,000,000
Change from budget request........................ +525,163,000
Mission.--The mission of NIDCR is to advance fundamental
knowledge about dental, oral, and craniofacial health and
disease and translate these findings into prevention, early
detection, and treatment strategies that improve overall health
for all individuals and communities across the lifespan.
Advancing Head and Neck Cancer Early Detection Research
(AHEAD).--The Committee commends NIDCR for establishing AHEAD
to accelerate translational and clinical research on the early
detection of head and neck cancers (HNC). The initiative aims
to increase scientific knowledge of the molecular
characteristics of dysplastic tissue lesions, which are the
predominant precursor for HNCs. The Committee encourages NIDCR
to support research to utilize data from The Cancer Genome
Atlas (TCGA) and other genomic and proteomic projects to help
match tumor defects with patient clinical outcomes, which could
lead to tailored biomarker identification for early diagnosis
and treatments.
Community Water Fluoridation.--The Committee notes the role
of community water fluoridation in public health as an
effective, economical, and evidence-based intervention for the
prevention of dental caries. The Committee is aware of concerns
regarding fluoride exposure and its potential impact on human
neurodevelopment and cognition. The Committee encourages NIDCR
and other institutes at NIH already conducting research in this
area such as NIEHS and NICHD, to support additional research to
investigate any possible links between total fluoride exposure
from fluoridated water systems and human neurodevelopment,
cognition, and other health outcomes.
Oral Health Research.--The Committee reaffirms that oral
health care and its maintenance are integral to the medical
management of numerous diseases and medical conditions and that
the lack of medically necessary oral healthcare heightens the
risk of costly medical complications. The Committee appreciates
NIH's support for research that has demonstrated that dental
care is closely linked to the clinical success of other covered
medical services and urges NIH to fund additional research in
this area. Continued research on the causal mechanisms that
link untreated oral microbial infections and chronic systemic
conditions will provide clinical evidence that can be used to
support coverage of medically necessary dental treatment in
various benefit programs.
NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES
(NIDDK)
Appropriation, fiscal year 2025....................... $2,310,721,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 2,330,721,000
Change from enacted level......................... +20,000,000
Change from budget request........................ +2,330,721,000
Mission.--The NIDDK mission is to conduct and support
medical research and research training and disseminate science-
based information on diabetes and other endocrine and metabolic
diseases; digestive diseases, nutritional disorders, and
obesity; and kidney, urologic, and hematologic diseases, to
improve people's health and quality of life.
Chronic Kidney Disease.--The Committee notes the
significant health burden caused by chronic kidney disease
(CKD) on individuals. According to the CDC, an estimated 35.5
million people, or more than 1 in 7 U.S. adults, have CKD. The
Committee is also aware that poor kidney function can also lead
to other burdensome or debilitating conditions. Therefore, the
Committee encourages robust support for kidney research at
NIDDK. The Committee requests an update on such research in the
fiscal year 2027 congressional justification.
Diabetes.--The Committee includes an increase of
$10,000,000 for diabetes research. The Committee urges NIH to
focus efforts on Type 1 Diabetes.
Diabetic Eye Disease.--The Committee notes the connection
between diabetes and eye health. The Committee encourages the
Institute to engage with relevant ICs and stakeholders to
identify collaborative opportunities to improve research and
community-level intervention activities in diabetic eye
disease.
Special Diabetes Program.--The Committee notes the role of
the Special Diabetes Program, which is supported by mandatory
funding under 42 U.S.C. 254c-2, in advancing research on the
prevention and cure of Type 1 Diabetes.
NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS)
Appropriation, fiscal year 2025....................... $2,603,925,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 2,633,925,000
Change from enacted level......................... +30,000,000
Change from budget request........................ +2,633,925,000
Mission.--The NINDS mission is to seek fundamental
knowledge about the brain and nervous system and use that
knowledge to reduce the burden of neurological disease.
21st Century Cures.--The Committee recommendation includes
$97,500,000 for the BRAIN Initiative as provided in the Cures
Act. The Committee notes that fiscal year 2026 is the final
year for this activity.
Alzheimer's Disease and Alzheimer's Disease-Related
Dementias (AD/ADRD).--The Committee includes an increase of
$15,000,000 above the fiscal year 2024 enacted level for AD/
ADRD research at NINDS.
Amyotrophic Lateral Sclerosis (ALS) Research.--NIH is the
primary Federal agency conducting and supporting basic,
clinical, and translational medical research and is
investigating the causes, treatments, and cures for common and
rare diseases. NINDS makes the largest investment in ALS
research. ALS is a rare, rapidly progressing neurological
disease that is 100 percent fatal, and most people only live
for two to five years after symptom onset. There are currently
very limited treatment options that offer only marginal benefit
to some people. The Committee notes that NIH-funded research
has facilitated the development of diagnostic and therapeutic
advances. While there is not yet a cure or treatment that halts
ALS, there has been significant progress in understanding what
causes ALS. The Committee urges NINDS to expand its portfolio
of research into ALS.
Amyotrophic Lateral Sclerosis Research and Treatments.--The
Committee recommends increasing funding for extramural research
and includes an increase of $10,000,000, to reduce the burden
of ALS on people as quickly as possible. It is crucial for
people living with ALS and people diagnosed with ALS in the
future, that NIH increase its ALS research portfolio and grow
the research workforce. This additional funding should focus
not only on new drugs for ALS but also on ALS diagnosis
protocols, enhancing the quality of care, and studying new ALS
biomarkers.
Angelman Syndrome.--The Committee understands NINDS may
convene relevant research leaders, patient organizations, and
other stakeholders to prepare a roadmap for clinical outcomes
measures and biomarkers for Angelman syndrome (AS), a rare
neurogenetic disorder. As part of this, the Committee
encourages NIH to support funding for clinical outcome measures
and biomarker development; determine more efficient pathways
for developing and manufacturing novel gene therapies for
neurodevelopmental diseases; and inform the next generation of
clinical studies to pursue based on approved biomarkers. The
Committee encourages NIH to ensure timely and comprehensive
data-sharing across investigators and industry. The Committee
notes the value of incorporating patient perspectives into
treatments for this devastating disorder, given that without
treatments, individuals with AS depend on a caregiver to do
daily activities and navigate their environment.
Brain Aneurysms.--The Committee remains concerned that an
estimated 1 out of every 50 individuals in the United States
has a brain aneurysm, and an estimated 30,000 Americans suffer
a brain aneurysm rupture each year, often with little or no
warning. Ruptured brain aneurysms are fatal in about 50 percent
of cases. Despite the widespread prevalence of this condition
and the high societal cost it imposes on the United States, the
Federal Government spends only about $2.94 per year on brain
aneurysm research for each person afflicted with a brain
aneurysm. The Committee encourages NINDS to increase its
support for research focused on prevention and early detection
of brain aneurysms.
Brain Research through Advancing Innovative
Neurotechnologies (BRAIN) Initiative.--The BRAIN initiative is
an ambitious program to develop and apply new tools and
technologies to answer fundamental questions about the brain
and to inspire new treatments, cures, and prevention for brain
diseases. NINDS and NIMH are leading partners in the
initiative, working with eight other NIH Institutes, Centers,
and Offices. The BRAIN Initiative has invested over $3.5
billion in more than 1,500 research projects, engaging
scientists from many areas of expertise as well as
mathematicians, engineers, and physicians in individual labs
and inter-disciplinary teams. This initiative promotes
scientific advances that provide opportunities to understand
the structure and function of the brain at an unprecedented
level of detail, helping bring advanced treatments for brain
disorders to clinical use.
Cerebral Palsy.--The Committee encourages NIH to continue
to prioritize and invest in research on Cerebral Palsy (CP) to
strengthen and accelerate CP research priorities across the
lifespan. NIH is encouraged to consider a Cerebral Palsy Notice
of Special Interest. Progress has been made, but addressing
remaining gaps can improve outcomes and treatment. The
Committee encourages NIH to focus on basic and translational
discoveries, as well as implementation, observational, and
clinical studies aimed at early detection and intervention,
comparative effectiveness, and functional outcomes. The
Committee encourages NIH to support research related to
lifespan issues to address needs of youth and adults with CP,
and that could lead to new and improved screening tools,
treatments, and interventions. NINDS, in coordination with
other institutes or centers which could include NICHD, is
encouraged to consider a neuroplasticity workshop and research
opportunities on the motor and health benefits of physical
activity for individuals with CP across all Gross Motor
Functional Classification levels.
Creutzfeldt-Jakob Disease.--The Committee commends the
National Alzheimer's Project Act Advisory Council report from
2023 that acknowledges the scientific connection between prion
diseases and Alzheimer's Disease and Related Dementias (ADRDs),
and the 2024 Update mentioning Creutzfeldt-Jakob Disease (CJD).
The Committee continues to encourage NIH to recognize prion
diseases as ADRDs and fund more research for prion diseases,
like CJD. ADRDs have already benefited from prion disease
research, and further integration of the fields could lead to
beneficial new treatments and improve our scientific
understanding of these devastating diseases.
Dystonia.--The Committee requests an update in the fiscal
year 2027 congressional justification on the implementation of
the recommendations from the NINDS workshop Defining Emergent
Opportunities in Dystonia Research that was held in 2018 and
encourages NINDS to continue collaboration with stakeholders.
Frontotemporal Dementia Research.--The Committee recognizes
the critical role NIH funding has in building foundational
knowledge and tools that can lead to effective treatments for
frontotemporal dementia (FTD). NIH-funded natural history
studies, such as the ARTFL LEFFTDS Longitudinal Frontotemporal
Lobar Degeneration (ALLFTD) Research Study, facilitate
biomarker discovery and enable the design of clinical trials to
test innovative treatments. The Committee supports ongoing
efforts to advance the understanding of FTD and encourages the
NIH to support research to accelerate the discovery of
effective treatments for FTD.
Guillain-Barre Syndrome.--The Committee recognizes the
effects of Guillain-Barre Syndrome (GBS) and related conditions
such as Chronic Inflammatory Demyelinating Polyneuropathy
(CIDP) and Multifocal Motor Neuropathy (MMN). The Committee
encourages NINDS to continue collaboration with stakeholders on
reviewing the progress made in GBS, CIDP, and MMN research and
treatment options, including a state of the science conference.
Multiple System Atrophy.--The Committee notes the
connection between Multiple System Atrophy (MSA) and
Parkinson's Disease and the potential for advancements in
research that impacts both communities. The Committee notes the
lack of treatment options and the lengthy time to diagnose MSA
and encourages NINDS to work with community stakeholders on
implementation of the National Plan to End Parkinson's Act
(P.L. 118-66).
Parkinson's Disease.--The Committee commends NINDS for
taking critical steps in identifying priority research
recommendations to advance research on Parkinson's disease,
which impacts between 500,000 and 1,500,000 Americans and is
the second most prevalent neurodegenerative disease in the U.S.
The Committee recognizes that NINDS is prioritizing public
health concerns with severe gaps in unmet medical needs and
supports the research recommendations set forth by the NINDS
planning strategy to bring us closer to better treatments and a
cure for Parkinson's disease. Additionally, the Committee
encourages NIH to support projects studying dementia in
Parkinson's disease. Parkinson's disease is the second most
common and fastest growing neurodegenerative disease and is
characterized by the abnormal folding of a protein in the
brain. Channeling resources into research could help unlock
groundbreaking discoveries in crucial areas like Parkinson's
disease and other closely associated neurological disorders.
Pediatric-Onset Epilepsies Network.--The Committee
encourages NIH to establish a pediatric-onset epilepsies
network. This network could support continued pediatric-onset
epilepsies research and help coordinate research of pediatric-
onset epilepsies across institutions to increase the potential
for scientific progress in the era of precision medicine. Such
a network could create a collaborative, multidisciplinary
research model to enroll patients from many hospitals in the
same system to enable cooperative research studies, accelerate
knowledge development about the epilepsies, and rapidly advance
therapeutic options and their implementation to improve
treatments and healthcare outcomes.
Preventive and Early-Treatment Cognitive and Brain Health
Research.--The Committee encourages NIH to give greater
attention to the study of the presymptomatic or preclinical
stages of neurological disorders, that is, alterations in
cognitive and brain health before the first clinical symptoms
of neurological disease when individuals typically encounter
medical professionals. Learning what happens during these
stages may guide the development of measures for detection and
monitoring earlier in the course of the disease, including
sensitive neuropsychological measures and biomarkers, which
could improve early intervention development and testing for
neurological disease before it becomes disabling and,
ultimately, prevent diseases like Alzheimer's disease,
Parkinson's disease, multiple sclerosis, stroke, and epilepsy.
Mounting evidence suggests that significant pathologies have
already accumulated by the time symptoms appear and early,
presymptomatic intervention may lead to more effective care.
Such discoveries may also reduce the costs that neurological
diseases pose to our healthcare delivery system.
Spinal Muscular Atrophy.--The Committee encourages
continued NIH research into spinal muscular atrophy (SMA), a
neuromuscular disease that causes degenerative nerve damage and
results in severe muscle loss and impaired motor function. The
Committee is aware that past NINDS research has led to greater
understanding of the nervous system and contributed toward SMA
treatments that slow or stop future nerve damage. The Committee
also recognizes that current treatments do not cure the disease
or reverse its debilitating symptoms. Without additional SMA
research, the Committee is concerned that adults and children
with SMA who were born after treatments and early diagnosis
were available will continue to face chronic health challenges
and significant barriers to independence. Furthermore, it is
not yet fully known the extent of need among children treated
prior to symptom onset. As such, the Committee encourages NINDS
to expand its research in SMA into the role and function of
survival motor neuron (SMN) protein, investigation of non-SMN
pathways and targets capable of modifying disease, and how to
combine SMN-enhancing and non-SMN approaches for optimal
therapeutic outcomes.
Undiagnosed Diseases Network.--The Committee recommendation
continues to include $18,000,000 for the Undiagnosed Diseases
Network, the same as the fiscal year 2024 enacted level. The
Undiagnosed Diseases Network (UDN) builds on the success of the
Undiagnosed Diseases Program at the NIH Clinical Center, which
is a nationwide network of clinicians and researchers who use
basic and clinical research to uncover the underlying disease
mechanisms associated with rare and undiagnosed conditions. It
is estimated that approximately 25 million Americans suffer
from a rare disorder. The UDN pioneered a new personalized
medicine model for helping patients who have historically been
the most difficult for the medical community to diagnose,
taking advantage of cutting-edge technologies such as genomic
sequencing, metabolomics and assessing patient variants in
model organisms to give clinicians new, powerful information to
help understand the cause of extremely rare diseases.
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)
Appropriation, fiscal year 2025....................... $6,562,279,000
Budget request, fiscal year 2026...................... 4,174,965,000
Committee Recommendation.............................. 6,582,279,000
Change from enacted level......................... +20,000,000
Change from budget request........................ +2,407,314,000
Mission.--The NIAID mission is to conduct and support basic
and applied research to better understand, treat, and
ultimately prevent infectious, immunologic, and allergic
diseases.
Alpha-gal Syndrome.--The Committee is concerned by the rise
in incidence of alpha-gal syndrome, an emerging allergic
condition associated with tick bites that can cause potentially
life-threatening hypersensitivity to galactose-alpha-1,3-
galactose. The Committee encourages NIH to increase efforts to
understand the immunological mechanisms and natural history of
alpha-gal syndrome, which could lead to new protocols,
therapies, and tools for managing this condition.
Antimicrobial Resistance.--The Committee includes
$570,000,000, an increase of $5,000,000, to support
antimicrobial resistance research. This funding supports NIAID
research to combat antimicrobial resistance (AMR) and the
training of new investigators to improve AMR research capacity
as outlined in the 2020-2025 National Action Plan for Combating
Antibiotic-Resistant Bacteria. The Committee is aware of the
challenge that antimicrobial resistance poses to public health,
with more than 2.8 million antimicrobial-resistant infections
occurring in the U.S. annually according to the CDC. The
Committee encourages NIAID's continued basic, translational,
and clinical research on AMR.
Antimicrobial Stewardship.--The Committee is aware that
antibiotic stewardship programs are a key component in
preventing the spread of antibiotic resistance in all
healthcare facilities in the U.S. and across the world. In the
2020-2025 National Action Plan for Combating Antibiotic-
Resistant Bacteria, one of the five goals was to Accelerate
Basic and Applied Research and Development for New Antibiotics,
Other Therapeutics, and Vaccines to improve understanding of
the many factors that contribute to the emergence, spread, and
persistence of antibiotic resistance and to support new
strategies for preventing and mitigating infections. The
Committee recognizes that NIH has supported research to
understand the mechanisms of AMR spread and to mitigate
inappropriate usage of antibiotics.
Antiviral Drug Discovery Centers.--Researching and
developing new antivirals is essential for combating new viral
outbreaks and preventing them from spreading into pandemics.
The Committee supports the Antiviral Drug Discovery Centers and
their mission to develop antiviral drugs to serve as our first
line of defense against forthcoming viral outbreaks. The
Committee is concerned that NIH reported to the Comptroller
General of the U.S. that future funding for the Antiviral Drug
Discovery Centers program has been eliminated. The Committee
urges NIH to continue supporting the Antiviral Drug Discovery
Centers to mitigate the risk of future viral outbreaks.
Bacteriophage Therapy.--The Committee recognizes that
engineered bacteriophage therapy has emerged as one of the most
promising technologies for combating the global crisis of
multi-drug-resistant bacterial infections. The Committee
further notes that recent advancements in artificial
intelligence, high-throughput robotic screening, and advanced
biomanufacturing have enabled bacteriophage therapy to
selectively eliminate pathogenic bacterial species while
preserving the body's natural microbiome. The Committee
encourages NIAID to support research and clinical trials on
bacteriophage therapy in the United States.
Celiac Disease.--The Committee commends the NIH for issuing
a Notice of Special Interest to spur additional research on the
study of celiac disease. Today, the only known treatment is a
gluten-free diet; however, recent public and private sector
research confirms that this is insufficient for many who suffer
from this disease. The Committee supports focused research
celiac disease and encourages the newly created NIH Office of
Autoimmune Disease Research to work with NIAID and other NIH
Institutes to support new research on celiac disease,
coordinate existing research, and focus new research efforts on
causation, diagnosis, management, treatment, and a cure of this
disease. The Committee requests an update in the fiscal year
2027 congressional justification on celiac disease research,
projects, and programs.
Consortium for Food Allergy Research.--The Committee
recognizes the serious issue of food allergies which affect
approximately 8 percent of children and 10 percent of adults in
the United States. The Committee commends the ongoing work of
NIAID in supporting a total of 27 clinical sites for this
research, including 14 sites as part of the Consortium of Food
Allergy Research (CoFAR). The Committee continues to include
$12,100,000 for CoFAR to maintain its clinical research network
of centers of excellence in food allergy clinical care and
expertise in food allergy research.
Hereditary Angioedema with Normal C1 Inhibitor.--The
Committee notes that challenges persist in diagnosis,
treatment, and care for HAE patients with normal C1 inhibitor
and encourages NIAID to work with other institutes and centers
and the stakeholder community to advance research in this key
area.
Lyme and Other Tick-Borne Diseases.--The Committee includes
not less than $110,000,000, an increase of $10,000,000 over the
fiscal year 2024 enacted level, for NIH research into Lyme and
Other Tick-Borne disease research. NIH is encouraged to support
research to better understand the causes of tick-borne
diseases, including alpha gal syndrome and allergic or immune/
inflammatory conditions triggered by tick-borne infections, to
support research on Lyme disease and emerging tick-borne
pathogens, and to support the development of reliable
diagnostics and therapies to address this growing health
concern that affects more than 476,000 Americans annually. Oher
possible research topics could include Lyme diagnostic and
therapeutic development, pediatric Lyme disease clinical
studies, pregnancy with Lyme disease and outcomes in child
development, neuropsychiatric and mental health effects of Lyme
disease, clinical studies related to Alpha-gal Syndrome
treatment and management, and clinical studies for
immunological symptoms and responses resulting from a tick
bite. The Committee also is aware of tick-borne infection-
triggered chronic illnesses such as long COVID, long Lyme,
Bartonella henselae, West Nile virus, and multiple sclerosis.
The Committee encourages NIH to periodically review progress on
activity to address tick-borne infection-triggered chronic
illnesses and to include a status report in the fiscal year
2027 congressional justification.
National Biocontainment Laboratories.--The Committee notes
the roles of the National Biocontainment Laboratories in
developing and maintaining research resources, facilities, and
personnel to meet national biodefense and emerging infectious
diseases research needs in the event of a deliberate act of
bioterrorism or naturally occurring public health emergency.
Research on high consequence zoonotic viruses requires high-
containment BSL-4 laboratories. Such laboratories enable
researchers to safely diagnose and investigate these types of
pathogens, and develop rapid and reliable diagnostics, novel
antiviral therapeutics, and vaccines. The Committee encourages
NIH to prioritize: maintaining the research resources for
biodefense, emerging infectious disease agents, and other
infectious disease threats to global health; training new
researchers in biosafety level 4 practices; maintaining a
workforce skilled in BSL-4 research; and establishing best
practices for the safe and efficient conduct of research in
BSL-4 facilities.
Regional Biocontainment Laboratories.--The Committee notes
the role that the 12 regional biocontainment laboratories
(RBLs) have had as part of the nation's biodefense
infrastructure, helping the U.S. prepare and respond to
emerging infectious disease agents. The Committee appreciates
that NIAID competitively awarded UC7 awards and encourages
continued support of the RBLs. The Committee includes
$52,000,000 for the 12 RBLs to support core and shared
resources for BSL-3 containment and related activities within
the RBL facility in its entirety. No less than $3,000,000 shall
be provided to each of the 12 RBLs to support training and
maintaining a capable research workforce with broad, relevant
biomedical, technological, veterinary, and regulatory
expertise, supporting operations, facilities, and equipment
purchase costs, and supporting research utilizing the
capabilities of the RBLs. The remaining funding shall go to the
12 RBLs to support: (1) research on biodefense, emerging
infectious disease agents, and other infectious disease threats
to global health; (2) training new researchers, including in
biosafety level 3 practices; (3) maintaining a workforce
skilled in BSL-3 research; and (4) establishing best practices
for the safe, effective, and efficient conduct of research in
BSL-3 facilities. All funding shall be used to support the
aforementioned activities conducted within the RBL, and should
not be limited to just the BSL-3 space.
Swine Resource and Research Centers.--The Committee
recognizes the biomedical advances made utilizing swine models
of human health and disease and supports the efforts of the
swine research centers. These centers support innovative basic
and translational research on human diseases.
Universal Influenza Vaccine.--The Committee continues to
include no less than $270,000,000 for this activity. NIAID's
influenza research program is working to develop a universal
flu vaccine, or a vaccine that provides robust, long-lasting
protection against multiple subtypes of flu, rather than a
select few. Such vaccines would provide protection against
zoonotic flu and eliminate the need to update the seasonal flu
vaccine each year. Universal flu vaccine research includes the
improvement of current vaccines and could provide important
foundational work in outbreak responses. In February 2018,
NIAID released its Universal Influenza Vaccine Strategic Plan,
which focuses on 3 research areas to broaden knowledge around
basic influenza immunity and advance translational research
efforts to drive universal flu vaccine development.
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)
Appropriation, fiscal year 2025....................... $3,244,679,000
Budget request, fiscal year 2026...................... 3,677,297,000
Committee Recommendation.............................. 3,265,679,000
Change from enacted level......................... +21,000,000
Change from budget request........................ -411,618,000
The Committee recommendation includes $1,900,677,000 in
discretionary appropriations and $1,365,002,000 in PHS Act
section 241 evaluation set-aside transfers.
Mission.--NIGMS supports basic research that increases our
understanding of biological processes and lays the foundation
for advances in disease diagnosis, treatment, and prevention.
Biomedical Research Workforce Training.--Training programs
at the NIH provide a quality standard of training for graduate
students and postdoctoral fellows in biomedical research. The
training grants that support these programs at research
institutions across the country play a vital role in
establishing a biomedical research ecosystem and train the next
generation of researchers for health-related research needs.
Despite the success of training programs, the number of
students and postdoctoral scholars supported on training grants
has remained constant over the years. The Committee applauds
NIH efforts to increase funding for institutional development
awards (IDeA) States and urges the NIH to also emphasize the
importance of supporting training grants in IDeA States. The
Committee directs NIH to provide a portfolio analysis to the
Committee within 60 days of enactment of this Act on the
distribution of T32 training grants among States, including the
number of applicants and success rates per State to ensure NIH
is supporting capacity building and a robust workforce for the
future biomedical research enterprise. In addition to the
portfolio analysis, in the fiscal year 2027 congressional
justification, NIH is instructed to provide an update on
specific actions NIH will take to identify and remove barriers
for applying for training grants in IDeA States.
Bridge Programs.--The Committee strongly supports
opportunities for students with limited access to STEMM
(Science, Technology, Engineering, Mathematics, and Medicine)
education and research. The Committee recognizes the
effectiveness and importance of the National Institute of
General Medicine Services bridging programs that support
historically underserved students and researchers to pursue
STEMM studies and become the nation's next generation of
researchers, including programs such as the Bridges to the
Baccalaureate Research Training Program, Bridges to the
Doctorate Research Training Program, Postbaccalaureate Research
Education Program (PREP), Advancing Research Careers (ARC)
program, and Maximizing Opportunities for Scientific and
Academic Independent Careers (MOSAIC) program. The Committee is
concerned that NIH terminated many of these programs in 2025
and urges NIH to reestablish them. The Committee urges NIH to
expand the size of existing training programs that bridge
different educational or career stages and establish these
programs at institutions that have historically received low
levels of funding support from NIH, including Minority Serving
Institutions and institutions that are eligible under the
Department of Education's Strengthening Institutions Program.
The Committee urges NIH to set clear mentorship and support
standards for students participating in these programs. The
Committee urges NIH to encourage and provide more guidance to
participating institutions to account for sufficient staff and
outreach, budget, and other training-related expenses in grant
applications. Finally, the Committee directs NIH to provide a
report on these activities within 90 days of enactment.
Experimental Research.--The Committee recognizes the
success of the NIGMS Maximizing Investigators' Research Award
program and encourages the NIH to continue expanding similar
experimental research opportunities to other institutes.
Institutional Development Awards
The Committee provides $455,956,000 for IDeA, which is
$25,000,000 above the fiscal year 2024 enacted level. The IDeA
program increases our nation's biomedical research capability
by improving research capacity in States that have historically
had lower levels of NIH biomedical research funding. IDeA
supports competitive basic, clinical, and translational
research, faculty development, and infrastructure improvements.
The IDeA program aims to strengthen States' and institutions'
abilities to support biomedical research, enhance the
competitiveness of investigators in securing research funding,
and enable clinical and translational research that addresses
the needs of medically underserved communities. The Committee
does not support changes to eligibility for the IDeA program to
any system that would deviate from the original goal of
supporting more NIH research in States with the lowest levels
of NIH funding. The Committee urges NIH to take steps to ensure
robust participation by institutions located throughout a State
when awarding grants as part of the IDeA program and requests
an update on this effort in the fiscal year 2027 congressional
justification.
Institutional Development Award Networks for Clinical and
Translational Research (IDeA-CTR).--The Committee notes the
continued importance of the IDeA-CTR centers to develop
infrastructure and human resources to more effectively and
efficiently conduct clinical and translational research and
acknowledges the potential for further enhancement and progress
through meaningful collaboration with the CTSA program,
particularly in rural areas. The Committee encourages NIGMS and
NCATS to pursue collaborative opportunities between the IDeA-
CTRs and CTSAs that preserve the autonomy of both programs,
while removing barriers to allow them to collaborate for rapid
scientific advancement and improved local care and research.
EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN
DEVELOPMENT (NICHD)
Appropriation, fiscal year 2025....................... $1,759,078,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 1,759,078,000
Change from enacted level......................... - - -
Change from budget request........................ +1,759,078,000
Mission.--NICHD's mission is to lead research and training
to understand human development, improve reproductive health,
enhance the lives of children and adolescents, and optimize
abilities for all.
Centers of Excellence to Reduce Maternal Morbidity and
Mortality.--The Committee is aware that NICHD's current
Maternal Health Research Centers provide a platform to further
both research and clinical care in battling maternal morbidity
and mortality. However, the Committee remains concerned that
too few Centers exist in areas of the country that see the
highest rate of both. Therefore, the Committee encourages NICHD
to continue to expand its current Centers of Excellence with a
particular emphasis on establishing new ones in regions of
greatest need.
Endometriosis.--The Committee encourages NICHD to expand
basic, clinical, and translational research into the mechanisms
of endometriosis, including root causes of the disease and new
treatment methods. The Committee also encourages research in
additional areas, including: the genetic and immune system
components of endometriosis, targeted research of endocrine
disrupting chemicals in endometriosis, the relationship of
endometriosis and cancer, prenatal, and epigenetic influences
on the risk for this condition, non-invasive diagnostics of
endometriosis to reduce delays in diagnosis and improve
treatment, and growth of endometriosis, and recurrence post-
surgical procedures.
Impact of Technology and Digital Media Use Among Infants,
Children, and Teens.--The Committee remains concerned about the
impacts of technology use and media consumption on infant,
child, and adolescent development. The Committee appreciates
NIH's ongoing engagement on this key topic and urges expanded
support for research into the cognitive, physical, and mental
health impacts of young people's use of technologies and the
long-term developmental effects on children's social,
communication, and creative skills. The Committee encourages
NIH to study potential correlations between increased use of
digital media and technologies on suicidal thoughts and
ideation among children. NIH is encouraged to consider
different forms of digital media and technologies including
mobile devices, smart phones, tablets, computers, and virtual
reality tools, as well as social media content, video games,
and television programming.
Infertility.--The Committee remains concerned about the
rate of infertility suffered by couples trying to conceive. In
the U.S., 11 percent of women of reproductive age have
difficulty getting pregnant or carrying a pregnancy to term.
The Committee urges NICHD to continue to research female
reproductive conditions, specifically adenomyosis, uterine
fibroids, endometriosis, and polycystic ovary syndrome. This
research could include diagnostic testing, causes of the
conditions, and treatment options, especially non-
pharmacological intervention. The Committee also urges NICHD to
continue supporting research on male mechanisms of infertility,
given the gap in knowledge of how to diagnose and treat male
infertility.
Learning Disabilities Research Centers and Learning
Disabilities Innovation Hubs.--The Committee notes the need for
continued research and improved interventions to address the
concerning decline in achievement for students with
disabilities. The Committee recognizes the importance of
NICHD's funding of Learning Disabilities Research Centers and
Learning Disabilities Innovation Hubs, which are the only
source of Federal funding available to researchers interested
in exploring child development and learning disabilities to
conduct randomized control trials and explore the relationships
between different variables at work. While learning
disabilities do influence an individual's education and
academic achievement, these disorders are brain-based, so
clinical research using the latest technology and advances in
neuroscience is essential.
Maternal-Fetal Medicine Units Network.--The Maternal-Fetal
Medicine Units Network is a network of 14 centers across the
country that conduct clinical studies to improve maternal,
fetal, and neonatal health that ultimately improves the
clinical practice of obstetrics. Broadly, 22 of 27 institutes
and centers at NIH support at least one grant or project
related to pregnancy which will further improve maternal and
infant health outcomes and address maternal mortality. The
Committee commends the work of the maternal-fetal medicine
units and supports robust funding for this activity.
Pelvic Organ Prolapse.--Pelvic organ prolapse (POP) occurs
when the pelvic floor muscles and connective tissue supporting
the pelvic organs fail, and one or more of the pelvic organs
fall downward, protruding from the body. It is common, with one
out of eight women undergoing surgery for prolapse at some
point in their life. Symptomatic POP is associated with urinary
incontinence, depression, anxiety, sleep disturbance,
deteriorating physical function, and diminished socialization.
The Committee encourages the NICHD to convene a workshop to
design prospective studies related to POP including research
studies being conducted in underserved areas, to assess
preventative strategies for POP, including ways to decrease
pelvic floor trauma or denervation during delivery, with the
goal of reducing the risk of subsequent POP and its
complications. The Committee also encourages continued support
of POP research. The Committee requests an update in the fiscal
year 2027 congressional justification on research to advance
POP prevention and treatment.
Polycystic Ovary Syndrome.--The Committee encourages NICHD
to continue supporting basic, clinical, and translational
research into the causes and mechanics of polycystic ovary
syndrome (PCOS). The Committee also encourages NIH to support
targeted research of endocrine-disrupting chemicals in PCOS;
the genetic, metabolic, and immune system dysfunction of PCOS;
the efficacy of various treatments for PCOS; and the incidence
and impact of PCOS on the development of related comorbidities.
Population Research.--The Committee has commended NICHD for
supporting prospective, population representative longitudinal
studies, including the Panel Study of Income Dynamics Child
Development Supplement, Future of Families and Child Wellbeing
Study, and National Longitudinal Survey of Youth. Data from
these studies are used widely to inform research and training
activities conducted by thousands of scientists at universities
nationwide, including underserved institutions, and are heavily
used by new and early-stage investigators. These studies are
the only nationally representative data scientists may use to
analyze, for example, how parental and grandparental
characteristics affect children's outcomes and the impact of
adverse childhood experiences over the course of life. The
Committee is concerned to learn that NICHD is proposing funding
reductions to these surveys, which could result in the
permanent loss of invaluable data that could be used to assess
and track long-term health and wellbeing outcomes in infants,
children, and adolescents. NICHD is encouraged to prioritize
supporting these surveys. The Committee requests an update on
this topic in the fiscal year 2027 congressional justification.
Pregnant and Lactating Women.--The Committee remains
concerned about the lack of pregnant and lactating women in
clinical research. Women with chronic health conditions lack
access to appropriate treatments during pregnancy, putting them
and their infants at risk. Despite 90 percent of pregnant women
taking prescription medication, only 5 percent of medications
have data on the impact of the medications during pregnancy.
The Committee urges NICHD to conduct priority research projects
on existing medications and therapeutics prescribed to pregnant
and lactating women, and to prioritize research applications in
the following areas: an unmet medical need or gap in treatment,
and severity and prevalence of a specific disease or condition.
The Committee requests an update in the fiscal year 2027
congressional justification on this effort.
NATIONAL EYE INSTITUTE (NEI)
Appropriation, fiscal year 2025....................... $896,549,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 896,549,000
Change from enacted level......................... - - -
Change from budget request........................ +896,549,000
Mission.--The mission of the National Eye Institute is to
eliminate vision loss and improve quality of life through
vision research.
Blepharospasm.--The Committee encourages continued support
for research into blepharospasm, a form of dystonia, and
encourages continued collaboration with stakeholders and across
NIH institutes and centers.
Retinitis Pigmentosa.--The Committee continues to encourage
NEI to expand research into Retinitis Pigmentosa and requests
an update in the fiscal year 2027 congressional justification
on collaborative efforts among stakeholders and other
Institutes and Centers on work toward curative treatments and
therapeutics for retinitis pigmentosa.
Usher Syndrome.--The Committee strongly encourages NIH to
enhance and prioritize Usher syndrome research at NEI. Usher
syndrome is a rare genetic disease that causes deafness and
blindness, and there is no viable treatment or cure. The
Committee requests an update in the fiscal year 2027
congressional justification, and such update should include
efforts to stimulate the field and to accelerate viable human
treatment options for those with Usher syndrome.
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)
Appropriation, fiscal year 2025....................... $913,979,000
Budget request, fiscal year 2026...................... 594,086,000
Committee Recommendation.............................. 913,979,000
Change from enacted level......................... - - -
Change from budget request........................ +319,893,000
Mission.--NIEHS's mission is to discover how the
environment affects people in order to promote healthier lives.
Microplastics.--The Committee urges NIH to review primary
chemicals in the life cycle analysis of plastic materials that
are impacting the environment and human health. The Committee
urges NIH to research the presence of microplastics and
nanoplastics in the human body, including in organs and
biospecimens and how such presence impacts human health.
Wildfire Smoke Health Research.--The lack of data about the
health impacts of wildland fire smoke and wildfire management
strategies is a gap in our firefighting arsenal. The Committee
encourages NIEHS to help fill this gap by pursuing research to
evaluate smoke health impacts for communities experiencing
different types of wildfire and to develop datasets linking
wildfire smoke to health impacts.
NATIONAL INSTITUTE ON AGING (NIA)
Appropriation, fiscal year 2025....................... $4,507,623,000
Budget request, fiscal year 2026...................... 2,686,541,000
Committee Recommendation.............................. 4,507,623,000
Change from enacted level......................... - - -
Change from budget request........................ +1,821,082,000
Mission.--NIA's mission is to understand the nature of
aging and the aging process, and diseases and conditions
associated with growing older, to extend the healthy, active
years of life.
Alzheimer's Disease and Alzheimer's Disease-Related
Dementias (AD/ADRD).--The Committee urges continued robust
funding for AD/ADRD research at the NIA at no less than the
level provided for fiscal year 2025. The Committee notes that
Alzheimer's Disease and related dementias pose challenges to
the nation's health, and AD/ADRD research at NIA is an
investment in the treatment, prevention, and eventual cure of
these diseases.
Basic Biology of Aging.--The healthspan-lifespan gap--the
average number of years that a person is burdened by disease--
is growing globally and is wider in the United States than in
any other country. This impacts the nation's economy, but
closing this gap remains a challenge, because so much remains
unknown about how best to target the underlying biology
responsible for the transition from healthy to unhealthy life.
The Committee urges the NIA to prioritize funding for the
Division of Aging Biology and other divisions conducting work
to explore the precipitating biology of the frailty and loss of
resilience that defines ill health in people's later years. The
Committee requests an update on such efforts in the fiscal year
2027 congressional budget justification.
Geroscience Research.--Recent advances in geroscience
suggest it may be possible to prevent or treat a wide range of
adult-onset health concerns, including functional declines such
as frailty and lost resilience, and overt diseases such as
Alzheimer's disease, cancer, cardiovascular diseases and many
others. This could be achieved by slowing or reversing certain
genetic, molecular and cellular hallmarks of aging discovered
through research on the basic biology of aging. The Committee
strongly urges NIA to prioritize funding for geroscience
research. The Committee also understands that the enormous
promise of this field is limited by a shortage of investigators
with expertise in the biology of aging and the clinical
translation of basic research findings. Therefore, NIA is
encouraged to increase support for early career investigators,
especially postdoctoral researchers and junior faculty, to help
attract, retain, and develop top talent in the field of
geroscience. Finally, the Committee encourages NIA to increase
funding for basic and translational research in aging to
provide more options and test more treatments as quickly as
possible.
NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES
(NIAMS)
Appropriation, fiscal year 2025....................... $685,465,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 685,465,000
Change from enacted level......................... - - -
Change from budget request........................ +685,465,000
Mission.--NIAMS's mission is to support research into the
causes, treatment, and prevention of arthritis and
musculoskeletal and skin diseases; the training of basic and
clinical scientists to carry out this research; and the
dissemination of information on research progress in these
diseases.
Alopecia Areata.--The Committee notes that NIAMS research
has uncovered genetic factors that are associated with alopecia
areata, many of which have been implicated in other autoimmune
diseases. The Committee encourages NIAMS to explore
collaborative opportunities with key stakeholders to advance
critical research projects into causes and treatments.
NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS
(NIDCD)
Appropriation, fiscal year 2025....................... $534,333,000
Budget request, fiscal year 2024...................... - - -
Committee Recommendation.............................. 534,333,000
Change from enacted level......................... - - -
Change from budget request........................ +534,333,000
Mission.--NIDCD conducts and supports biomedical and
behavioral research and research training in the normal and
disordered processes of hearing, balance, taste, smell, voice,
speech, and language. NIDCD also conducts and supports research
and research training related to disease prevention and health
promotion; addresses special biomedical and behavioral problems
associated with people who have communication impairments or
disorders; and supports efforts to create devices which
substitute for lost and impaired sensory and communication
function.
Spasmodic Dysphonia or Laryngeal Dystonia.--The Committee
notes the research that NIDCD continues to facilitate regarding
spasmodic dysphonia and collaborative efforts with relevant
institutes and centers and other stakeholders. The Committee
continues to encourage sustained collaboration with key
stakeholders and agencies.
NATIONAL INSTITUTE OF NURSING RESEARCH (NINR)
Appropriation, fiscal year 2025....................... $197,693,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 197,693,000
Change from enacted level......................... - - -
Change from budget request........................ +197,693,000
Mission.--The mission of NINR is to lead nursing research
to solve pressing health challenges and inform practice and
policy for health optimization.
NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM (NIAAA)
Appropriation, fiscal year 2025....................... $595,318,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 595,318,000
Change from enacted level......................... - - -
Change from budget request........................ +595,318,000
Mission.--NIAAA's mission is to generate and disseminate
fundamental knowledge about the adverse effects of alcohol on
health and well-being, and apply that knowledge to improve
diagnosis, prevention, and treatment of alcohol-related
problems, including alcohol use disorder, across the lifespan.
Fetal Alcohol Spectrum Disorders.--The Committee supports
NIAAA's efforts to accelerate fetal alcohol spectrum disorders
(FASD) basic, prevention, diagnosis, and treatment research.
The Committee encourages NIAAA to continue efforts to support
innovative research and to disseminate research findings to the
public to inform the efforts of States, Tribes, and provider
and nonprofit organizations in increasing FASD diagnostic
capacity, enhancing FASD prevention programs, developing
resources for systems of care, and training services providers
and professionals.
NATIONAL INSTITUTE ON DRUG ABUSE (NIDA)
Appropriation, fiscal year 2025....................... $1,662,695,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 1,662,695,000
Change from enacted level......................... - - -
Change from budget request........................ +1,662,695,000
Mission.--NIDA's mission is to advance science on the
causes and consequences of drug use and addiction and to apply
that knowledge to improve individual and public health.
Cocaine Overdose Reversal Antidote.--The Committee is aware
of NIH's investment into countermeasures for overdoses
attributed to other stimulants such as cocaine. The Committee
remains supportive of NIDA funding targeting the surge in
overdose deaths involving cocaine and is aware of the current
lack of FDA approved cocaine overdose reversal medications to
address the increase in fatalities. The Committee understands
there is ongoing research and development of treatments, which
the NIH contributes, which can rapidly reverse cocaine toxicity
and reduce mortality rates. Therefore, the Committee urges NIDA
to continue to prioritize and fund research to advance a life-
saving treatment for overdoses caused by cocaine.
Marijuana Research.--The Committee is concerned that
development of a drug-impairment standard for marijuana remains
unlikely in the near-term and encourages NIH to continue
supporting a full range of research on the health effects of
marijuana and its components, including research to understand
how marijuana policies affect public health issues such as
drug-impaired driving. The Committee is aware that the majority
of Federal research has been limited to marijuana from a single
source and encourages NIH to undertake research that strives to
encompass the variety, quality, and potency of commonly
available cannabis strains within the current constraints of
law. Additionally, the Committee continues to support the
development of an objective standard to measure marijuana
impairment and a related objective field sobriety test to
ensure highway safety.
Methamphetamines and Other Stimulants.--The Committee is
concerned that, according to predicted provisional data
released by CDC, over 25,000 overdose deaths involved cocaine
and over 34,000 involved drugs in the category that includes
methamphetamine in the 12-month period ending in August 2024.
These elevated levels have led some to refer to stimulant
overdoses as the ``fourth wave'' of the current drug addiction
crisis in America following the rise of opioid-related deaths
involving prescription opioids, heroin, and fentanyl-related
substances. No FDA approved medications are available for
treating methamphetamine, cocaine, and other stimulant use
disorders. The Committee continues to support NIDA's efforts to
address the opioid crisis, has provided continued funding for
the Helping to End Addiction Long-term (HEAL) Initiative, and
supports NIDA's efforts to combat the growing problem of
methamphetamines and other stimulant use disorders and related
deaths.
The Committee also notes that the HEAL Initiative is
currently supporting basic science and translational studies in
animal models of opioid addition and how pain mechanisms are
generated. Continuing these studies will be critical for
identifying mechanisms and targets for treatment that can be
translated into clinical studies already occurring in HEAL.
Opioid Initiative.--The Committee remains concerned about
the high mortality rate due to the overdose epidemic and
appreciates the role that research plays in Federal initiatives
aimed at this crisis. Approximately 220 people die each day in
the U.S. from drug overdose (more than 149 of them involving
opioids), making it one of the most common causes of non-
disease-related deaths for adolescents and young adults. The
Committee notes the strong concerns related to overdose deaths
involving synthetic opioids, namely fentanyl. Research is
needed to find new and better agents to prevent or reverse the
effects of this class of chemicals and to improve access to
treatments for those with addiction to these drugs. To combat
this crisis, the Committee has provided within NIDA's budget no
less than the fiscal year 2024 enacted level for the
institute's management of its share of the HEAL Initiative and
in response to elevated rates of stimulant use and overdose.
The Committee encourages NIDA to support research on the
development of safe and effective medications and new
formulations to treat substance use disorders and prevent or
reverse overdose, and to support research on comprehensive care
models in communities nationwide to prevent opioid misuse,
expand treatment capacity, enhance access to overdose reversal
medications, and enhance prescriber practice; test
interventions in justice system settings to expand the uptake
of medications for opioid use disorder and methods to scale up
these interventions; and develop evidence based strategies to
integrate screening and treatment for opioid use disorders in
emergency department and primary care settings. The Committee
has included language expanding the allowable use of these
funds to include research related to stimulant use and
addiction. Recognizing the increasing severity of the national
opioid crisis and the need to improve options for responding
to, treating, and preventing overdoses, the Committee
encourages NIDA to prioritize research to expedite treatments
for and prevention of overdose from fentanyl and related
analogs.
Pain Management and Addiction.--The Committee urges NIDA to
continue and expand efforts to educate physicians and other
medical professionals on safe prescribing for pain and managing
patients who abuse prescription opioids, as well as best
practices for incorporating substance abuse and addiction
screening and treatment into their clinical practices.
Raising Awareness and Engaging the Medical Community in
Drug Abuse and Addiction Prevention and Treatment.--Education
is a key component of any effort to curb drug use and
addiction, and it must target all segments of society,
including healthcare providers (doctors, nurses, dentists, and
pharmacists), patients, and families. Medical professionals
must be in the forefront of efforts to curb the opioid crisis.
The Committee continues to be pleased with the NIDAMED
initiative, targeting physicians-in-training, including medical
students and resident physicians in primary care specialties
(e.g., internal medicine, family practice, emergency medicine,
and pediatrics). The Committee urges NIDA to continue its
efforts in this area, providing physicians and other medical
professionals with the tools and skills needed to incorporate
substance use and abuse screening and treatment into their
clinical practices.
Wastewater Drug Testing.--The Committee supports NIDA's
research of testing wastewater to detect and understand trends
in drug substances. Wastewater-based drug testing is a
technique where wastewater samples from the sewer are tested
for specific targets. It is intended to complement more
traditional methods of monitoring drug use patterns, with the
potential to detect such patterns near real time and in hard-
to-reach populations. The Committee recognizes that such
testing can be proactive and may allow agencies and related
stakeholders to respond appropriately when spikes or new trends
are identified in certain areas or of certain drugs. The
Committee encourages NIDA to report data collection and
analysis of trends and drugs from this research so that the
field can improve and validate wastewater testing methods and
enable local governments to target support and reduce overdose
deaths.
NATIONAL INSTITUTE OF MENTAL HEALTH (NIMH)
Appropriation, fiscal year 2025....................... $2,187,843,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 2,187,843,000
Change from enacted level......................... - - -
Change from budget request........................ +2,187,843,000
Mission.--NIMH's mission is to transform the understanding
and treatment of mental illnesses through basic and clinical
research, paving the way for prevention, recovery, and cures.
21st Century Cures.--The Committee recommendation includes
$97,500,000 available from the Cures Act for the BRAIN
Initiative. The Committee notes that fiscal year 2026 is the
final year of funding under the Cures Act for this activity.
Autism Spectrum Disorder.--The Committee encourages NIH to
support greater investment in research related to autism,
particularly in areas outlined in the Interagency Autism
Coordinating Committee (IACC) Strategic Plan for Autism
Spectrum Disorder (ASD). The Committee notes NIH's initiative
to build a real-world data platform focused on autism. NIH is
encouraged to ensure any large autism initiatives supplement
existing funding for autism research. The Committee requests an
update in the fiscal year 2027 congressional justification on
the implementation of NIH-related provisions of the Autism
Collaboration, Accountability, Research, Education, and Support
Act of 2024 (P.L. 118-80), which include providing an annual
budget estimate for autism research, ensuring research reflects
the entire population of individuals with ASD, and establishing
a process for the public to access information on existing and
planned autism research activities and provide comments. The
Committee also encourages the reestablishment of the IACC.
Mental Health Research.--The Committee supports NIMH's
high-quality basic research on serious mental illnesses. The
Committee requests an update in the fiscal year 2027
congressional justification on the funding allocations at NIMH
detailing the percentage of funds spent on basic,
translational, and clinical research.
Reducing Mental Health Disparities in Youth.--The Committee
is alarmed by new CDC data on depression and trauma among
adolescents and acknowledges the NIMH strategic framework for
addressing mental health among underserved and underrepresented
youth, including those in rural communities, by 2031. The
Committee recognizes ongoing collaborative work with NICHD and
NIMHD to execute this framework through research, workforce
development, and stakeholder engagement. New investments in
research to guide recovery are key to resolving the rise in
youth mental health issues.
Suicide Prevention.--Suicide is complex, and multiple
factors--biological, psychological, social, and environmental--
play a role. The Committee encourages NIMH to provide
additional attention to suicide prevention research across all
these areas, as well as the application of novel measurement
techniques, statistical analysis, digital initiatives, and
information systems. The Committee encourages NIMH to promote
greater collaboration with other institutes and centers with
expertise in research areas that can contribute to suicide
prevention, especially NIA, NICHD, NHGRI, NIAAA and NIDA.
NATIONAL HUMAN GENOME RESEARCH INSTITUTE (NHGRI)
Appropriation, fiscal year 2025....................... $663,200,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 663,200,000
Change from enacted level......................... - - -
Change from budget request........................ +663,200,000
Mission.--NHGRI's mission is to accelerate scientific and
medical breakthroughs that improve human health by driving
cutting-edge research, developing new technologies, and
studying the impact of genomics on society.
Pharmacogenomic Research.--NHGRI's pharmacogenomic research
and programs include working to develop community resources.
Such efforts support a pharmacogenomics knowledge resource that
provides clinical information such as clinical guidelines and
drug labels, potentially clinically actionable gene-drug
associations, and genotype-phenotype relationships, to
scientific and healthcare professionals, which in part informs
the work of the clinical pharmacogenetics implementation
consortium to develop practice guidelines for pharmacogenomics
use in clinical care. The Committee encourages continued
support for such research.
NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING (NIBIB)
Appropriation, fiscal year 2025....................... $440,627,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 440,627,000
Change from enacted level......................... - - -
Change from budget request........................ +440,627,000
Mission.--The NIBIB mission is to improve health by leading
the development and accelerating the application of biomedical
technologies.
NATIONAL CENTER FOR COMPLEMENTARY AND INTEGRATIVE HEALTH (NCCIH)
Appropriation, fiscal year 2025....................... $170,384,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 170,384,000
Change from enacted level......................... - - -
Change from budget request........................ +170,384,000
Mission.--The mission of NCCIH is to define, through
rigorous scientific investigation, the fundamental science,
usefulness and safety of complementary and integrative health
approaches and their roles in improving health and health care.
NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES (NIMHD)
Appropriation, fiscal year 2025....................... $534,395,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 544,395,000
Change from enacted level......................... +10,000,000
Change from budget request........................ +544,395,000
Mission.--NIMHD's mission is to lead scientific research to
improve minority health and reduce health disparities.
Improving Native American Cancer Outcomes.--The Committee
continues to be concerned that Native Americans experience
overall cancer incidence and mortality rates that are
strikingly higher than non-Native populations. The Committee
includes $14,000,000, which is an increase of $8,000,000 above
the fiscal year 2024 enacted level, to continue the Initiative
for Improving Native American Cancer Outcomes to support
efforts including research, education, outreach, and clinical
access related to cancer in Native American populations. The
Committee further directs NIMHD to work with NCI to continue
support for the current grantees.
Multiple Chronic Disease Research Centers.--The Committee
is aware and strongly supports the regional chronic disease
centers established by NIMHD. To further the promotion of their
mission, the Committee encourages NIMHD to establish a
dissemination and implementation hub, where investigators could
obtain expert guidance on pragmatic trial design, and
dissemination and implementation frameworks to assist in
evaluating promising interventions in reducing chronic disease
disparities. The Committee strongly urges NIMHD to establish a
hub at one of the regional chronic disease centers aimed at
reducing disparities in diabetes and hypertension.
Native Hawaiian/Pacific Islander Health Research Office.--
The Committee provides $6,000,000, which is an increase of
$2,000,000 above the fiscal year 2024 enacted level, for the
Native Hawaiian/Pacific Islander Health Research Office
(NHPIHRO) with a focus on both addressing Native Hawaiian and
Pacific Islander (NHPI) health disparities, as well as
supporting the pathway and research of NHPI investigators. The
Committee encourages NHPIHRO to develop partnerships with
academic institutions with a proven track record of working
closely with NHPI communities and NHPI-serving organizations
located in States with significant NHPI populations to support
the development of future researchers from these same
communities.
Research Endowment Program.--The Committee continues to
include $12,000,000 for the Research Endowment Program. The
Committee is pleased with NIMHD's reinvigoration of the
Research Endowment Program and has continued funding for fiscal
year 2026. The Committee supports efforts to increase funding
available to existing grantees and continue to expand and
assist eligible institutions receiving grants through a
competitive process.
Research Centers at Minority Institutions (RCMI) Program.--
The Committee notes that NIMHD's investment in the RCMI program
provides opportunities for institutions with historical
missions and precedence of serving minorities and building
infrastructure to conduct minority health and health
disparities research. The Committee urges NIMHD to continue
investing in the RCMI program.
JOHN E. FOGARTY INTERNATIONAL CENTER (FIC)
Appropriation, fiscal year 2025....................... $95,162,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 95,162,000
Change from enacted level......................... - - -
Change from budget request........................ +95,162,000
Mission.--FIC's mission is to support and facilitate global
health research conducted by U.S. and international
investigators, building partnerships between health research
institutions in the U.S. and abroad, and training the next
generation of scientists to address global health needs.
Obstetric Fistula Research.--The Committee notes that an
estimated 500,000 women and girls worldwide live with obstetric
fistula--with thousands of additional cases occurring annually.
Obstetric fistula occurs disproportionately among impoverished,
vulnerable, and marginalized women and girls. It can be
prevented by skilled health personnel at birth and emergency
obstetric and newborn care. The Committee is concerned that
fistula repairs were widely halted or slowed down due to COVID,
as they were deemed non-urgent and unsafe during the pandemic.
This may have resulted in an increased backlog of fistula
cases. The Committee requests an update in the fiscal year 2027
congressional justification on the annual funding level for
training on obstetric fistula over the preceding five fiscal
years, including the types of grants supported during this
period.
NATIONAL LIBRARY OF MEDICINE (NLM)
Appropriation, fiscal year 2025....................... $497,548,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 497,548,000
Change from enacted level......................... - - -
Change from budget request........................ +497,548,000
Mission.--As a leader in computational health and the
world's largest medical library, NLM collects, organizes,
preserves, and disseminates data and information important to
biomedicine and health; serves as a national information
resource for medical education, research, and health service
activities; enhances access to biomedical literature through
electronic services; serves the public by providing electronic
access to reliable health information for consumers; supports
and directs the Network of the NLM; provides grants for
research in biomedical communications, medical library
development, and training health information specialists;
conducts and supports research and research training in
biomedical informatics, computational health, computational
biology, and data science; supports development, maintenance,
and dissemination of health data standards that promote
interoperability among clinical and research information
systems; and manages and maintains information resources for
genomics, molecular biology, clinical trials, medical images,
environmental health, public health, and health services
research.
Epitranscriptomics Database Standards.--The Committee is
aware of interest in establishing clear, consistent standards
for data and databases for sequencing RNA and its
modifications, to facilitate data access and sharing. NLM's
National Center for Biotechnology Information (NCBI)
collaborates with the scientific community to support
development of standards for databases and biological
nomenclature. The Committee encourages the establishment of
data and database standards for epitranscriptomics, in
collaboration with the scientific community.
NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES (NCATS)
Appropriation, fiscal year 2025....................... $928,323,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 928,323,000
Change from enacted level......................... - - -
Change from budget request........................ +928,323,000
Mission.--NCATS was established to transform the
translational process so that new treatments and cures for
disease can be delivered to patients faster.
Clinical and Translational Science Awards (CTSA).--The
Committee notes the role of the CTSA program in supporting a
national network of medical institutions to advance the
translation of research into improved clinical care in
communities and encourages continued robust support for CTSA
activities.
Cures Acceleration Network.--The Committee continues to
include $75,000,000 for this activity. The Cures Acceleration
Network is authorized to conduct and support advances in basic
research, accelerate the development of high need cures, and
reduce barriers between discoveries in the laboratory and
clinical trials for new therapies.
National Clinical Cohort Collaborative.--The Committee
strongly supports the National Clinical Cohort Collaborative
(N3C)'s open-science, privacy-preserved data-sharing platform
to accelerate biomedical research and discovery and includes no
less than $75,000,000 for the N3C. Supported by the CTSA
program, N3C combines electronic health record data with other
types of data such as imaging, mortality, and Medicare and
Medicaid data from CMS to answer key research questions on a
variety of diseases, with 2 diseases being piloted. The
Committee supports the continuation of N3C and encourages NCATS
to coordinate with other HHS agencies to make N3C available as
an underlying common real-world data platform to drive faster
discovery across a range of diseases. The Committee encourages
NCATS to formulate a public-private strategy on the viability
of N3C in the challenging diagnostic complexities of rare
disease research, to be detailed in a report to the Committee
within one year of enactment of this Act and made available on
the agency's website.
Rare Disease Research.--The Committee encourages NCATS to
leverage the investments made in NCATS rare disease research,
to accelerate the development of new treatments for the over 95
percent of 10,000+ rare diseases with no FDA approved
treatment. Such investments have led to investigational new
drugs and approved therapies. The Committee urges NCATS to
increase its support for rare disease research.
OFFICE OF THE DIRECTOR
Appropriation, fiscal year 2025....................... $2,605,514,000
Budget request, fiscal year 2026...................... 1,650,062,000
Committee Recommendation.............................. 2,441,514,000
Change from enacted level......................... -164,000,000
Change from budget request........................ +791,452,000
Mission.--The OD is responsible for the research, mission,
policies, and administration of the agency. The OD leads and
supports NIH-wide initiatives in partnership with NIH
Institutes and Centers and their constituents. OD guides the
development and management of intramural and extramural
research and research training policy, the review of program
quality and effectiveness, the coordination of selected NIH-
wide program activities, and the administration of centralized
support activities essential to the operations of NIH.
The items below include issues and programs specific to the
Office of the Director as well as those that involve multiple
institutes and centers.
ACT for Amyotrophic Lateral Sclerosis Expanded Access.--In
addition to encouraging more research broadly for Amyotrophic
Lateral Sclerosis (ALS), the Committee includes $80,000,000,
which is a $5,000,000 increase above the fiscal year 2024
enacted level, to support expanded access grants as authorized
in the Accelerating Access to Critical Therapies for ALS Act
(P.L. 117-79). The Committee continues to direct NIH to handle
this funding as separate from, not competitive with, other
funding for research on ALS. The Committee encourages NINDS and
OD to continue to strengthen the expanded access grant
application process as discussed in the joint explanatory
statement which accompanied the fiscal year 2023 consolidated
appropriations Act. The Committee commends efforts by NINDS to
engage stakeholders and grow the sustainability of this
program.
Furthermore, after the review and award of meritorious
applications under section 2, the Committee recommends NIH
apply any unused funds to programs authorized under ACT for ALS
including section 3 public-private research partnership and
section 5 Rare Neurodegenerative Disease Grant Program at FDA,
as well as the NIH ALS Strategic Priorities.
Adult Cellular Therapies.--To support collaborative
evidence development, the Committee encourages HHS--in
coordination with FDA, NIH, and HRSA--to continue efforts to
enhance transparency regarding outcomes from adult (somatic)
cellular therapies that are FDA approved or being administered
under FDA Investigational New Drug or Investigational Device
Exemption protocols by ensuring that results are submitted to
appropriate databases such as the Stem Cell Therapeutic
Outcomes Database and ClinicalTrials.gov.
Advancing Gene and Cell Based Therapies.--The Committee
recognizes that cell-based therapies hold promise for a broad
range of conditions, including neurological conditions,
musculoskeletal conditions, cancer, radiation damage,
cardiovascular disease, diabetes, wound healing, and autoimmune
and immune-mediated disease. The Committee encourages the
development and launch of a coordinated program to support
research, development, and manufacturing of somatic (adult)
gene and cell-based therapies for patients with serious and
life-threatening conditions. Such efforts could support large-
scale, randomized, placebo-controlled clinical trials exploring
the use of somatic gene and cell-based therapies for serious
and life-threatening conditions; support for characterization,
optimization, and scaling of manufacturing of cell-based
therapies; a clinical trials network to support sharing of best
practices and lessons learned; workforce development
activities; and collaborative, evidence development, including
the development and operation of an outcomes database. The
Committee encourages support for cell-based therapies to
incorporate the knowledge of experts with experience in
clinical trials involving cell-based therapies. Initial areas
of focus for the program could include neurological conditions,
musculoskeletal conditions, cancer, radiation damage,
immunological disease, and cardiovascular disease.
All of Us.--The Committee recommendation includes
$31,000,000 available in the Cures Act for the All of Us
Research program. The Committee supports the work on this
program to allow for continued participant enrollment from
historically underrepresented populations and to continue its
efforts to enroll participants from rural communities,
including pediatric enrollment. The Committee notes that this
initiative supports large-scale genome sequencing, innovations
in health data science, and the development of a next-
generation biomedical workforce. The Committee notes that
fiscal year 2026 is the final year of funding under the Cures
Act for this activity. As NIH evaluates plans for the
activities currently supported by this program, the Committee
encourages the agency to consider the merits of integrating
such activities into an existing institute or center such as
NCATS or NHGRI.
Alternatives to Animal Testing.--The Committee commends NIH
for launching an initiative to expand human-based research
technologies--such as tissue chips and computational models--
and reduce the use of traditional animal models. Within this
effort, a new Office of Research Innovation, Validation, and
Application will coordinate agency-wide development and
expansion of non-animal approaches in NIH's research. The
Committee also notes that NIH announced in July 2025 that it
will no longer issue Notices of Funding Opportunities that rely
solely on animal models. Additionally, the Committee supports
the Complement Animal Research In Experimentation (Complement-
ARIE) Program, intended to spur the development,
standardization, validation, and use of new approach
methodologies (NAMs) intended to more accurately model human
biology. The Committee encourages NIH, in new announcements and
other indications of funding opportunities, to continue
consideration of NAMs as the preferred option for areas of
preclinical research when it is not appropriate to use human
participants. The Committee encourages implementation of non-
animal methods based on human biology in developing and
evaluating potential treatments for rare diseases, where
scientifically justifiable non-animal models exist to mimic
human disease.
Additionally, to encourage investigators to consider the
use of NAMs and promote the competitive evaluation of
applications that use NAMs, the Committee encourages NIH to
include grant proposal reviewers with expertise in NAMs and
provide reviewers with access to appropriate resources as
relates to evaluating applications that may include NAMs, such
as a reference librarian with expertise in evaluating the
adequacy of the search methods used by the applicant for non-
animal methods. The Committee requests an update in the fiscal
year 2027 congressional justification on the feasibility of
such actions and progress made on implementation.
Artificial Intelligence Innovation.--The Committee notes
the Bipartisan Artificial Intelligence Task Force's efforts to
issue a December 2024 report that outlines principles,
recommendations, and proposals for ensuring U.S. leadership in
responsible artificial intelligence (AI) innovation. The report
highlighted past and future benefits of AI, machine learning,
and informatics in basic biomedical research, including at NIH.
It underscored the role of basic scientific research in
contributing scientific data that AI can leverage to find new
discoveries.
Bayh-Dole.--The Committee notes that the prior
Administration proposed a ``Draft Interagency Guidance
Framework for Considering the Exercise of March-in Rights,''
(Framework) which reviewed factors, including price, that a
Federal agency could consider when deciding whether to exercise
march-in authority as provided in the Bayh-Dole Act. The
Committee believes that if implemented by Federal agencies,
particularly the NIH, such an approach could adversely impact
America's global leadership in pharmaceutical innovation. It
could lead to negative effects on current and future scientific
advancements in promising new therapies under development to
treat cancer, immune disorders, and other chronic conditions,
and could threaten the United States' global leadership in
pharmaceuticals. The Committee notes that since the inception
of the Bayh-Dole Act more than 40 years ago, the U.S. has never
exercised its march-in rights authority. U.S. investment and
technology communities, universities, and research institutions
have been empowered to take risks and efforts needed to bring
new ideas to the pharmaceutical marketplace. In 2022 alone, 850
new commercial products utilizing inventions developed by U.S.
universities and research institutions became available to the
public in 2022 thanks in large part to the Bayh-Dole Act.
Cancer Vaccines.--While much progress has been made in the
study of mRNA cancer vaccines and the mRNA vaccine platform
continues to hold potential, additional advances from ongoing
research are needed to hasten the development of effective
personalized cancer therapies using this technology. Findings
from the ongoing NCI-supported research will inform progress in
this promising field. The Committee urges NIH to continue to
provide robust funding for research that moves the field
forward for mRNA vaccines in cancer, collaborating closely with
interested parties. Areas of particular opportunity include
enhancing immune recognition of solid tumors, overcoming
suppression in the tumor microenvironment, and personalization
of mRNA vaccines. These strategies have high potential for
increasing the effectiveness for cancer immunotherapy treatment
and prevention.
Childhood Post Infectious Neuroimmune Disorders, Pediatric
Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune
Neuropsychiatric Disorders Associated with Streptococcus.--The
Committee supports efforts to advance scientific research
related to the devastating diseases of Pediatric Acute-Onset
Neuropsychiatric Syndrome (PANS) & Pediatric Autoimmune
Neuropsychiatric Disorder Associated with Streptococcus
(PANDAS). Although the NIH has undertaken research in this
area, significantly more needs to be done. Understanding the
causes, diagnosis, and treatment of these life-threatening
diseases is essential to expedite early identification and
intervention, thereby reducing the risk of chronic illness and
associated costs to families, school systems, health care
systems, and insurers. PANS/PANDAS research also would further
the understanding of the critical link between neuropsychiatric
illness and infections. The Committee urges NIH to continue to
prioritize research on PANS/PANDAS and related to autoimmune
encephalitic conditions and requests an update on such research
in the fiscal year 2027 congressional justification.
Collaborations with the Department of Energy.--The
Committee supports collaborations between the NIH and the
Department of Energy (DOE) to strategically leverage NIH's
research needs in cancer research, brain mapping, drug
development that requires DOE's high frequency imaging,
supercomputing, instrumentation, materials, modeling
simulation, and data science. Increased coordination could be
instrumental to assist in the development of the nation's
health, security, biomedical technologies, and in the
development of more strategic enabling technologies. The
Committee requests an update from NIH regarding their current
and projected collaborations with DOE, including the
identification of future opportunities for continued
partnership growth as part of the fiscal year 2027
congressional justification.
Diet and Chronic Disease Research.--The Committee commends
the NIH for convening a workshop in August 2024 that explored
the role food and diet have in developing mucosal immunity for
conditions such as Crohn's disease, ulcerative colitis, and
other digestive and auto-immune or immune-mediated diseases.
The Committee is aware of the increasing interest in research
focused on preventing such conditions, especially through
targeted research on environmental and dietary factors that may
trigger these conditions, particularly during the pre-clinical
windows. The Committee encourages NIH to build upon these
activities across NIH. Additionally, the Committee encourages
NIH efforts to address gaps in knowledge about the role diet
and environmental factors may have in development of IBD and
other digestive and auto-immune or immune-mediated diseases.
Such efforts could include collaborations between NIEHS or
other institutes and the Office of Nutrition Research, as well
as the incorporation of immune-mediated digestive diseases and
nutrition into existing programs which could include the
Environmental Influences on Child Health Outcomes program.
Disease Prevalence and Population Health.--The Committee
urges the NIH to prioritize improving population health in its
work and is encouraged by the budget request indicating NIH
shares this view. As the U.S. and global leader in biomedical
research, NIH research has led to scientific and medical
breakthroughs that have enhanced and saved countless lives.
Progress has been made in many areas, yet the Committee remains
concerned about prevalent diseases including chronic conditions
ranging from heart disease and stroke to cancer, diabetes, and
AD/ADRD. Such prevalent diseases are among the leading causes
of death and bring high costs to individuals, the health care
system, and the economy. Maximizing research investments to
address prevalent diseases can have a tremendous positive
impact on population health outcomes, as discoveries lead to
new strategies for prevention, as well as treatments,
therapies, and cures. The Committee also believes that NIH is
uniquely positioned to conduct and support fundamental
scientific and biomedical research, and the Committee urges NIH
to prioritize such core research.
Dog and Cat Research.--Congress has previously expressed
concern about the use of dogs and cats in biomedical research,
particularly in research classified in pain category D or E as
defined by the USDA. The Committee remains concerned about this
issue. The Committee is encouraged by NIH's commitment to
prioritize human-focused research and expand the use of non-
animal approaches, while reducing the use of animals. Similar
efforts are being implemented by the Department of Veterans
Affairs. The Committee directs NIH to submit a report to the
Committee within 180 days of enactment of this Act that
includes an update on efforts to reduce and replace the use of
dogs and cats in NIH-funded intramural or extramural research
classified in pain category D or E, as part of NIH efforts to
advance human-focused research and reduce the use of animals,
including objective performance metrics to assess progress. The
contents of the final report shall be made publicly available
on the agency's website.
Duchenne and Becker Muscular Dystrophy.--There are multiple
therapies approved to treat Duchenne, but research data does
not show that these key treatments halt or reverse this
devastating condition, so more research investment is
warranted. The Committee encourages NIH to ensure that research
data produced by its grants is shared in a timely and
transparent way to accelerate progress. The Committee
emphasizes the importance of robust data-sharing plans that
facilitate access to data for sub analyses, enabling
researchers to maximize insights, identify trends, and advance
innovation in the field. The Committee encourages a review of
the structure and processes of the Muscular Dystrophy
Coordinating Committee, to incorporate Duchenne muscular
dystrophy patient and caregiver perspectives with a transparent
process and timeline for participation. The Committee urges NIH
to respond to the 2025 recommendations of the Muscular
Dystrophy Coordinating Committee and maintain a public record
of progress in implementation.
Early-Career Scientists.--The Committee highlights the
important role of NIH fellows and other early-career
scientists. The Committee encourages NIH to continue support
for research fellows and other early-career scientists, which
will encourage talented students to pursue a scientific career
path, strengthen the research workforce, and ultimately
contribute to the nation's place as the global leader in
scientific innovation.
Facilities and Administrative Costs.--The Committee is
aware of the longstanding cost-sharing model for facilities and
administrative (F&A) costs, or indirect costs, between the
Federal government and research institutions, and that this
cost-sharing has an important role in supporting NIH-funded
research. The Committee is aware of concerns about high
negotiated F&A rates and that if such rates were lower, Federal
funding could support more biomedical research. The Committee
is also aware of interests in making the current model more
transparent and efficient, and better tailoring costs to
different types of research, among other possible changes.
Additionally, the Committee understands that research
institutions' effective--or actual--reimbursement rates may be
quite lower than their negotiated rates. Three researchers
analyzed this difference for about 350 research institutions
that account for roughly 90 percent of NIH's extramural
funding, in ``Indirect Cost Recovery in U.S. Innovation Policy:
History, Evidence, and Avenues for Reform,'' a National Bureau
of Economic Research working paper issued in March 2025. They
found that most institutions' negotiated rates were between 50
and 70 percent, averaging 58 percent, while their effective
rates tended to be between 25 and 45 percent and averaged 42
percent. They found that while negotiated rates have increased
during the past several decades, effective rates have remained
relatively constant. The Committee recognizes recent efforts by
interested stakeholders to develop recommendations for a new
F&A model and notes that such efforts are a valuable
contribution to the dialogue about the future of F&A rates.
Firearm Injury and Mortality Prevention Research.--The
Committee does not include funding for this activity.
Focused Ultrasound.--The Committee understands focused
ultrasound is a noninvasive, non-pharmacological, safe, and
cost-effective alternative or complement to conventional
surgery, radiation therapy, or drug-based treatments. It is a
promising intervention for patients suffering from serious
conditions like Parkinson's disease, essential tremor, and
prostate cancer, as well as for conditions and diseases
affecting women such as breast cancer, gynecological cancers,
uterine fibroids, and endometriosis, and it is being explored
for many other indications. The Committee encourages NIH to
continue engaging with the focused ultrasound stakeholder
community, explore existing focused ultrasound research groups,
and ensure coordinated cross-NIH research. The Committee
directs NIH to provide an update in the fiscal year 2027
congressional justification, including an NIH-wide overview of
grants awarded to support focused ultrasound research and
research opportunities for advancing increased focused
ultrasound research across the institutes and centers. The
Committee also encourages the development and implementation of
effective approaches to integrate patient perspectives into
research, which could include the establishment of a Focused
Ultrasound Patient Engagement Advisory Board.
Food as Medicine.--The Committee understands the potential
for food as medicine interventions such as medically tailored
meals, medically tailored groceries, and produce prescriptions,
to improve health outcomes and treat diet-related chronic
diseases. The Committee encourages NIH to provide an update in
the fiscal year 2027 congressional justification on its food as
medicine research, including consideration of Food as Medicine
Centers of Excellence and collaborations with the scientific
community.
Forced Swim/Tail Suspension Tests.--The Committee commends
NIH's efforts to decrease the use of animal models in research
but remains concerned about the use of certain neurobehavioral
approaches, such as the forced swim and tail suspension test,
which are known to have poor predictive value for understanding
human mental illness, such as depression, or developing
effective therapeutics. The Committee is aware that other
countries have limited the use of the forced swim test due to
scientific and animal welfare concerns. The Committee
appreciates that NIH has provided guidance to potential
research applicants considering the use of animal
neurobehavioral approaches in basic and pre-clinical research
relevant to mental illnesses. In such guidance, NIH explains
NIMH's priorities when determining funding priorities include
the ability of the proposed model to answer the project's
research question. The guidance also recommends using animal
models for addressing neurobiological questions versus models
of specific mental illnesses and strongly discourages proposals
from describing animal behaviors in terms of human emotions.
The Committee urges NIH to limit any funding for grants
involving the forced swim test or tail suspension test. The
Committee strongly encourages NIH to continue to increase
support for human-specific mental health and behavioral health
research, including imaging, epidemiological, clinical,
computational, and cell-derived approaches, which can provide
more translational insights into the underlying neurobiology of
human mental illness.
Fragile X.--The Committee notes the importance of expanding
the base of researchers and clinicians who are familiar with
and trained in Fragile X-associated disorders and promoting
collaboration between basic scientists and clinicians to enable
researchers to better understand phenotypes, document
variations in how the disorder presents itself, identify
potential biomarkers and outcome measures, and develop new
interventions. The Committee commends the NIH for recognizing
the ethical, legal, and social issues in premutation screening
and testing and encourages NIH to look at existing pilot
studies that are looking at innovative ways to screen newborns,
study Fragile X across the lifespan, and coordinate efforts and
research with the CDC as they look at screening solutions for
FMR1-related conditions.
Gabriella Miller Kids First Pediatric Research Program.--
The Committee includes $12,600,000 to support pediatric
research as authorized by the Gabriella Miller Kids First
Research program, which is the same as the fiscal year 2025
enacted level.
Gene Expression.--The Committee notes recent precision
medicine developments focused on commercialized blood/biopsy
tests that provide clinical decision support by analyzing gene
expression, for example RNA, to determine disease status,
identify abnormalities in drug targets, and predict drug
options. The benefits of this technology include the ability to
stretch clinical trial resources efficiently to address patient
needs. The Committee acknowledges that if properly implemented
during the drug development process, this technology could
increase the likelihood that a drug will be approved by the FDA
and that, after approval, it will reach patients who
desperately need the drug to improve their condition. The
Committee directs NIH to provide an update in the fiscal year
2027 congressional justification on efforts and progress made
to implement clinical decision support that incorporates
genomic information.
INCLUDE Down Syndrome Research Initiative.--The Committee
includes no less than $110,000,000, a $20,000,000 increase
above the level provided in fiscal year 2025, within OD for the
INvestigation of Co-occurring conditions across the Lifespan to
Understand Down syndrome (INCLUDE) Initiative. With the
Committee's support, NIH launched the INCLUDE Initiative in
June 2018. The Committee remains pleased with a focus on large
cohort studies across the lifespan, novel clinical trials, and
multi-year, trans-NIH research driving important advances in
understanding immune system dysregulation, Alzheimer's disease,
and leukemia that is contributing to improvements in the health
outcomes and quality of life of individuals with Down syndrome
as well as millions of typical individuals. The Committee
directs NIH to provide an updated plan within 60 days of
enactment of this Act that includes a timeline and description
of potential grant opportunities and deadlines for all expected
funding opportunities so that young investigators and new
research institutions may be further encouraged to explore
research in this space. This plan should also incorporate and
increase pipeline research initiatives specific to Down
syndrome and be made available on the agency's website.
Infection Associated Chronic Conditions and Illnesses
(IACCIs).-- These are a related family of diseases with many
overlapping similarities and commonalities. The Committee urges
NIH to streamline, coordinate, and synergize research for
IACCIs across the NIH institutes, centers, and offices, to
reduce duplication, inefficiency, and redundancies.
Menopause Research.--The Committee is aware of the research
gaps related to basic research into and knowledge and
understanding of menopause and perimenopause and treatments.
Addressing this gap could improve health outcomes and the
quality of life for the nation's middle aged and older women.
The Committee encourages NIH to research more into the
different stages of menopause, including research related to
symptoms and treatments for menopause at its different stages.
As part of the fiscal year 2027 congressional justification,
the Committee requests an update on recent NIH research into
menopause and its treatments.
Mental Health, Addiction, and Resilience Research.--
Diseases of the mind and brain can develop early in life,
contribute to the burden of overall health and daily life
function, and contribute to the persistent and rising rates of
deaths of despair from mental illness and addiction. The
Committee encourages NIH to support collaborative research
efforts to uncover the root causes, risk, and resilience/
protective factors of mental health and addiction. These
efforts could include leveraging existing longitudinal research
to examine the biological, psychological, and social factors
and their interactions across multiple layers of analysis that
put people at risk for addiction and mental illness including
patterns of intergenerational transmission of mental illness,
discover ways to better prepare and respond to stress, trauma
and adversity, and inform and guide new strategies for
prevention, recovery, and resilience.
Microplastics.--The Committee notes that research has
identified microplastics and nanoplastics in water, food, and
air, and in the human body. The Committee encourages NIH to
review primary chemicals in the life cycle analysis of plastic
materials and impacts on human health. The Committee also
requests that NIH research the presence of microplastics and
nanoplastics in the human body and the impacts on health.
Mitochondrial Disease.--The Committee recognizes the need
for the NIH to prioritize research on primary and secondary
mitochondrial disease. A constellation of rare diseases linked
to impaired mitochondrial function needs further research while
potentially promising interventions work through the FDA
approval process. At the same time, research continues to
validate the substantial connections between mitochondrial
function and major conditions such as Alzheimer's, Parkinson's,
ALS, Muscular Dystrophy, heart failure, and long COVID. The
Committee strongly encourages NIH to advance primary
mitochondrial disease research, continue its ongoing outreach
and collaboration with the FDA related to research that may
lead to future mitochondrial disease-related drug approvals,
ensure that support for long COVID research includes
opportunities for studies to explore the role of mitochondrial
impairment, and ensure that opportunities remain available to
support collaborative research on mitochondrial disease to
centralize a critical mass of research, clinical care, and
provider education.
Morgan Island.--The Committee is concerned about the Morgan
Island rhesus macaque breeding colony supported by NIAID and
available for other institutes and centers to use for research
purposes. The Committee understands that the more than 3,000
NIAID-owned rhesus monkeys currently held there are considered
an invasive species that may pose health and environmental
risks. The Committee is aware other Federal agencies such as
the FDA and Department of Veterans Affairs are implementing
initiatives to reduce animal testing and research in animals,
respectively, and in the case of the FDA to advance new
alternative methods (NAMs), too. The Committee commends NIH's
recently announced efforts to advance human-focused research,
such as NAMs, and reduce the use of animals. Such efforts will
encourage research investigators to consider and use the models
that best translate research findings to human health and
disease. The Committee urges NIH to assess whether there
remains a scientific need to continue breeding primates on
Morgan Island. Such assessment should be included in the fiscal
year congressional justification.
Mucopolysaccharidoses and Mucolipidosis.--The Committee
recognizes the severity of Mucopolysaccharidoses and
Mucolipidosis (MPS/ML) diseases and the need for additional
research to improve life expectancy and quality of life for
patients.
National Primate Research Centers and Caribbean Primate
Research Center.--The Committee does not include funding for
this activity.
Neuroarts Research.--The Committee notes the contribution
of NIH to the burgeoning field of neuroarts, which shows great
promise in advancing health and wellbeing for all.
Neurofibromatosis.--The Committee supports efforts to
increase funding and resources for Neurofibromatosis (NF)
research and treatment at multiple Institutes, including NCI,
NINDS, NIDCD, NHLBI, NICHD, NIMH, NCATS, and NEI. Children and
adults with NF are at elevated risk for the development of many
forms of cancer, deafness, blindness, developmental delays, and
autism. The Committee encourages NCI to continue to support a
robust NF research portfolio in fundamental laboratory science,
patient directed research, and clinical trials focused on NF-
associated benign and malignant cancers. The Committee also
encourages NCI to support preclinical research and clinical
trials. Because NF can cause blindness, pain, and hearing loss,
the Committee urges NINDS and NIDCD to continue to support
fundamental basic science research on NF relevant to restoring
normal nerve function. Based on emerging findings from numerous
researchers worldwide demonstrating that children with NF have
a higher chance of developing autism, learning disabilities,
motor delays, and attention deficits, the Committee encourages
NINDS, NIMH, and NICHD to continue their support of research
investigations in these areas. Since NF2 accounts for some
genetic forms of deafness, the Committee encourages NIDCD to
expand its investment in NF2-related research. NF1 can cause
vision loss due to optic gliomas. The Committee encourages NIH
to expand its investment in NF1-focused research on optic
gliomas and vision restoration.
Non-Human Primates.--The Committee recognizes the critical
role of non-human primate research in virtually all areas of
biomedical research. Research with these unique models makes
irreplaceable contributions to understanding the biological
processes that cause diseases. These models are essential in
the discovery and evaluation of new therapeutics before they go
to clinical trials. As the U.S. population ages, and millions
of Americans suffer from chronic and degenerative diseases,
including those that affect the nervous system such as
Alzheimer's and Parkinson's disease, non-human primate research
will continue be vital to understanding both the underlying
mechanisms and potential cures for these diseases. Non-human
primate research remains critical to understand the causes of
age-related degenerative diseases and to improve the
effectiveness of new compounds and non-pharmaceutical
treatments such as deep brain stimulation, neuromodulation,
cancer, chronic pain, and metabolic disorders. The Committee
encourages NIH to award funding to meritorious research
proposals to study these degenerative disorders, as well as
research into preventing the next pandemic, including studies
that utilize non-human primates.
Nutrition Research.--The Committee acknowledges NIH's past
investments in nutrition research, including through various
institutes and centers, the Office of Nutrition Research, and
initiatives such as the Nutrition for Precision Health powered
by the All of Us Research program. The Committee also notes the
recently announced NIH-FDA initiative, the Nutrition Regulatory
Science Program. This effort seeks to advance nutrition
research to inform policy decisions and improve health
outcomes, by exploring research topics such as the relationship
between ultra-processed foods and health, maternal and infant
dietary exposures and health outcomes over the lifespan, and
others. The Committee notes with concern the limited research
into rates of chronic disease among the population and the role
of nutrition in preventing and addressing chronic disease. To
support increased NIH investment in nutrition and its relation
to human health and disease, the Committee directs an increase
of $10,000,000 for nutrition research, out of funding available
under the Office of the Director.
Office for Research on Women's Health.--The Committee
provides $100,000,000 for the Office of Research on Women's
Health, which is $23,520,000 above the fiscal year 2024 enacted
level. The Committee recognizes that women's health includes
conditions and diseases that disproportionately or differently
affect women and that sex differences are at the cellular
level. Despite prior investments and progress made, gaps remain
in research, scientific understanding, and medical care due to
factors such as a lack of consistent sex-based data,
coordination across disciplines, and representative
participation in clinical trials. The Committee notes that
opportunities to enhance NIH efforts focused on the health of
women across the lifespan could address these gaps and urges
NIH to prioritize research that addresses the most pressing
research gaps. The Committee supports expanded, integrated NIH-
wide investment in women's health research focused on
accelerating innovative biomedical discoveries and solutions
and requests an update in the fiscal year 2027 congressional
justification on such research.
Open Access Genetic Sequence Data Repositories.--The
Committee is concerned NIH may not have sufficient safeguards
in place for open access databases with human genetic data. The
Committee directs NIH to submit a report within 180 days of
enactment of this Act on the authentication protocols in place
to restrict the ability for foreign adversary entities to
access such a database.
Osteopathic Medical Schools.--Osteopathic medicine
represents a vibrant portion of the medical student education
and health systems ecosystem. However, the Committee remains
concerned with the historic disparity in NIH funding and
representation for Colleges of Osteopathic Medicine (COMs), as
well as NIH's past failure to respond to requests to create an
action plan to address the agency's chronic underfunding of
osteopathic research and underrepresentation of osteopathic
scientists on NIH National Advisory Councils and study
sections. Additionally, the Committee is concerned that NIH
continues to associate osteopathic medicine most strongly with
the National Center for Complementary and Integrative Health
(NCCIH). The Committee encourages the NIH to expand funding
opportunities and representation across NIH Institutes and
Centers, outside of NCCIH. Further, the Committee requests NIH
include in the fiscal year 2027 congressional justifications
information on the representation of COMs in NIH applications
and awards. Additionally, the Committee encourages engagement
by the NIH with osteopathic education leaders.
Pediatric Lyme Disease.--As part of the fiscal year 2027
congressional justification, the Committee requests an update
on the agency's plans to advance research on pediatric Lyme
disease. The Committee encourages NIH, including NIAID, NINDS
and NIMH, to increase study of neurologic symptoms of Lyme
disease, including in children, and to investigate novel
treatments of neurologic symptoms.
Pediatric Researchers.--The Committee urges NIH to maintain
a robust pediatric research portfolio spanning basic,
translational, and clinical research, to support early career
researchers focused on pediatrics, to ensure pediatric
components are included within larger NIH research priorities,
structures or processes influence the number of investigator-
initiated pediatric research projects, pediatric research
priorities are established, and pediatric research activity is
coordinated across NIH.
Peripheral Neuropathy.--Peripheral neuropathy is a
debilitating condition that affects 30 million Americans, often
causing considerable pain, mobility issues, and other forms of
disability. The Committee encourages NIH institutes researching
peripheral neuropathy to coordinate efforts related to the
diagnosis and treatment of various types of peripheral
neuropathy. There are several known causes of this condition,
including Type 2 diabetes and chemotherapy. The Committee
encourages NIH to consider the merits of a Peripheral
Neuropathy Center of Excellence program, as part of NIH's
overall efforts to expand research into the multiple causes and
manifestations of this condition.
Physician Scientist Workforce.--The Committee encourages
NIH to continue supporting efforts to increase the number of
physician-scientists who pursue biomedical research
opportunities. Such efforts could include supporting research-
oriented career development grants with mentorship activities
and postdoctoral trainees, empowering researchers to
independently pursue new fields of research, and building on
the findings of its June 2014 Physician-Scientist Workforce
Working Group Report.
Polycystic Ovary Syndrome.--The Committee commends OD for
incorporating Polycystic Ovary Syndrome (PCOS) into Research,
Condition, and Disease Categories (RCDC) reporting. Despite
progress, the Committee notes the profound impact that PCOS has
on 10 percent of women and its annual economic burden of over
$15,000,000,000 in the U.S., compared to $10,000,000 in
research projects supported in 2023, per the RCDC. PCOS has a
large health and economic burden, given its metabolic,
cardiovascular, reproductive, maternal health, and mental
health manifestations and the lack of FDA approved treatments
specifically for it. The Committee urges increased NIH support
for PCOS research, including the metabolic, cardiovascular,
psychosocial, maternal fetal, oncologic, pediatric,
dermatologic, neurologic, and reproductive aspects of PCOS. The
Committee encourages the NIH to invest in fundamental
laboratory science, patient-oriented research, clinical trials,
and longitudinal studies on the cardiometabolic features and
endocrinopathy of PCOS throughout the lifespan. Areas of
interest include closing knowledge gaps, researching novel
diagnostics and treatments, research opportunities identified
from the NHLBI report based on its 2021 NIH workshop on
cardiovascular risks across the lifespan in PCOS, and applying
insights from the PCOS Externally Led Patient-Focused Drug
Development Meeting and Voice of the Patient Report to address
patients' unmet needs and treatment priorities.
Replication Experiments and Fraud Detection.--The Committee
is concerned that many biomedical research studies have turned
out to be irreproducible or even outright fraudulent. The
recent Reproducibility Project in Cancer Biology showed that
cancer biology studies in top journals often failed to be
replicable (with replication effects that were 85 percent
smaller than the original study), and a prominent line of
Alzheimer's studies was found in recent years to be based on an
allegedly fraudulent study funded by NIH in the early 2000s.
Additionally, the Committee commends the NIH for setting
reproducibility and rigor among its key priorities, as outlined
in the budget request, for enabling the agency to advance
science in pursue of improving health for Americans, as well as
to restore public trust and confidence in the agency's research
findings. Given the importance of both reproducibility in the
scientific enterprise and the detection of fraud, the Committee
provides $100,000,000 to establish a program out of the Common
Fund in the Office of the Director to fund replication
experiments on significant lines of research, as well as
attempts to proactively look for signs of academic fraud. The
Committee directs NIH to brief the Committee within 180 days of
enactment of this Act on the establishment, staffing, and plans
for this effort in fiscal years 2026 and 2027.
Reporting on Monetary Donations.--The Committee is
concerned by findings in the HHS OIG report, ``Most
Institutions That Received NIH Funding Did Not Fully Understand
When They Must Report Monetary Donations,'' published in March
2025. NIH-funded institutions must report all ``other support''
that their NIH-funded investigators receive related to their
research, including resources from foreign and domestic
entities, such as financial support, high-value materials, and
in-kind contributions such as laboratory space or employees.
Before making awards, NIH uses this to determine if the other
support and an NIH award would result in a scientific,
budgetary, or commitment overlap. NIH disburses more than 80
percent of its approximately $48 billion budget to
universities, medical schools, and other research institutions.
It is therefore concerning that only one in five institutions
that responded to OIG's survey could accurately identify
instances in which they must report monetary donations to NIH.
One quarter of the institutions did not correctly identify any
of the instances that require monetary reporting. Insufficient
reporting by institutions undermines NIH's oversight of awards,
and it increases the risk that taxpayer dollars are spent on
duplicative support to researchers. The Committee requests an
update in the fiscal year 2027 congressional justification on
NIH's efforts to implement the OIG's recommendation that NIH
provide clarity to institutions on their monetary reporting
requirements.
Sjogren's Disease.--Recognizing that research into
Sjogren's disease can lead to improved care for those living
with this disease, the Committee requests an update in the
fiscal year 2027 congressional justification on NIH research
and other activities related to the diagnosis and treatment of
Sjogren's disease.
Somatic Mosaicism Across Human Tissues Program.--The
Somatic Mosaicism across Human Tissues program, supported by
the Common Fund, aims to discover somatic mutations in the
tissues of 150 otherwise healthy, but deceased individuals, to
identify fundamental mutational mechanisms that may give rise
to common human diseases. The Committee encourages continued
support of such efforts, including planned efforts to generate
somatic variant catalogs, develop of tools and methods, and
create an integrative data workbench.
Spina Bifida Research.--The Committee encourages NIH to
study the causes and care of the neurogenic bladder to improve
the quality of life of children and adults with spina bifida,
and to support research related to the treatment and management
of spina bifida and associated conditions, such as
hydrocephalus, wounds and related amputations, and sudden death
in the adult spina bifida population. The Committee requests an
update in the fiscal year 2027 congressional justification on
research findings on spina bifida and related issues. The
Committee supports NICHD's research to understand early human
development, set the foundation for a healthy pregnancy, and
promote lifelong wellness of women and children with spina
bifida. NIH is encouraged to support research to identify time
sensitive periods to optimize health interventions,
therapeutics, and devices to improve health during transition
from adolescence to adulthood.
Success Rates.--No later than 180 days after enactment of
this Act, the agency is directed to publicly post and maintain
on the agency's website a listing of all grant success rates by
institute or center, grant mechanism, and fiscal year. Such
website information shall be easily accessible and include
options to export into an electronic data format. Initial
information should include the last 10 years, to the extent
practicable, and be maintained on the website indefinitely.
Ultra Processed Foods.--The Committee recognizes more
research is required to better understand the health impacts of
ultra-processed foods, and how to best define ultra-processed
foods. The Committee encourages NIH, in coordination with CDC
and FDA, to support research on ultra-processed foods.
BUILDINGS AND FACILITIES
Appropriation, fiscal year 2025....................... $350,000,000
Budget request, fiscal year 2026...................... 210,000,000
Committee Recommendation.............................. 352,000,000
Change from enacted level......................... +2,000,000
Change from budget request........................ +142,000,000
Mission.--This account provides for the design,
construction, improvement, major repair, and demolition of
clinical, laboratory, and office buildings and supporting
facilities essential to the mission of the NIH. The funds in
this appropriation support the buildings on the main NIH campus
in Bethesda, Maryland; the Animal Center in Poolesville,
Maryland; the National Institute of Environmental Health
Sciences facility in Research Triangle Park, North Carolina;
the National Institute of Allergy and Infectious Diseases in
Hamilton, Montana; and other smaller facilities throughout the
U.S.
The Committee understands that safe, reliable, and up-to-
date facilities are integral for supporting NIH research now
and in the future. The Committee is aware that according to the
fiscal year 2027 congressional justification, the agency's
maintenance and repairs backlog across its campuses exceeded
$4.1 billion as of the end of fiscal year 2024. The Committee
appreciates the Building and Facilities program's commitment to
its Repairs and Improvements program, as such investments in
existing facilities are intended to enhance facility
performance and reduce building emergencies which can be costly
and disruptive to research.
NIH INNOVATION ACCOUNT
Appropriation, fiscal year 2025....................... $127,000,000
Budget request, fiscal year 2026...................... 226,000,000
Committee Recommendation.............................. 226,000,000
Change from enacted level......................... +99,000,000
Change from budget request........................ - - -
This account supports NIH programs authorized in the Cures
Act. The Committee recommendation includes funding for
initiatives authorized by the Cures Act; $31,000,000 for the
All of Us precision medicine initiative within the Office of
the Director and $195,000,000 for the BRAIN initiative split
equally between NIMH and NINDS. The Committee notes that fiscal
year 2026 is the final year of funding from the Cures Act for
these activities.
ADVANCED RESEARCH PROJECTS AGENCY FOR HEALTH (ARPA-H)
Appropriation, fiscal year 2025....................... $1,500,000,000
Budget request, fiscal year 2026...................... 945,000,000
Committee Recommendation.............................. 945,000,000
Change from enacted level......................... -555,000,000
Change from budget request........................ - - -
Mission.--The Advanced Research Projects Agency for Health
fosters the development of novel, breakthrough, and broadly
applicable capabilities and technologies to accelerate
transformative innovation in biomedical science and medicine in
a manner that cannot be readily accomplished through
traditional Federal biomedical research and development
programs or commercial activity.
Commercialization Network.--Speeding the translation of
innovative health technologies to market is essential for the
success of ARPA-H. This acceleration depends on meaningful
collaboration between researchers, entrepreneurs, and investors
across sectors and geographic areas. The Committee supports the
establishment of the Investor Catalyst Hub in the ARPANET-H
hub-and-spoke network and appreciates its initial efforts to
build a wide-ranging network of experts to advance innovation
and commercialization of medical technologies. Additionally,
the Committee notes the role of funding sprints to rapidly
accelerate innovation in targeted priority areas, by delivering
specialized entrepreneurial assistance, commercialization and
market readiness programming, and other targeted services as
innovators seek to translate critical transformative biomedical
and health breakthroughs.
Fall Prevention Research.--Falls are the top cause of
injury and injury-related death among adults 65 and older. The
Committee encourages ARPA-H to support research on fall risk
factors and interventions to reduce falls among older adults.
Lyme and Other Tick-Borne Diseases (TBD).--The Committee
recognizes the value of and encourages ARPA-H to evaluate the
potential benefits of supporting research and development
programs and projects related to TBD. Examples of potential
research and development activities may include research
related to TBD diagnostics and Bartonella unit.
Mental Health Research.--The Committee encourages ARPA-H to
support mental health research, including on the diagnosis and
treatment of severe mental illness to address widespread
behavioral health issues. The committee also encourages
research on developing treatments and cures for dementia, given
the prevalence and impact of this disease on society and the
potential for such an investment to spur industry developments
and new academic partnerships.
Nanovaccine Research.--The Committee recognizes the
importance of investing in vaccine research at U.S.
universities to improve upon existing vaccines such as room
temperature stable nanovaccines that can be rapidly designed,
tested, and deployed. The Committee encourages ARPA-H to
support funding for academic researchers working on
nanovaccines.
Respiratory Health.--The Building Resilient Environments
for Air and Total Health (BREATHE) program seeks to
revolutionize the early detection, treatment, and long-term
management of respiratory conditions, including asthma, COPD,
pulmonary fibrosis, and other lung diseases. The Committee
recognizes that current diagnostics and therapies for many
respiratory illnesses remain inadequate, and that improved
interventions could improve patient outcomes and reduce health
care system costs. The Committee encourages ARPA-H to include
populations living in communities with poor air quality as part
of efforts to continue this program.
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
Insert 133AAppropriation, fiscal year 2025............ $7,374,306,000
Budget request, fiscal year 2026...................... 5,693,278,000
Committee Recommendation.............................. 7,075,855,000
Change from enacted level......................... -298,451,000
Change from budget request........................ +1,382,577,000
The Committee recommendation for the SAMHSA program level
includes $6,932,188,000 in discretionary budget authority,
$131,667,000 in PHS Evaluation Tap Funding, and $12,000,000 in
transfers from the PPHF.
SAMHSA is the agency within HHS that leads public health
efforts to reduce the impact of substance abuse and mental
illness in the United States. The Committee notes that CDC's
provisional data on national drug overdose fatalities revealed
a promising 26.9 percent decrease in 2024, reaching the lowest
level since 2019. While drug overdose fatalities remain
exceptionally high, the Committee commends this progress and
recognizes SAMHSA's efforts in reducing drug overdose
fatalities in the United States.
The Committee further notes that the Department proposes to
incorporate SAMHSA into a new Administration for a Healthy
America. The Committee looks forward to working with the
authorizing committees of jurisdiction as they consider this
proposal.
The Committee continues to include bill language that
exempts the MHBG and the SUPTRS Block Grant as a source of
funding for the PHS Act section 241 evaluation set-aside in
fiscal year 2025.
Eligible Grantees.--Where permitted in the authorizing
statute, the Committee directs SAMHSA, when issuing new funding
opportunity announcements, to include as an eligible applicant
States, political subdivisions of States (including local
governments, communities, and municipalities), Tribes or Tribal
organizations, other public or nonprofit entities, and faith-
based organizations. The Committee encourages SAMHSA to provide
outreach and technical assistance to ensure the maximum level
of awareness and participation in new grant announcements to
ensure robust competition.
Female Adolescent Mental Health.--The Committee remains
concerned about the high rates of mental health challenges and
suicidal ideation among adolescent females. Recent studies find
that adolescent females are highly susceptible to negative
health outcomes associated with extended social media use,
including higher rates of psychological distress, body image
issues, and eating disorders. The Committee directs the
Secretary, through SAMHSA, to work across HHS, and in
consultation with other departments as appropriate, to develop
a comprehensive interagency coordinating plan to improve
adolescent mental health, with a focus on the unique challenges
facing female adolescents. The Committee requests a briefing
outlining these efforts within 180 days of enactment of this
Act.
Gambling Addiction.--The Committee notes that problem
gambling costs the United States millions each year. This
behavioral disorder often leads to poor financial, emotional,
social, occupational, and physical health outcomes. Therefore,
the Committee directs SAMHSA to include in its fiscal year 2027
congressional justification information on how the agency is
supporting prevention and treatment efforts for individuals
struggling with gambling addiction.
Hair Testing Guidance.--The Committee recognizes that
section 5402 of the Fixing America's Surface Transportation
(FAST) Act (P.L. 114-94) required the Secretary to ``issue
scientific and technical guidelines for hair testing as a
method of detecting the use of a controlled substance for
purposes of section 31306 of title 49, United States Code,''
which is the drug and alcohol testing program for operators of
commercial motor vehicles. While more than seven years have
passed since the enactment of the FAST Act, the Committee notes
that HHS is currently considering hair testing as an
alternative method of drug testing and issued proposed
mandatory guidelines relating to hair testing in September
2020, but has not issued final guidelines, as required by the
FAST Act.
The Committee also recognizes that since the FAST Act was
signed into law, our nation has experienced a crippling
substance use epidemic--particularly from opioids, synthetic
opioids, and polysubstance abuse--and Federal inaction to
recognize hair testing as a viable alternative to urinalysis
has denied Americans a legitimate tool to stem the crisis. This
is a glaring reminder that drug-impaired driving remains a
serious issue and poses a tremendous risk to the safety of the
motoring public. Therefore, the Committee directs HHS to
produce guidelines for the use of hair testing as an
alternative drug testing method for commercial motor vehicle
operators, in accordance with section 5402 of the FAST Act. The
Committee requests an update on this effort in the fiscal year
2027 congressional justification.
Harm Reduction.--The Committee commends the Trump
Administration's efforts to prioritize prevention, treatment,
and long-term recovery in relation to substance use disorder.
The Committee continues to support the availability and
provision of naloxone to reduce overdose deaths, however, the
Committee provides no funding to support harm-reduction
activities related to supporting the continued use of illicit
controlled substances.
Homelessness.--The Committee directs HHS to include in the
fiscal year 2027 congressional justification information on how
the Department currently prioritizes substance use and mental
health programs for populations at high risk of becoming
homeless, evaluates the effectiveness of current policies, and
considers new policies that could lead to improved outcomes.
The Committee also directs HHS to prioritize programs that
require proper treatment, robust accountability, and pathways
to self-sufficiency.
Right to Bear Arms.--The Committee recognizes that firearm
ownership is a constitutionally guaranteed right recognized by
the United States Supreme Court. SAMHSA should issue no
guidance, nor make a requirement of any recipient of Federal
funding, that seeks to restrict, limit, hinder, or further
diminish this fundamental right.
Rural Opioid Technical Assistance Regional Centers.--The
Committee directs SAMHSA to maintain funding for the 10
cooperative agreements under the Rural Opioid Technical
Assistance Regional Centers program at not less than the fiscal
year 2024 level without consolidation of the program. The
Committee further directs SAMHSA to provide a briefing on this
topic within 90 days of enactment of this Act.
Substance Abuse Treatment.--The Committee recognizes the
potential benefits of Glucagon-like peptide-1 (GLP-1)
medications in treating and reducing alcohol and substance
abuse disorders and encourages SAMHSA to take steps to support
the use of GLP-1s to target such disorders.
Suicide Prevention.--The Committee recognizes that suicide
is a serious public health problem requiring strategic suicide
prevention solutions, especially among disproportionately
impacted populations. The Committee further recognizes that
suicide prevention requires a strategic public health approach
that addresses multiple risk factors at the individual,
community, and societal levels. States, Tribes, and territories
are most suited to lead a comprehensive public health approach
to suicide prevention, which demands effectively coordinating
with multisector partners to take a data-driven, evidence-based
process that addresses the broad range of risk and protective
factors associated with suicide.
MENTAL HEALTH
Appropriation, fiscal year 2025....................... $2,808,546,000
Budget request, fiscal year 2026...................... 1,463,331,000
Committee Recommendation.............................. 2,700,560,000
Change from enacted level......................... -107,986,000
Change from budget request........................ +1,237,229,000
988 Suicide & Crisis Lifeline
The Committee provides $519,618,000 for the 988 Suicide &
Crisis Lifeline, which is the same as the fiscal year 2025
enacted program level, to support the national suicide hotline
to continue to support State and local suicide prevention call
centers as well as a national network of backup call centers
and the national coordination of such centers.
Campus Awareness Activities.--The Committee encourages HHS,
in coordination with the Department of Education and relevant
State and local stakeholders, to increase awareness of the 988
Lifeline among college students, including the publication of
988 on newly-printed standard issue student identification
cards.
Program Integrity.--The Committee recognizes the vital work
of the 988 Lifeline service and the important role of State
partners in suicide prevention and behavioral health. As States
continue to establish and develop 988 programs, the Committee
directs SAMHSA to maintain State choice in their technology
platform. States should have the flexibility to utilize a
platform that best facilitates seamless coordination with local
crisis and emergency response teams, accommodates a connection
to follow-up and community resources, incorporates robust
cybersecurity standards, and ensures that sensitive user data
is being safeguarded and protected. In addition, the Committee
requests a briefing within 90 days of enactment of this Act on
SAMHSA's 988 program integrity activities, including with
respect to safeguarding 988 user data, strengthening 988
cybersecurity infrastructure, and responding to feedback from
States and other 988 program partners.
Public Awareness and Education Activities.--The Committee
remains concerned that suicide is a leading cause of death in
the United States, with particular concern regarding the
suicide rates among youth, adolescents, young adults, veterans,
and rural and underserved communities. The Committee notes that
despite studies repeatedly demonstrating that crisis
intervention services such as 988 are effective in reducing
suicidal ideation and providing support to individuals in
crisis, public awareness of the 988 Lifeline remains below 50
percent. Therefore, the Committee directs SAMHSA to prioritize
funding for 988 public awareness and education activities
targeted toward all high-risk populations. The Committee
requests that SAMHSA include an update in the fiscal year 2027
congressional justification on the agency's progress in
addressing disparities in public awareness and utilization of
the 988 Lifeline, including the allocation of funds for
carrying out public awareness and education activities.
Tribal Capacity Building.--Tribal Nations continue to face
unique challenges with fully adopting 988 services, including
access to technology and crisis support services,
intergovernmental coordination, and culturally responsive
mental health services. Therefore, the Committee requests a
briefing within 90 days of enactment of this Act on SAMHSA's
988 crisis capacity activities as they relate to Tribal
communities funded under the Bipartisan Safer Communities Act
(P.L. 117-159).
Assisted Outpatient Treatment for Individuals With Serious Mental
Illness
The Committee provides $26,420,000 for Assisted Outpatient
Treatment for Individuals with Serious Mental Illness (AOT),
which is a $5,000,000 increase above the fiscal year 2025
enacted program level, to deliver outpatient treatment under a
civil court order to adults with a serious mental illness who
meet State civil commitment AOT criteria, such as prior history
of non-adherence to treatment, repeated hospitalizations, or
arrest. The Committee notes that AOT may reduce psychiatric
hospitalizations, emergency department visits, and
incarceration rates while improving health outcomes and
treatment satisfaction and adherence. The Committee encourages
HHS to continue supporting the implementation and evaluation of
new AOT programs, including the continued support for the
technical assistance center. The Committee notes ongoing
assessment challenges of existing AOT programs and urges the
Department to identify program metrics that can be reliably
reported by grantees for the purpose of assessing the grant
program's effectiveness. The Department should also continue to
work with grantees to ensure that their programs are consistent
with the goals of the AOT program and focused on serving
participants who would not otherwise agree to participate in
treatment voluntarily.
Certified Community Behavioral Health Clinics
The Committee provides $385,000,000 for the CCBHC program,
which is the same as the fiscal year 2025 enacted program
level. CCBHCs are designed to ensure access to coordinated,
comprehensive behavioral health care by providing services for
mental health and substance use disorders to all who request
them, regardless of age or ability to pay. CCBHCs provide
access to crises services around the clock, support outpatient
mental health and substance use treatment, and provide
community-based mental health care for veterans.
Technical Assistance and Screening for Physical Health
Conditions.--The Committee recognizes that individuals living
with serious mental illnesses and substance use disorders face
higher risks for developing chronic physical conditions
commonly associated with long-term use of certain mental health
medications, including diabetes, cardiovascular disease, and
medication-induced movement disorders. The Committee encourages
SAMHSA to expand technical assistance to improve integrated
care through the CCBHC State Technical Assistance Center and
the CCBHC Expansion Grantee National Training and Technical
Assistance Center. This technical assistance and training would
enhance routine screening, prevention, and early intervention
for physical health conditions commonly associated with long-
term use of antipsychotic medications, particularly among high-
risk populations. The Committee further encourages SAMHSA to
coordinate with HRSA to facilitate dissemination of technical
information on screening at-risk patients in integrated care
models to Federally Qualified Health Centers and Rural Health
Clinics.
Children's Mental Health Services
The Committee provides $132,000,000 for Children's Mental
Health Services, which is a $2,000,000 increase above the
fiscal year 2025 enacted program level, to fund grants and
technical assistance for community-based services for children
and adolescents with serious emotional, behavioral, and/or
other mental health disorders. Grants assist States, local
jurisdictions, and Tribes in developing integrated systems of
community care. The Committee directs SAMHSA to continue
supporting grant funding and the technical assistance center,
including increasing mental health services and supports for
children and youth.
Mental Health Services Block Grant
The Committee provides $1,017,571,000 for the MHBG, which
is $10,000,000 above the fiscal year 2025 enacted program
level. Of the funds provided, $21,039,000 shall be derived from
evaluation set-aside funds available under section 241 of the
PHS Act. The MHBG provides funds to States to support mental
illness prevention, treatment, and rehabilitation services.
Funds are allocated according to a statutory formula among the
States that have submitted approved annual plans. The Committee
continues the 10 percent set-aside within the MHBG for
evidence-based programs that address the needs of individuals
with early serious mental illness, including psychotic
disorders among at-risk youth and young adults, and the 5
percent set-aside for crisis-based services. The Committee
notes that, consistent with State plans, communities may choose
to direct additional funding to crisis stabilization programs.
Behavioral Health Integration.--The Committee encourages
SAMHSA to develop school-based and evidence-based best
practices addressing behavioral health intervention training to
support practices that assist children and youth with
behavioral health needs, including behavioral intervention
teams, a team of qualified mental health professionals who are
responsible for identifying, screening, and assessing behaviors
of concern and facilitating the implementation of evidence-
based interventions.
National Child Traumatic Stress Initiative
The Committee provides $100,887,000 for the National Child
Traumatic Stress Initiative (NCTSI), which is a $2,000,000
increase above the fiscal year 2025 enacted program level, to
increase access to effective trauma and grief focused treatment
and services systems for children, adolescents, and their
families, who experience traumatic events. The Committee
recognizes NCTSI's network for building, evaluating,
disseminating, and delivering evidence-based services and best
practices to prevent and mitigate the impact of exposure to
trauma among children and families. The Committee encourages
SAMHSA to continue awarding new Category I, II, and III grants
to meet core mission activities of NCTSI, support collaboration
among grantees, and expand the capacity of current National
Child Traumatic Stress Network grantees for activities related
to child trauma.
Projects for Assistance in Transition From Homelessness
The Committee provides $66,635,000 for the Projects for
Assistance in Transition from Homelessness program, which is
the same as the fiscal year 2025 enacted program level, to
provide grants to States and territories for assistance to
individuals suffering from severe mental illness and/or
substance use disorders and who are experiencing homelessness
or are at imminent risk of becoming homeless. Grants may be
used for outreach, screening and diagnostic treatment services,
rehabilitation services, community mental health services,
alcohol or drug treatment services, training, case management
services, supportive and supervisory services in residential
settings, and a limited set of housing services.
Protection and Advocacy for Individuals With Mental Illness
The Committee provides $40,000,000 for the Protection and
Advocacy for Individuals with Mental Illness program (PAIMI),
which is the same as the fiscal year 2025 enacted program
level, to support legal-based advocacy services to ensure the
rights of individuals with mental illness, protect and advocate
for these rights, and investigate incident of abuse and/or
neglect. The Committee notes that Federal funding continues to
supplement non-Federal funds available to States for PAIMI
activities.
Within the total provided for Mental Health Programs of
Regional and National Significance, the Committee includes the
following amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity FY 2025 Enacted Committee
------------------------------------------------------------------------
Capacity:
Seclusion and Restraint....... $1,147,000 $1,147,000
Project AWARE................. 140,001,000 126,551,000
Tribal Set-Aside.......... - - - 12,655,000
Mental Health Awareness 27,963,000 - - -
Training.....................
Healthy Transitions........... 28,451,000 28,451,000
Infant and Early Childhood 15,000,000 15,000,000
Mental Health................
Children and Family Programs.. 7,229,000 8,229,000
Consumer and Family Network 4,954,000 - - -
Grants.......................
Project LAUNCH................ 23,605,000 - - -
Mental Health System 3,779,000 - - -
Transformation...............
Primary and Behavioral Health 55,877,000 55,877,000
Care Integration.............
Mental Health Crisis Response 20,000,000 - - -
Grants.......................
National Strategy for Suicide 28,200,000 30,200,000
Prevention...................
Zero Suicide.............. 22,800,000 23,800,000
American Indian and Alaska 3,400,000 4,400,000
Native Set-Aside.........
Garrett Lee Smith-Youth
Suicide Prevention
State Grants.............. 43,806,000 46,806,000
Campus Grants............. 8,488,000 12,488,000
American Indian and Alaska 3,931,000 4,931,000
Native Suicide Prevention....
Tribal Behavioral Health 22,750,000 30,000,000
Grants.......................
Homeless Prevention Programs.. 33,696,000 - - -
Minority AIDS................. 9,224,000 - - -
Criminal and Juvenile Justice 11,269,000 - - -
Programs.....................
Assertive Community Treatment 9,000,000 9,000,000
for Individuals with Serious
Mental Illness...............
Interagency Task Force on 2,000,000 2,000,000
Trauma-Informed Care.........
Science and Service:
Garrett Lee Smith-Suicide 11,000,000 11,000,000
Prevention Resource Center...
Practice Improvement and 7,828,000 7,828,000
Training.....................
Consumer and Consumer Support 1,918,000 1,918,000
Technical Assistance Centers.
Primary and Behavioral Health 2,991,000 2,991,000
Care Integration Technical
Assistance...................
Minority Fellowship Program... 11,059,000 11,059,000
Disaster Response............. 1,953,000 1,953,000
Homelessness.................. 2,296,000 - - -
Eating Disorder - - - 5,000,000
Identification, Treatment,
and Recovery.................
------------------------------------------------------------------------
Capacity:
Seclusion and Restraint.--The Committee provides
$1,147,000, which is the same as the fiscal year 2025 enacted
program level, to reduce the inappropriate use of seclusion and
restraint practices through the provision of technical
assistance and the promotion of alternatives to restraint,
seclusion, and other coercive practices.
Project AWARE.--The Committee provides $126,551,000 for
Project AWARE (Advancing Wellness and Resiliency in Education)
State and Tribal grants, which is a $13,450,000 decrease below
the fiscal year 2025 enacted program level and a $6,050,000
increase above the President's Budget, to implement mental
health related promotion, awareness, prevention, intervention,
and resilience activities to ensure that school-aged youth have
access and are connected to trauma-informed and developmentally
appropriate behavioral health services. The Committee notes
that program funding is intended to supplement State and local
investments in school mental health services.
Tribal Set-Aside.--Of the funds made available for Project
AWARE, the Committee directs that no less than 10 percent be
made available for Tribes and Tribal Organizations.
Mental Health Awareness Training.--The Committee provides
no funding for the Mental Health Awareness Training to better
ensure that SAMHSA prioritizes services and programing for
individuals with severe mental illness.
Healthy Transitions.--The Committee provides $28,451,000
for the Healthy Transitions program, which is the same as the
fiscal year 2025 enacted program level, to expand access to
services and supports for transition-aged youth and young
adults with serious mental illness.
Infant and Early Childhood Mental Health.--The Committee
provides $15,000,000 for the Infant and Early Childhood Mental
Health program, which is the same as the fiscal year 2025
enacted program level, to support human service agencies and
nonprofit organizations that provide age-appropriate mental
health promotion and early intervention or treatment for
children with significant risk of developing mental illness
including through direct services, assessments, and trainings
for clinicians and education providers.
Children and Family Programs.--The Committee provides
$8,229,000 for the Children and Family program, which is a
$1,000,000 increase above the fiscal year 2025 enacted program
level, to provide grants to Tribes and Tribal organizations for
community-based services and supports for children and youth,
with or at risk for mental illness.
Consumer and Family Network Grants.--The Committee provides
no funding for the Consumer and Family Network program in
accordance with the President's Budget. The Committee
prioritizes treatment, prevention, and support services for
individuals with serious mental illness and does not provide
funding for broad advocacy activities that may promote bias
views on mental health treatment.
Project Launch.--The Committee provides no funding for
Project Launch. The Committee notes that this program is
duplicative of programs in the Department of Education, the
Administration for Children and Families, and the Centers for
Disease Control and Prevention.
Mental Health System Transformation.--The Committee
provides no funding for the Mental Health System Transformation
program in accordance with the President's Budget. The
Committee notes that the Transforming Lives through Supported
Employment Program (SEP) is also funded through the Practice
Improvement and Training programs.
Primary and Behavioral Health Care Integration.--The
Committee provides $55,877,000 for the Primary and Behavioral
Health Care Integration program, which is the same as the
fiscal year 2025 enacted program level, to promote full
integration and collaboration in clinical practice between
behavioral healthcare and primary/physical healthcare. The key
goal of this program is to improve patient access to integrated
health care services which requires bilateral cooperation
between physicians and technical assistance centers.
The Committee notes that integration of primary and
behavioral health has been found to increase access to mental
health and substance use recovery services for communities,
including rural communities, that lack access to such services
and encourages SAMHSA in making awards to prioritize such
communities.
Mental Health Crisis Response Partnership Pilot Program.--
The Committee provides no funding for this program and notes
that the Edward Byrne Memorial Justice Assistance Grant
program, under the Department of Justice, provides funding for
State crisis intervention programs.
National Strategy for Suicide Prevention.--The Committee
provides $30,200,000 for the implementation of the National
Strategy for Suicide Prevention, which is a $2,000,000 increase
above the fiscal year 2025 enacted program level.
Within the amount provided, the Committee includes
$23,800,000 for the Zero Suicide program, which is an increase
of $1,000,000 above the fiscal year 2025 enacted program level.
Zero Suicide grants support suicide prevention efforts in
health systems, including screening adults for suicide risks,
providing referral services, implementing evidence-based
practices to provide services to high-risk adults, and raising
awareness of such risks.
Within the amount provided, $4,400,000 is included for Zero
Suicide grants to American Indian and Alaska Native health
systems, which is an increase of $1,000,000 above the fiscal
year 2025 enacted program level.
Garrett Lee Smith Youth Suicide Prevention.--The Committee
provides $59,294,000 for GLS Youth Suicide Prevention grant
programs, which is a $7,000,000 increase above the fiscal year
2025 enacted program level.
Within the amount provided, the Committee includes
$46,806,000 for grants to States and Tribes to support
development and implementation efforts of youth suicide
prevention activities and services, which is a $3,000,000
increase above the fiscal year 2025 enacted program level. Of
the funds provided, $12,000,000 shall be transferred from the
PPHF.
Within the amount provided, $12,488,000 is included for
grants to institutions of higher education to support students
with mental health or substance use disorders, which is an
increase of $4,000,000 above the fiscal year 2025 enacted
program level.
Garrett Lee Smith Peer Support Activities.--The Committee
recognizes that delayed mental health treatment can lead to
higher acuity, health care costs, and suicide rates. Campus
programs that provide peer training on early intervention and
education on primary prevention have shown promise in improving
treatment-seeking behaviors and mental health referrals among
students. Therefore, the Committee encourages SAMHSA to
prioritize funding for grantees that support on-campus student
groups with peer-to-peer crisis intervention training and
primary prevention education for mental health. The Committee
requests that SAMHSA include an update in the fiscal year 2027
congressional justification on the agency's efforts to improve
peer support activities as part of the grants to institutions
of higher education program.
American Indian/Alaska Native Suicide Prevention
Initiative.--The Committee provides $4,931,000 for the Tribal
Training and Technical Assistance Center, which is a $1,000,000
increase above the fiscal year 2025 enacted program level, to
facilitate the development and implementation of comprehensive
and collaborative community-based prevention plans to reduce
suicide among American Indians/Alaska Natives (AI/AN), prevent
substance abuse, and reduce substance misuse among AI/AN
communities.
Tribal Behavioral Grants.--The Committee provides
$30,000,000, which is a $7,250,000 increase above the fiscal
year 2025 enacted program level, to prevent and reduce suicidal
behavior and substance use, reduce the impact of trauma, and
promote mental health among AI/AN youth, through age 24.
Homelessness Prevention Programs.--The Committee provides
no funding for the Homelessness Prevention Programs, noting
that these programs are duplicative of the Projects for
Assistance in Transition from Homelessness program and other
Federal housing assistance programs administered by the
Department of Housing and Urban Development.
Criminal and Juvenile Justice Activities.--The Committee
provides no funding for Criminal and Juvenile Justice
Activities in accordance with the President's Budget. The
Committee notes that the Office of Juvenile Justice and
Delinquency Prevention under the Department of Justice provides
funding to States and Tribes for the purpose of improving the
juvenile justice system, including support for mental health
and substance abuse treatment.
Assertive Community Treatment for Individuals with Serious
Mental Illness.--The Committee provides $9,000,000 for
Assertive Community Treatment programs, which is the same as
the fiscal year 2025 enacted program level, to support a multi-
disciplinary service-delivery approach for individuals with
severe functional impairments associated with a serious mental
illness.
Interagency Task Force on Trauma Informed Care.--The
Committee provides $2,000,000, for the Interagency Task Force
on Trauma-Informed Care, which is the same as the fiscal year
2025 enacted program level.
Science and Service:
Garrett Lee Smith Suicide Prevention Resource Center.--The
Committee provides $11,000,000 for the GLS Suicide Prevention
Resource Center, which is the same as the fiscal year 2025
enacted program level, to build national capacity for
preventing suicide by providing technical assistance, training,
and resources to assist States, Tribes, private organizations,
and SAMHSA grantees to develop suicide prevention strategies.
The Committee encourages SAMHSA to continue expanding training
opportunities and public-private collaboration on youth suicide
prevention and early intervention strategies.
Practice Improvement and Training.--The Committee provides
$7,828,000, which is the same as the fiscal year 2025 enacted
program level, to support the dissemination of key information,
such as evidence-based mental health practices, to the mental
health delivery system.
Consumer and Consumer Support Technical Assistance
Centers.--The Committee provides $1,918,000, which is the same
as the fiscal year 2025 enacted program level, to facilitate
quality improvement of the mental health system by the specific
promotion of consumer-directed approaches for adults with
serious mental illness.
Primary and Behavioral Health Care Integration Technical
Assistance.--The Committee provides $2,991,000, which is the
same as the fiscal year 2025 enacted program level, to provide
technical assistance to Primary and Behavioral Health Care
Integration grantees. Of the funds provided, the Committee
directs that $1,000,000 be allocated to the Technical
Assistance activities authorized under section 520K of the PHS
Act to implement the psychiatric collaborative care model in
primary care practices/systems. Pursuant to such law, these
technical assistance centers may be funded through cooperative
agreements.
Minority Fellowship Program.--The Committee provides
$11,059,000, which is the same as the fiscal year 2025 enacted
program level, to increase behavioral health practitioners'
knowledge of issues related to prevention, treatment, and
recovery support for mental illness and addiction among
minority populations.
Disaster Response.--The Committee provides $1,953,000,
which is the same as the fiscal year 2025 enacted program
level, to support the Disaster Distress Helpline, the Crisis
Counseling Assistance and Training Program, and the Disaster
Technical Assistance Center.
Eating Disorders.--The Committee provides $5,000,000 to
improve the availability of health care providers to respond to
the needs of individuals with eating disorders including the
work of the National Center of Excellence for Eating Disorders
to increase engagement with primary care providers, including
pediatricians, to provide specialized advice and consultation
related to the screening and treatment of eating disorders. The
Committee encourages SAMHSA to conduct a public service
announcement with the purpose of raising awareness about
identifying, preventing, and treating eating disorders.
SUBSTANCE ABUSE TREATMENT
Appropriation, fiscal year 2025....................... $4,159,298,000
Budget request, fiscal year 2026...................... 19,770,000
Committee Recommendation.............................. 4,008,963,000
Change from enacted level......................... -150,335,000
Change from budget request........................ +3,989,193,000
State Opioid Response Grants
The Committee includes $1,575,000,000 for State Opioid
Response (SOR) grants, which is the same as the fiscal year
2025 enacted program level. The Committee supports efforts from
SAMHSA through SOR grants to expand access to substance use
disorder treatments in rural and underserved communities,
including through funding and technical assistance. Within the
amount provided, the Committee includes a set-aside for Indian
Tribes and Tribal organizations of not less than 5 percent.
The Committee continues to support the continuum of
prevention, treatment, and recovery support services within SOR
for individuals with opioid or stimulant use disorder including
co-occurring addictions such as alcohol addiction. The
Committee encourages SAMHSA to increase awareness of grantees
regarding the availability of SOR funding to support treatment
and support for co-occurring additions, including alcohol use
disorder.
Data Collection and Sharing Information.--The Committee
recognizes the importance of data collection and reporting
information to help inform grant recipients and subrecipients
of effective Opioid Response interventions and to inform
congressionally mandated reporting of the Opioid Response
program. As noted in a December 2024 Government Accountability
Office report (GAO-25-106944), grant recipients have used
Federal funds to support a variety of prevention, treatment,
and recovery services. However, opportunities exist to improve
data sharing and transparency, particularly about subrecipients
of Opioid Response funding. Therefore, the Committee directs
SAMHSA to finalize implementation of subrecipient data
collection and reporting requirements for grant recipients as
authorized under 42 U.S.C. Sec. 290ee-3a(c) and (f). The
Committee further directs SAMHSA to publicly report aggregated,
de-identified grantee data or other information about the use
of Opioid Response funding for purposes of advancing best
practices among grant recipients. The Committee requests SAMHSA
brief the congressional committees of jurisdiction on its
implementation plans no later than 90 days after the enactment
of this Act.
FDA Approved Medications.--SAMHSA is directed to include as
an allowable use of funds all FDA approved medications for
opioid use disorder and overdose reversal and other clinically
appropriate services to treat opioid use disorder.
Substance Use Prevention, Treatment, and Recovery Services Block Grant
The Committee includes $2,013,079,000 for the SUPTRS Block
Grant, which is a $5,000,000 increase above the fiscal year
2025 enacted program level. Of the funds provided, $79,200,000
shall be derived from evaluation set-aside funds available
under section 241 of the PHS Act. The SUPTRS Block Grant is a
critical component of each State's publicly funded substance
use disorder system designed to address all substance use
disorders--including those related to alcohol. SUPTRS Block
Grant funds may support initiatives related to alcohol in
settings such as emergency rooms and primary care offices. In
addition, States utilize SUPTRS Block Grant funds to support
alcohol use disorder treatment services in outpatient,
intensive outpatient, and residential programs. Further, the
Committee is also aware that SUPTRS Block Grant funds may be
allocated to support medications for the treatment of alcohol
use disorders, an important tool that should be available to
those in need. The Committee also understands SUPTRS Block
Grant funds are utilized by States to support recovery
community organizations to provide recovery support for those
with alcohol use disorders.
The Committee recognizes the critical role the block grant
plays in State and Territory systems across the country, giving
States and Territories the flexibility to direct resources to
address the most pressing needs of their communities. The
Committee also recognizes that the 20 percent prevention set-
aside within the SUPTRS Block Grant is a vital source of
funding for primary prevention.
Opioid Use Disorder in Rural Communities.--The Committee is
aware that the opioid use disorder crisis continues to pose
unique challenges for rural America, including limited access
to both appropriate care and health professionals critical to
identifying, diagnosing, and treating patients along with
supporting recovery from substance use disorders. The Committee
recognizes that the COVID pandemic exacerbated many of rural
America's unique challenges and resulting needs, creating added
isolation for many, and an increasing number of individuals in
crisis. These issues further emphasize the urgency of a
comprehensive approach including training to provide care for
diverse populations; the use of technologies to ensure improved
access to medically underserved areas; and workforce and skill
development including peer recovery specialist training and
other initiatives to increase effective responsiveness to
unique rural challenges. The Committee encourages SAMHSA to
support initiatives to advance opioid use disorder objectives
in rural areas, specifically focusing on addressing the needs
of individuals with substance use disorders in rural and
medically underserved areas, and programs that stress a
comprehensive community-based approach involving academic
institutions, health care providers, and local criminal justice
systems.
Opioid Use Disorder Relapse and Overdose Prevention.--The
Committee is concerned that relapse following opioid
detoxification is a contributing factor to the overdose crisis.
The Committee notes SAMHSA's efforts to address this within the
Federal grant population by emphasizing that opioid
detoxification should be followed by proper treatment and long-
term recovery services. The Committee encourages SAMHSA to
continue these programs in all settings where detoxification is
offered, including opioid treatment programs, rehabilitation
centers, and criminal justice settings.
Prevention Activities.--The SUPTRS Block Grant's prevention
set-aside requires States to allocate at least 20 percent of
Block Grant funds to primary prevention. States may use these
prevention set-aside funds to support initiatives aimed at
addressing underage drinking; such efforts can reduce access to
alcohol, reduce risk factors, and increase protective factors.
Preventing Prescription Drug and Opioid Overdoses.-- The
Committee notes strong concerns about the high number of
unintentional overdose deaths attributable to prescription,
nonprescription, and illicit opioids. SAMHSA is encouraged to
take steps to support the use of SUPTRS Block Grant funds for
opioid safety education and training, including initiatives
that improve access for licensed healthcare professionals,
including paramedics, to emergency devices used to rapidly
reverse the effects of opioid overdoses. Such initiatives
should incorporate robust evidence-based intervention training
and facilitate linkage to treatment and recovery services.
Within the total provided for Programs of Regional and
National Significance, the Committee recommends the following
amounts:
------------------------------------------------------------------------
FY 2025 FY 2026
Budget Activity Enacted Committee
------------------------------------------------------------------------
Capacity:
Opioid Treatment Programs and $10,724,000 $10,724,000
Regulatory Activities..............
Screening, Brief Intervention, 33,840,000 - - -
Referral to Treatment..............
PHS Evaluation Funds............ 2,000,000 - - -
Targeted Capacity Expansion-General. 122,416,000 131,416,000
Medication-Assisted Treatment 111,000,000 120,000,000
for Prescription Drug and
Opioid Addiction...............
Tribal Set-Aside............ 14,500,000 20,000,000
Grants to Prevent Prescription Drug 16,000,000 16,000,000
Opioid Overdose....................
First Responder Training............ 57,000,000 58,000,000
Rural Emergency Medical Services 32,000,000 33,000,000
Training Grants (non-add)......
Pregnant and Postpartum Women....... 38,931,000 38,931,000
Recovery Community Services Program. 4,434,000 4,434,000
Children and Families............... 30,197,000 30,197,000
Treatment Systems for the Homeless.. 37,144,000 - - -
Minority AIDS....................... 66,881,000 - - -
Criminal Justice Activities......... 94,000,000 75,000,000
Drug Courts..................... 74,000,000 75,000,000
Improving Access to Overdose 1,500,000 1,500,000
Treatment..........................
Building Communities of Recovery.... 17,000,000 8,500,000
Peer Support Technical Assistance 2,000,000 - - -
Center.............................
Comprehensive Opioid Recovery 6,000,000 8,000,000
Centers............................
Emergency Department Alternatives to 8,000,000 8,000,000
Opioids............................
Treatment, Recovery, and Workforce 12,000,000 12,000,000
Support............................
Youth Prevention and Recovery 2,000,000 2,000,000
Initiative.........................
Science and Service:
Addiction Technology Transfer 9,046,000 9,046,000
Centers............................
Minority Fellowship Program......... 7,136,000 7,136,000
------------------------------------------------------------------------
Eligible Grantees.--The Committee directs the Secretary to
expand eligibility for grants under SAMHSA Prevention Programs
of Regional and National Significance and the corresponding
services provided by the Center for the Application of
Prevention Technologies to private, nonprofit, regional
organizations, including faith-based organizations. The broad
coalitions orchestrated by these regional organizations are
uniquely positioned to supplement the work already being done
by the State, Tribal, and community organizations currently
eligible for such grants.
Capacity:
Opioid Treatment Programs and Regulatory Activities.--The
Committee provides $10,724,000, which is the same as the fiscal
year 2025 enacted program level, to support access to FDA
approved medications for opioid use disorder through opioid
treatment programs and to approve organizations that accredit
opioid treatment programs.
Screening, Brief Intervention, and Referral to Treatment.--
The Committee provides no funding for the Screening, Brief
Intervention, and Referral to Treatment program in accordance
with the President's Budget.
Targeted Capacity Expansion.--The Committee provides
$131,416,000 for the Targeted Capacity Expansion program
including the Medication-Assisted Treatment for Prescription
Drug and Opioid Addition program (MAT-PDOA), which is a
$9,000,000 increase above the fiscal year 2025 enacted program
level. These programs support State and local governments,
Tribes, nonprofit organizations, and health care facilities to
respond to treatment and capacity gaps for purposes of
providing services to individuals with opioid use disorder.
MAT-PDOA provides access to FDA approved medications for opioid
use disorders to reduce opioid use and related deaths. The
Committee directs SAMHSA to use the increase to support
nonprofit treatment facilities engaged in community enhancement
projects to improve the provision of services to rural
communities in surrounding regions. Better access to care
mitigates community safety risks while expanding treatment
services and recovery support programs for patients and their
families.
SAMHSA is further directed to include all FDA approved
medications for opioid use disorder as an allowable use to
achieve and maintain remission and recovery.
Grants to Prevent Prescription Drug/Opioid Overdose.--The
Committee provides $16,000,000 for Grants to Prevent
Prescription Drug/Opioid Overdose Deaths (PDO), which is the
same as the fiscal year 2025 enacted program level. The PDO
program trains first responders and other community providers
on the prevention of prescription drug/opioid overdose-related
deaths including through the purchase and distribution of
naloxone.
The Committee notes that while fatal opioid overdose rates
among young Americans have decreased, the issue remains a
serious public health threat. Studies show that access to
opioid overdose reversal agents such as naloxone reduce
overdose deaths, therefore, the Committee encourages SAMHSA to
provide schools access to and administration training for
naloxone and other effective drug reversal agents.
First Responder Training.--The Committee provides
$58,000,000 for First Responder Training program. This amount
includes $33,000,000 for Rural Emergency Medical Services
Training Grants, which is a $1,000,000 increase above the
fiscal year 2025 enacted program level, to recruit and train
emergency medical services personnel in rural areas with a
focus on addressing substance use disorders and co-occurring
mental health conditions.
Pregnant and Postpartum Women.--The Committee provides
$38,931,000 for the Pregnant and Postpartum Women program,
which is the same as the fiscal year 2025 enacted program
level. The Pregnant and Postpartum Women program supports
comprehensive residential substance use disorder treatment,
prevention, and recovery support services for pregnant and
postpartum women, their minor children, and other family
members.
Recovery Community Services Program.--The Committee
provides $4,434,000 for the Recovery Community Services
Program, which is the same as the fiscal year 2025 enacted
program level. This program provides grants to develop, expand,
and enhance community and statewide recovery support services.
Children and Families Program.--The Committee provides
$30,197,000, which is the same as the fiscal year 2025 enacted
program level, to support early identification and services to
children, adolescents, and young adults at risk of substance
use disorders, and treatment for such populations with co-
occurring mental illnesses.
Drug Courts.--The Committee provides $75,000,000 for
SAMSHA's Drug Court initiative, which is a $1,000,000 increase
above the fiscal year 2025 enacted program level. The Committee
continues to direct SAMHSA to ensure that all funding
appropriated for drug treatment courts is allocated to serve
people diagnosed with a substance use disorder as their primary
condition. The Committee directs SAMHSA to ensure that all drug
treatment court grant recipients work directly with the
corresponding State substance use agency in the planning,
implementation, and evaluation of the grant. The Committee
further directs SAMHSA to expand training and technical
assistance to drug treatment court grant recipients to ensure
evidence-based practices are fully implemented.
Improving Access to Opioid Treatment.--The Committee
provides $1,500,000, which is the same as fiscal year 2025
enacted program level, to support awards to expand access to
FDA approved drugs or devices for emergency treatment of known
or suspected opioid overdose.
Building Communities of Recovery.--The Committee provides
$8,500,000 for the Building Communities of Recovery program,
which is a $8,500,000 decrease below the fiscal year 2025
enacted program level and $8,500,000 above the President's
Budget. This program enables the development, expansion, and
enhancement of recovery community organizations.
Peer Support Technical Assistance Center.--The Committee
provides no funding for the Peer Support Technical Assistance
Center in accordance with the President's Budget.
Comprehensive Opioid Recovery Centers.--The Committee
provides $8,000,000 for Comprehensive Opioid Recovery Centers,
which is a $2,000,000 increase above the fiscal year 2025
enacted program level. This program provides grants to entities
that operate comprehensive treatment and recovery centers for
individuals with opioid use disorder.
Emergency Department Alternatives to Opioids.--The
Committee provides $8,000,000 for the Emergency Department
Alternatives to Opioids program, which is the same as the
fiscal year 2025 enacted program level. This program provides
funding to hospitals and emergency departments to develop and
implement alternative pain management protocols and treatments
that limit the prescribing of opioids in emergency departments.
Treatment, Recovery, and Workforce Support.--The Committee
provides $12,000,000 for the Treatment, Recovery, Workforce
Support program, which is the same as the fiscal year 2025
enacted program level. This program supports individuals in
substance use disorder treatment and recovery to live
independently and participate in the workforce.
Youth Prevention and Recovery Initiative.--The Committee
provides $2,000,000 for the Youth Prevention and Recovery
Initiative, which is the same as the fiscal year 2025 enacted
program level, to support early identification and services to
children, adolescents, and young adults at risk of substance
use disorders, and treatment for such populations including
those with co-occurring mental illnesses.
Science and Services:
Minority Fellowship Program.--The Committee provides
$7,136,000, which is the same as the fiscal year 2025 program
level, to increase behavioral health practitioners' knowledge
of issues related to prevention, treatment, and recovery
support for mental illness and addiction among minority
populations.
Substance Use Disorder Treatment.--The Committee encourages
SAMHSA to expand the availability of treatment services
tailored to adolescents, pregnant women, and parents.
SUBSTANCE ABUSE PREVENTION
Appropriation, fiscal year 2025....................... $236,879,000
Budget request, fiscal year 2026...................... 18,704,000
Committee Recommendation.............................. 205,009,000
Change from enacted level......................... -31,870,000
Change from budget request........................ +186,305,000
Within the total provided for Programs of Regional and
National Significance, the Committee provides the following
amounts:
------------------------------------------------------------------------
Budget Activity FY 2025 Enacted FY 2026 Committee
------------------------------------------------------------------------
Capacity:
Strategic Prevention Framework $135,484,000 $140,484,000
Federal Drug-Free Workplace... 5,139,000 5,139,000
Minority AIDS................. 43,205,000 - - -
Sober Truth on Preventing 14,500,000 14,500,000
Underage Drinking............
National Adult-Oriented 2,500,000 2,500,000
Media Public Service
Campaign.................
Community Based Coalition 11,000,000 12,000,000
Enhancement Grants.......
Interagency Coordinating 1,000,000 - - -
Committee to Prevent
Underage Drinking........
Tribal Behavioral Health 23,665,000 30,000,000
Grants.......................
Science and Service:
Center for the Application of 9,493,000 9,493,000
Prevention Technologies......
Science and Service Program 4,072,000 4,072,000
Coordination.................
Minority Fellowship Program... 1,321,000 1,321,000
------------------------------------------------------------------------
Capacity:
Drug Free Communities.--The Committee notes that the
Department proposes to transfer the Drug-Free Communities (DFC)
from the Office of National Drug Control Policy (ONDCP) to the
Administration for a Healthy America. DFC supports community-
based coalitions that engage multiple sectors of the community
to prevent youth substance use. The Committee looks forward to
working with the authorizing committees of jurisdiction as they
consider this proposal.
Strategic Prevention Framework.--The Committee provides
$140,484,000 for the Strategic Prevention Framework (SPF),
which is a $5,000,000 increase above the fiscal year 2025
enacted program level. SPF provides grants to States, Tribes,
and local governmental organizations to prevent substance
abuse. The Committee provides no funding for SPF Rx in
recognition of the continually evolving nature of substance
addiction and abuse. The Committee strongly believes that
investing in prevention is essential to ending the substance
abuse crisis, and supports the core SPF program, which is
designed to prevent the onset of substance abuse, while
strengthening prevention capacity and infrastructure. The
Committee intends that this program supports comprehensive,
multi-sector substance use prevention strategies to stop or
delay the age of initiation of each State or local applicant's
most pressing substance use issues, as determined by the State
and/or local epidemiological data.
The additional funding for core the SPF program is based on
the Committee's recognition that substance use prevention is
underutilized relative to its ability to prevent and delay
substance use initiation as well as slow the pathways to
addiction and overdose, and that demand for community-based
primary prevention resources far outpaces available funding.
The Committee directs that the additional funding be split
evenly between States and communities.
Federal Drug Free Workplace.--The Committee provides
$5,139,000 for Federal Drug-Free Workplace Programs (DFWP),
which is the same as the fiscal year 2025 enacted program
level. DFWP ensures employees in national security, public
health, and public safety positions are tested for the use of
illegal drugs and the misuse of prescription drugs and ensures
the laboratories that perform this regulated drug testing are
inspected and certified by HHS.
Sober Truth on Preventing Underage Drinking Act.--The
Committee provides $14,500,000 for the Sober Truth on
Preventing Underage Drinking (STOP) Act, which is the same as
the fiscal year 2025 enacted program level. The STOP Act
supports an adult-oriented national media campaign to provide
parents and caregivers of youth under the age of 21 with
information and resources to discuss the issue of alcohol with
their children and provides grants to prevent and reduce
alcohol use among youth under the age of 21. This program has
also historically funded the Interagency Coordinating Committee
on the Prevention of Underage Drinking (ICCPUD).
The Committee is concerned that under the Biden
Administration, funding for ICCPUD was diverted for purposes
unrelated to preventing underage drinking. The Committee notes
concern that ICCPUD carried out research on adult alcohol
consumption and used those findings as input for the 2025
Dietary Guidelines for Americans. Furthermore, this research is
duplicative as the Committee had previously allocated
$1,300,000 under section 772 of the Consolidated Appropriations
Act, 2023, for an independent study on alcohol consumption
practices for the purposes of informing the Dietary Guidelines.
These actions raise serious concerns about ICCPUD's ability to
function within its scope and authority, maintain transparency
with Congress, and prevent duplicative efforts. Therefore, the
Committee provides no funding for the Interagency Coordinating
Committee on the Prevention of Underage Drinking.
Tribal Behavioral Grants.--The Committee provides
$30,000,000, which is $6,335,000 increase above the fiscal year
2025 enacted program level, to address the high incidence of
substance abuse and suicide among the AI/AN population. Despite
the recent national decline in drug overdose deaths, Tribal
communities continue to experience disproportionately higher
rates of illicit drug use, opioid misuse, misuse of
prescription drugs, and fatal and non-fatal drug overdoses. The
AI/AN population is also at higher risk of dying by suicide
compared to the general U.S. population.
Fentanyl and Prescription Drug Misuse Prevention.--The
Committee supports efforts to better educate the public and
increase awareness about the potential lethality of fentanyl
and polysubstance and other prescription drug misuses.
Science and Service:
Center for the Application of Prevention Technologies.--The
Committee provides $9,493,000 for the Center for the
Application of Prevention Technologies, which is the same as
the fiscal year 2025 enacted program level, to improve
implementation and delivery of effective substance use
prevention interventions and provide training and technical
assistance services to the substance use prevention field.
The Committee recognizes the Center for Substance Abuse
Prevention and the Prevention Technology Transfer Centers for
their work in implementing the Prevention Fellowship Program.
This program supports early career prevention fellows in
gaining hands on experience working in State alcohol and drug
agencies. Fellows, coached by mentors, developed leadership
skills; received training in professional development; acquired
proficiency in core competencies to prepare for certified
prevention specialist exams; and prepared for employment
opportunities in the substance use prevention field.
The Committee directs the Secretary to expand eligibility
for the Center for the Application of Prevention Technologies
to private, nonprofit, regional organizations, including faith-
based organizations. The broad coalitions orchestrated by these
regional organizations are uniquely positioned to supplement
the work already being done by the State, Tribal, and community
organizations currently authorized for such grants.
Science and Service Activities.--The Committee provides
$4,072,000, which is the same as the fiscal year 2025 enacted
program level, to support the adoption and use of effective
substance use disorder prevention strategies across the
continuum of care, with a special focus on health systems. The
program also supports the Tribal Training and Technical
Assistance Center, which provides specialized training and
assistance to improve Tribal behavioral health outcomes.
Minority Fellowship Program.--The Committee provides
$1,321,000, which is the same as the fiscal year 2025 enacted
program level, to provide stipends to increase the number of
addiction and mental health professionals who teach,
administer, conduct services research, and provide direct
mental health or substance use disorder treatment services for
minority populations.
The Committee directs SAMHSA to ensure that Center for
Substance Abuse Prevention funded fellowships focus on
substance use disorder prevention related activities.
HEALTH SURVEILLANCE AND PROGRAM SUPPORT
Appropriation, fiscal year 2025....................... $169,583,000
Budget request, fiscal year 2026...................... 65,823,000
Committee Recommendation.............................. 161,323,000
Change from enacted level......................... -8,260,000
Change from budget request........................ +95,500,000
The Committee provides the following amounts for Health
Surveillance and Program Support:
------------------------------------------------------------------------
Budget Activity FY 2025 Enacted FY 2026 Committee
------------------------------------------------------------------------
Health Surveillance............... $50,623,000 $50,623,000
PHS Evaluation Funds.......... 30,428,000 30,428,000
Program Support................... 84,500,000 84,500,000
Public Awareness and Support...... 13,260,000 5,000,000
Performance and Quality 10,200,000 10,200,000
Information Systems..............
Drug Abuse Warning Network........ 10,000,000 10,000,000
Behavioral Health Workforce....... 1,000,000 1,000,000
PHS Evaluation Funds.......... 1,000,000 1,000,000
------------------------------------------------------------------------
National Online Treatment Services Locator.--The Committee
recognizes the importance of individuals and families having
access to timely, accurate, and complete information on
substance use and mental health treatment services. The
Committee is concerned that SAMHSA's national treatment
locator, FindTreatment.gov, contains inaccurate information
that may be hindering access to care. As noted in a March 2025
HHS Office of the Inspector General report (A-09-23-01003), an
estimated 14,283 of 22,106 facilities found on this platform
contained inaccurately reported information such as contact and
services information. Therefore, the Committee directs SAMHSA
to brief the congressional committees of jurisdiction--no later
than 90 days after the day of the enactment of this Act--on the
actions the agency, in coordination with its contractor, have
taken to meet OIG's recommendations, including additional steps
taken to improve the accuracy of the online treatment services
locator.
Agency for Healthcare Research and Quality
HEALTHCARE RESEARCH AND QUALITY
Appropriation, fiscal year 2025....................... $369,000,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. - - -
Change from enacted level......................... -369,000,000
Change from budget request........................ - - -
The Committee provides no funding for AHRQ. Similar work is
done by several agencies funded in this bill, including the
National Institutes of Health, the Centers for Disease Control
and Prevention, the Substance Abuse and Mental Health Services
Administration, and the Office of the Assistant Secretary for
Health.
Centers For Medicare & Medicaid Services
GRANTS TO STATES FOR MEDICAID
Appropriation, fiscal year 2025................ $383,609,399,000
Budget request, fiscal year 2026............... 508,148,791,000
Committee Recommendation....................... 508,148,791,000
Change from enacted level.................. +124,539,392,000
Change from budget request................. - - -
Medicaid provides health coverage to eligible populations,
including eligible low-income adults, children, pregnant women,
elderly adults, and people with disabilities. Medicaid is
administered by States, according to Federal requirements. The
program is funded jointly by States and the Federal government.
This amount does not include $261,063,820,000, which was
provided as advance funding for the first quarter of fiscal
year 2026. In addition, the Committee recommends an advance
appropriation of $316,514,725,000 for program costs in the
first quarter of fiscal year 2027, to remain available until
expended.
The Committee continues bill language providing indefinite
budget authority for unanticipated costs in fiscal year 2026.
Federal Medicaid grants reimburse States for a portion of their
expenditures in providing health care for individuals whose
income and resources fall below specified levels. Subject to
certain minimum requirements, States are provided certain
limited authority within the law to set eligibility, coverage,
and payment levels.
PAYMENTS TO THE HEALTH CARE TRUST FUNDS
Appropriation, fiscal year 2025................ $521,757,000,000
Budget request, fiscal year 2026............... 593,817,000,000
Committee Recommendation....................... 593,817,000,000
Change from enacted level.................. +72,060,000,000
Change from budget request................. - - -
This account includes the general fund subsidy to the
Federal Supplementary Medical Insurance Trust Fund for Medicare
Part B benefits, and Medicare drug benefits and administration,
as well as other reimbursements to the Federal Hospital
Insurance Trust Fund for benefits and related administrative
costs, which have not been financed by payroll taxes or premium
contributions. The Committee continues bill language providing
indefinite authority to pay the general revenue portion of the
Medicare Part B premium match and resources for the Medicare
Part D drug benefit program if the annual appropriation is
insufficient.
PROGRAM MANAGEMENT
Appropriation, fiscal year 2025................ $3,669,744,000
Budget request, fiscal year 2026............... 3,464,391,000
Committee Recommendation....................... 3,474,391,000
Change from enacted level.................. -195,353,000
Change from budget request................. +10,000,000
The Committee notes that the Department proposes to
administer the Office of Pharmacy Affairs within CMS rather
than HRSA. The Committee looks forward to working with the
authorizing committees of jurisdiction as they consider the
Department's proposal.
Program Operations
The Committee includes $2,302,942,000 for Program
Operations. This office administers the programs under the
Centers for Medicare & Medicaid Services (CMS), funds
beneficiary outreach and education, maintains information
technology infrastructure needed to support various claims
processing systems, and supports other programmatic
improvements.
Advancing Non-Opioid Alternatives for Chronic Pain.--The
Committee recognizes the impact of chronic pain on millions of
Americans and is concerned that, despite advances in expanding
access to non-opioid alternatives for acute pain, barriers
remain for chronic pain that limit beneficiaries' treatment
options. The Committee requests an update no later than 180
days after enactment of this Act on the availability of non-
opioid treatment options to manage chronic pain conditions and
encourages CMS to work with Congress and relevant stakeholders
to identify coverage and payment incentives to improve access
to non-opioid alternatives for chronic pain.
Area Wage Index.--The Committee notes the significant
disparities in Medicare reimbursement created by the current
wage index system. These disparities create financial and
operational disadvantages between hospitals, endangering
critical access to care for communities served by the lowest
paid providers, which are often rural and underserved areas.
The Committee strongly urges the establishment of a wage index
reclassification mechanism for hospitals in the lowest quartile
of wage indexes. Such a mechanism would ensure that hospitals
located near a higher wage index labor market would be able to
reclassify and receive the same wage index as that paid to
hospitals located in the same geographical area.
Artificial Intelligence in Prior Authorization.--The
Committee acknowledges the use of artificial intelligence (AI)
in the prior authorization process within Federal health
insurance programs such as Medicare, Medicaid, Tricare, and the
Federal Employees Health Benefits Program. The Committee
directs GAO to provide a preliminary briefing to the Committees
on Appropriations, Energy and Commerce, and Ways and Means of
the House of Representatives and the Committee on
Appropriations of the Senate no later than 12 months following
the enactment of this Act with a report to follow on the
current and planned use of AI as part of prior authorization
processes within a subset of plans across these programs. The
study should examine how the Federal government evaluates the
sources of data and data updates used to generate prior
authorization decisions drawn from AI applications, the
accountability measures ensuring quality of care, and privacy
safeguards in place.
Behavioral and Mental Health Guidance for Home and
Community-Based Behavior Health Services.--The Committee
requests that CMS issue a guide similar to the guide CMS issued
on school-based behavioral health services titled, ``Delivering
Service in School-Based Settings'', outlining how States can
implement intensive home and community-based behavioral health
services to address the growing behavioral and mental health
crisis. The Committee encourages CMS to include in such
guidance information regarding potential billing codes that
States can use to cover intensive home and community-based
behavioral health services.
Calibrating the Risk Adjustment Model on MA Encounter.--The
Committee recognizes that a Medicare Advantage (MA) risk
adjustment model calibrated using fee-for-service claims data
does not account for coding patterns between volume-based and
value-based care differences. The Committee understands that MA
encounter data is available to CMS and more thoroughly
documents consumer diagnoses, treatments, and services, and the
use of encounter data to calibrate risk adjustment models will
lead to improved payment accuracy and deter aggressive coding
practices. The Committee encourages CMS to incorporate
encounter data where possible in calibrating MA risk adjustment
models.
Cancer Survivorship Alternative Payment Model.--The
Oncology Care Model ended in 2022 after a five-year test, and
the successor Enhancing Oncology Model was launched in 2023.
The trigger for an episode of care in these models is the
initiation of cancer drug therapy. However, these delivery
experiments exclude a population of cancer patients who might
benefit from the patient-centered care offered in care models,
such as cancer survivors who have completed active treatment
and are entering a period of long-term survivorship. The
Committee encourages CMS to consider appropriate options for
survivors.
Certified Registered Nurse Anesthetists.--The Committee is
aware of challenges surrounding patient access to anesthesia
services, particularly in rural areas. Therefore, the Committee
supports CMS in its continued consideration of the benefits of
Certified Registered Nurse Anesthetists performing services.
The Committee requests a briefing on how expanding the
anesthesia rural pass-through program to include all types of
anesthesia providers could help mitigate the health workforce
shortage in low patient volume rural hospitals and the
resulting delays in patient care.
Certificate of Need Requirements.--The Committee notes that
certificate of need (CON) laws vary widely across State
jurisdictions. Such laws require healthcare providers to obtain
authorization from State authorities to construct or expand
health care facilities or offer health care services. The
Committee directs GAO to examine, to the extent data are
available and reliable, how selected State CON laws may affect
Federal healthcare spending. The Committee requests that GAO
provide a preliminary briefing to the Committees on
Appropriations of the House of Representatives and the Senate
no later than 12 months following the enactment of this Act
with a report to follow.
Chronic Kidney Disease Guidelines (CKD) and Early Screening
for CKD.--The Committee is committed to ensuring that patients
with CKD have access to the most clinically appropriate
treatments. More effective diagnosis and care can help reduce
the rates of kidney failure and cardiovascular complications
for patients and generate savings to the Federal government.
Therefore, the Committee encourages CMS to work to ensure the
Medicare benefit guidelines reflect the most recent clinical
CKD guidelines and to increase access to early screening
utilizing both estimated glomerular filtration rate (eGFR) and
urine Albumin-to-Creatinine Ratio (uACR) testing, diagnosis,
and treatment for high-risk populations for CKD.
Chronic Obstructive Pulmonary Disease (COPD).--COPD has a
significant impact on the U.S. health care system as the fourth
most common reason for death and disability and the third
leading cause of hospital readmissions. The Committee
encourages CMS to increase awareness of best clinical practices
for COPD management, identify gaps in current Medicare quality
measure sets where more targeted measurement of the effective
COPD management is needed, and consider developing service
delivery models that increase access to high-quality COPD care.
Clarifying Organ Recovery Reimbursement.--The Committee
notes that Organ Procurement Organization (OPO) Recovery
Centers can increase the number of organs available for
transplantation and ICU bed capacity for living patients. The
Committee is concerned that the current reimbursement guidance
disincentives effective and efficient organ recovery.
Therefore, the Committee encourages CMS to consider updating
Medicare provider guidance to expand safe procurement of organs
including through other available measures such as deceased
donor organs sent to other Certified Transplant Centers (CTCs),
organs sent to OPOs, organs recovered from CTC patients
transferred to OPOs, and kidneys sent to U.S. military renal
transplant centers (MRTCs).
Coding Intensity Adjustments.--The Committee is aware that
Medicare Advantage (MA) payments are risk-adjusted to provide
sufficient resources to deliver comprehensive care for
individuals with complex health needs, but appropriate use of
diagnosis coding can vary. The Committee understands CMS
applies a statutory coding intensity adjustment equally to all
MA health plans regardless of any existing variance in coding
intensity. The Committee encourages CMS to evaluate existing
incentives for coding intensity and make recommendations to
Congress for revisions to coding intensity adjustments that
will result in more effective care management.
Cognitive Screening and Diagnostic Tools.--The Committee
notes the importance of early cognitive screening as a critical
step in diagnosing a patient with Alzheimer's disease (AD),
which is the most common cause of dementia, and recognizes the
limited uptake among Medicare beneficiaries during the Medicare
annual wellness visit (AWV). Additionally, the Committee notes
new AD blood-based biomarker tests are entering the field that
could make future diagnosis less invasive, less costly, and
more accessible to patients, but may not have clear coverage
pathways under Medicare. The Committee encourages CMS to
explore coverage policies that would improve access to
cognitive screening tools and AD blood-based biomarker tests
under Medicare.
Colorectal Cancer Screenings.--The Committee recognizes the
importance of ensuring access to medically necessary colorectal
cancer screenings. The Committee is concerned that barriers
including utilizing up-to-date clinical standards and ensuring
adequate access to wraparound services remain. The Committee
encourages CMS to review such barriers to support updated
clinical evidence for colorectal cancer screenings and related
services.
Convenient Access Standards for Medicare Part D
Beneficiaries.--The Committee is concerned that existing
convenient access standards for Medicare Part D beneficiaries
based on geographic distance do not take into consideration
true access to life-saving medications, including those that
are less common or facing shortages. The Committee supports
efforts by CMS to limit barriers to medication and pharmacist
access for Medicare patients and make, as appropriate, updates
to the Medicare Part D pharmacy access standards to improve
patient access to pharmacy services offered by pharmacies not
affiliated with a Pharmacy Benefit Manager. The Committee urges
CMS to consider what updates to Part D network adequacy
standards, including those that do not rely on physical
distance, could improve patient access to drugs and the
expertise of pharmacists.
Critical Access Hospital Designations.--The Committee is
aware that CMS periodically conducts reviews of Critical Access
Hospital (CAH) designations across the country. The Committee
is concerned that CMS is revoking CAH status from longstanding
CAHs without accounting for issues related to access to care.
This issue is particularly acute for rural communities with
hospitals that have retained and relied on a CAH designation
for decades, have been recertified multiple times, and have
nevertheless lost their CAH designation even though no new
primary or secondary roads or hospitals have been constructed
in the vicinity of the hospital. The Committee strongly urges
CMS to review such circumstances in which CAHs have reasonably
relied on their CAH designation for decades, work with hospital
officials and local stakeholders to restore CAH designations
where appropriate, and work with Congress on any further
reforms that may be needed to assist facilities in such
circumstances. The Committee requests an update on these
efforts in the fiscal year 2027 congressional justification.
Digital Services Modernization.--The Committee supports the
efforts by CMS to modernize and expand both internal and
public-facing digital services, consistent with the 21st
Century Integrated Digital Experience Act (P.L. 115-336). The
Committee recognizes that digitizing paper-based processes can
reduce administrative burden, enhance accuracy and speed of
benefits delivery, and improve overall efficiency. The
Committee encourages CMS to prioritize such efforts to
streamline provider enrollment, beneficiary services, and
program integrity functions, including the prevention of fraud,
waste, and abuse.
Enabling Radiologist Assistant Care.--The Committee notes
that Radiologist Assistants are advanced-level Radiographers
who are critically important members of the Radiologist-led
team. Radiologist Assistants work strictly under the
supervision of a Radiologist to promote high standards of
patient care by assisting Radiologists in performing diagnostic
and interventional image-guided radiology services, as
permitted by State law. The Committee remains concerned about
persistent radiology workforce shortages and is aware that
barriers to care provided by Radiologist Assistants exist
within the Medicare program. As such, CMS should consider how
it may promote efficiency, improve patient outcomes, and ensure
patient safety.
Ensuring Access to Colorectal Cancer Screening Continuum of
Care.--The Committee appreciates CMS's efforts to reduce
barriers to colorectal cancer screening. However, the Committee
remains concerned about increases in colon cancer incidence and
death rates, especially among individuals younger than 50 years
old. The Committee highlights the recommendation of the U.S.
Multi-Society Task Force on Colorectal Cancer that after the
initial screening, asymptomatic individuals with a personal
history of polyps should receive more frequent colonoscopy
exams given the increased risk of new polyps. The Committee
encourages CMS to support updated clinical evidence for
colorectal cancer screenings.
Flint Water Crisis.--The Committee recognizes the long-
lasting impacts of the Flint water crisis on the health and
well-being of affected residents. The Committee is aware that
settlement payments to impacted residents are forthcoming and
is concerned that CMS may assert liens or other penalties
against these payments. In order to ensure these resources are
delivered to those harmed by the Flint water crisis, the
Committee encourages CMS to avoid any actions that would unduly
reduce or delay the settlement funds due to Flint residents.
Guam Memorial Hospital TEFRA Rate Adjustment Study.--The
Committee notes that Medicare payments for the Guam Memorial
Hospital (GMH) are calculated using out-of-date payment data
and formulas under the Tax Equity and Fiscal Responsibility Act
of 1982 (TEFRA). The Committee urges CMS to deliver a report to
Congress on the feasibility of updating payment rates to GMH
pursuant to TEFRA.
Improving Veterans Enrollment Into Medicare Coverage.--The
Committee is aware that information gaps exist for some
veterans related to the differences between the hospital care
and medical services available in the VA system versus coverage
provided under Medicare. The information gaps may have resulted
in some veterans receiving late-enrollment penalties under the
Medicare program. The Committee encourages the Department to
work with the Department of Veterans Affairs to ensure that
veterans have complete information regarding the differences
between the VA system and Medicare coverage, including for
prescription drugs.
Long-Term Care Facility Metrics.--The Committee is
concerned the long-stay antipsychotic medication quality
measure from the Skilled Nursing Facility (SNF) Five-Star
Quality Rating System fails to distinguish between appropriate
and inappropriate use of these medications, as determined by
the HHS Office of the Inspector General. As such, the Committee
encourages CMS to develop an alternative long-term care
facility metric regarding the use of antipsychotic medication
for conditions associated with neurodegenerative diseases.
Maintaining Access to Essential Medical Devices.--The
Committee recognizes that CMS has authority to make payment
adjustments under the inpatient prospective payment system
(IPPS) and the hospital outpatient prospective payment system
(OPPS) to support higher-quality domestically sourced medical
products. The Committee encourages CMS to consider building on
existing payment adjustments under IPPS and OPPS to promote
access to domestically made medical devices and essential
medical supplies, such as needles, syringes, and blood
collection products.
Maternal Healthcare in Rural Hospitals.--The Committee
recognizes the importance of rural hospitals in providing
maternal health care services, educating patients, and ensuring
post-partum safety. The Committee is concerned that
insufficient reimbursement and payments, increasing costs of
operation, and narrowing profit margins threaten the viability
of hospitals in rural areas. The Committee is aware that
Medicaid payment rates are often insufficient for the costs of
labor and delivery for rural hospitals, leading to the closures
of labor and delivery departments and increased maternal health
deserts. The Committee directs CMS to submit a report to the
Committees on Appropriations and Energy and Commerce of the
House of Representatives and the Committee on Appropriations of
the Senate within 180 days of the enactment of this Act that
reviews State-by-State payment rates at rural health care
facilities and evaluates if increased payment rates would help
sustain the ability for rural health care providers to continue
maternal health care services. The report should include how
payment rates impact care options, including how the rates may
impact the utilization of new treatment pathways and devices
for birthing complications.
Medicare ``e-Prescribing'' Template.--The Committee is
aware that CMS developed a set of clinical data elements in
2018 to identify the data necessary to support medical
necessity of supplemental oxygen claims and allow for
electronic prescribing of supplemental oxygen. However, CMS has
not yet approved contractors to use this electronic template to
establish medical necessity and support all audit documentation
requirements. The Committee requests that CMS provide an update
on such efforts in its fiscal year 2027 congressional
justification.
Medicare Prescription Repayment Program.--The Committee
directs CMS to provide a quarterly report to Congress and post
on a publicly available website with (1) the number of
beneficiaries who have opted into the Medicare Prescription
Payment Plan, including trends and demographic breakdowns, to
ensure transparency and inform potential improvements to the
program; (2) the total number of beneficiaries categorized as
``likely to benefit'' by the Part D plan sponsor; (3)
information on the methods that CMS is utilizing to encourage
participation, such as the use of Medicare.gov, the Medicare
and You handbook, 1-800-MEDICARE, and provider-focused
communications such as the Medicare Learning Network; and (4)
information on additional outreach efforts that CMS is
conducting with stakeholders, including provider associations
and societies, patient and consumer advocacy groups, and
pharmacy benefit managers. The Committee also encourages CMS to
assess and identify barriers to participation and make targeted
investments in outreach, education, and enrollment facilitation
efforts to increase beneficiary uptake. The Committee
acknowledges concerns raised by pharmacy groups regarding
point-of-sale enrollment but emphasizes the need for a
streamlined and accessible enrollment process for
beneficiaries. As such, the Committee urges CMS to explore
mechanisms to facilitate point-of-sale enrollment, ensuring
that beneficiaries can easily access the program at the time of
filling their prescriptions in person or online.
Money Follows the Person Demonstration Grant.--The
Committee notes that it is not the intent of Money Follows the
Person Demonstration Grant (MFP) to eliminate the option of
institutional care. MFP funds may not be used for the wholesale
transfer of residents from certified care facilities to finance
facility closures or downsizing. MFP is a voluntary program
established to facilitate individual transitions to community
settings initiated by the beneficiary at the beneficiary's
choice and request. The Committee requests: (1) mortality data
on those who transfer under the MFP program from certified
facilities, and (2) data by category of disability
(developmental disabilities, mental illness, age, physical
disabilities) for sentinel events (911 calls; ER visits) for
MFP participants.
Obesity.--The Committee continues to encourage CMS to work
to ensure beneficiary access to care for obesity if determined
as clinically appropriate by the patient's physician and
consistent with statutory and regulatory authority. The
Committee requests CMS provide a report to the Committees on
Appropriations of the House of Representatives and the Senate,
no later than 180 days after enactment of this Act, that
delineates specific proposals to ensure access to care for an
obesity diagnosis and addresses steps CMS can take to include
anti-obesity medications under Medicare Part D. The report
should include an analysis on the ways CMS can integrate anti-
obesity medications to treat obesity as part of a comprehensive
response, which Medicare policies could be improved to reduce
obesity and its comorbidities for those that need clinical
intervention, and how those CMS policies will be updated.
One Big Beautiful Bill Act (OBBBA) Implementation.--Within
90 days of enactment of this Act, the Committee directs CMS to
provide a report to the Committees on Appropriations of the
House of Representatives and the Senate detailing the
obligation and expenditure of funds appropriated by the OBBBA
for the Rural Health Transformation Program (RHTP). The
Committee directs CMS to include in such report: (1) aggregate
commitments, obligations, and outlays for the RHTP, (2)
commitments, obligations and outlays for each State based on
the equal allotments provided for each State under the OBBBA,
and (3) commitments, obligations and outlays for each State
based on amounts determined by the Administrator under the
OBBBA. The Committee further directs CMS to provide thereafter
a biannual update on such report to the Committees.
Organ Procurement Organization (OPO) Performance.--The
Committee recognizes that in recent years, CMS has taken steps
to increase oversight of OPOs, including by establishing new
methods to evaluate performance and issuing rules to decertify
OPOs falling below the median performance on certain metrics.
The Committee remains extremely concerned by the findings of a
recent investigation by HRSA that revealed practices by a major
OPO that compromised patient safety. CMS has a considerable
responsibility for ensuring that OPOs operate in a safe, fair,
and efficient manner that is transparent, accountable, and
effective. Patients are also at risk if OPOs are unable to
operate due to stringent or unworkable requirements from CMS.
As CMS continues to work with OPOs to ensure that the organ
donation system promotes patient safety and operates
effectively, the Committee encourages the agency to prioritize
outreach and education to stakeholders; alleviate disruption;
ensure that OPOs can effectively expand into new service areas,
when necessary; and issue clarifying guidance. The Committee
urges CMS to continue to promote accountability, identify
vulnerabilities, and issue strict corrective actions as needed
to ensure that any donation processes do not continue if
patient safety concerns arise.
Overestimating Utilization of New Codes in the Fee
Schedule.--The Committee is concerned that CMS estimates for
the utilization of a new code in the initial calendar year in
the Medicare Physician Fee Schedule (MPFS) are inflated and
exceed what is statutorily required. The Committee is concerned
that CMS overestimates utilization when adjusting the number of
relative value units needed to account for coding changes, new
data on relative value components, or payment for new
procedures, and therefore the overall cost of such changes,
resulting in substantial resources being unnecessarily deducted
from the physician fee schedule required by budget neutrality.
As such, the Committee directs GAO to study the extent to which
CMS has overestimated the utilization of new fee schedule codes
in each of the last ten years, including data on related
reductions to the fee schedule for each of those years. The
Committee directs GAO to provide a briefing on this study to
the Committees on Appropriations, Energy and Commerce, and Ways
and Means of the House of Representatives, and the Committee on
Appropriations of the Senate, within 120 days of enactment of
this Act with a report to follow.
Pharmacists and Patient Care Services.--The Committee is
aware that certain Medicare Part B services and care frameworks
have provisions to include pharmacists and their patient care
services. However, CMS has few mechanisms to identify and
evaluate the contributions of pharmacists to patient care and
outcomes or to identify barriers within current service
requirements that prevent the scalable involvement of
pharmacists. The Committee encourages CMS to create a mechanism
to provide greater visibility into the quality and outcomes of
the Medicare services currently provided by pharmacists.
Program of All-Inclusive Care for the Elderly (PACE).--The
Committee acknowledges the important role the Program of All-
Inclusive Care (PACE) has had in keeping its medically complex
population living at home safely. Given the increasing demand
for home and community-based services by older adults and those
living with disabilities, the Committee encourages the
Secretary to move forward expeditiously on PACE-specific model
tests. Examining methods of increasing access and affordability
for this comprehensive, coordinated, integrated, and fully
risk-bearing model of care will allow more Medicare
beneficiaries, Medicaid beneficiaries, and dually eligible
individuals to age in place cost effectively and with better
health outcomes.
Protecting Essential Medicines.--The Committee recognizes
the critical importance of maintaining domestic manufacturing
capacity for essential medications. The Committee is concerned
that the statutory design of the Manufacturer Discount Program
(MDP) intended for brand products inadvertently includes
products that were approved under a New Drug Application (NDA)
rather than a generic Abbreviated New Drug Application (ANDA)
due solely to unique FDA regulatory circumstances. The
Committee requests the Department provide an update in the
fiscal year 2027 congressional justification specifying the
current impact on patients, steps that can be taken by CMS and
Congress to address this issue, and efforts to support domestic
manufacturers producing essential medicines.
Protecting Medicare Beneficiary Access to Therapy.--The
Committee is concerned with the HHS OIG's findings that
Medicare Part D payors have denied or delayed timely Medicare
beneficiary access to medically necessary medication through
excessive use of utilization management, and the negative
implications for beneficiaries with the implementation of Part
D benefit redesign. The Committee acknowledges the growing
concerns by patients regarding the consequences of Part D
redesign for Medicare beneficiaries and the timely opportunity
for the agency to improve transparency around the use of
utilization in response to these concerns. The Committee
requests an update in the fiscal year 2027 congressional
justification on the new actions the agency is taking to
protect Medicare beneficiaries by enhancing its oversight of
and transparency related to the use of utilization management
by Part D plans to ensure no adverse impacts to beneficiary
access to therapies.
Provider Education for Opioid Alternatives.--The Committee
recognizes the importance of the Non-Opioid Addiction in the
Nation (NOPAIN) Act, which went into effect in January 2025,
and seeks to increase access to non-opioid pain management. The
Committee directs CMS, in coordination with CDC, to furnish
educational materials and training for providers at outpatient
surgical settings in both hospital outpatient department and
ambulatory surgery centers on the usage, benefits, and options
for non-opioid pain management. The Committee directs CMS and
CDC to report on the status of these plans and activities
within 180 days of enactment of this Act.
Radiation Oncology.--The Committee remains concerned that
efforts to reform the delivery and payment of certain types of
radiation therapy may negatively affect patient access and
outcomes. The Committee continues to support efforts by CMS to
work closely with all affected stakeholders to develop reforms
that support patient's access to high quality, innovative care.
Recognition of Licensed Naturopathic Physicians.--The
Committee requests a report within three years of enactment of
this Act regarding the number of naturopathic physicians
enrolled in Medicaid, including an analysis of the impact of
covering naturopathic physicians as Medicaid providers.
Reducing False-Positive Sepsis Blood Cultures.--The
Committee is aware that false-positive results may occur with
blood culture tests used to diagnose blood stream infections,
like sepsis. These false-positive test results can lead to
morbidity and mortality among misdiagnosed patients, spending
on unnecessary treatment, and the overuse of antibiotics. The
Committee encourages CMS to adopt a blood culture contamination
rate measure to better address and account for factors that
lead to false-positive test results.
Reliance on Death Certificate Data for Performance
Management.--The Committee is aware that when establishing the
methodology to evaluate organ procurement organization
performance, the agency elected to rely on death certificate
data to determine the denominator of the donation and
transplant rates. The Committee recognizes that death
certificate data can be unreliable and would support efforts to
identify alternative data sources.
Review of Medicare Coverage Criteria for Insulin Pumps.--
Insulin pumps are critical for people with diabetes to manage
their condition and it is important for CMS to ensure Medicare
coverage policies are consistent with current clinical
standards of care. The Committee encourages CMS to review its
coverage policies to ensure that requirements, including those
relating to the measurement of C-peptide levels or an antibody
test, are consistent with clinical standards of care and report
to the Committees on Appropriations of the House of
Representatives and the Senate within 180 days of enactment of
this Act regarding the ability of Medicare beneficiaries to
receive covered insulin pumps.
Robotic Stereotactic Radiosurgery.--The Committee
recognizes how robotic stereotactic radiosurgery (SRS) and
robotic stereotactic body radiation therapy (SBRT) are
treatment options for many types of cancer in both the hospital
and freestanding center setting. The Committee encourages CMS
to review current billing arrangements to ensure access to
robotic SRS and robotic SBRT, including maintaining existing
applicable G-codes.
Rural Health Transformation Program.--The Committee notes
that the Rural Health Transformation Program, established by
the One Big Beautiful Bill Act (OBBBA), provides
$50,000,000,000 over the next five fiscal years to improve
access to hospitals and health care providers for rural
residents of each State. Fifty percent of such funding shall be
allotted in amounts to be determined by the Administrator
taking into consideration various enumerated factors, including
such factors that the Administrator determines appropriate. In
making such determinations, the Committee urges the
Administrator to take into consideration the financial
stability of hospitals that are adversely impacted by the
significant disparities in Medicare reimbursement created by
the current wage index system, hospitals located on Indian
Reservations that are not currently eligible for a Critical
Access Hospital designation, and hospitals in States that had
not fully implemented a Medicaid managed care program prior to
passage of the OBBBA.
Screening for Cervical Cancer With Human Papillomavirus
Self Sampling.--The Committee is pleased that CMS has included
its National Coverage Determination (NCD) for Screening for
Cervical Cancer with HPV Testing on its wait list for
reconsideration. Similar to the approval for self-sampling in
other countries with organized screening programs, the National
Cancer Institute's ``Last Mile'' initiative will also determine
the clinical effectiveness of self-collection-based HPV testing
for screening to be considered for additional labeling by FDA
after review. The Committee recognizes that self-sampling has
the potential to reach individuals who are never screened or
under-screened for HPV, which makes up about half of women who
get cervical cancer in the United States. Given the promise of
HPV self-sampling, the Committee urges CMS to expedite review.
Stark Law Compliance.--The Committee encourages CMS to
apply the updated definitions of ``commercially reasonable''
and ``fair market value'' as established in the CMS Final Rule
``Medicare Program; Modernizing and Clarifying the Physician
Self-Referral Regulations'' (published December 2, 2020 and
effective January 19, 2021) where appropriate in related
guidance, rulemaking, and enforcement action. The Committee is
concerned that these key definitions, which are foundational to
compliance with the Federal Physician Self-Referral Law
(commonly referred to as the ``Stark Law''), are not being
applied during the review of certain hiring practices by
hospitals. If these definitions are not properly applied,
arrangements that violate the Stark Law will continue to go
unaddressed, increasing costs to patients and the health care
system.
Strengthening Medicare Advantage Networks for Cancer
Patients.--The Committee acknowledges the remarkable advances
in more effective treatments and cures for patients affected by
cancer, a disease which afflicts more than 2 million Americans
each year. Approximately 60 percent of cancer patients are aged
65 or older and rely on the Medicare program as their primary
source of health care coverage. The Committee notes that many
Medicare Advantage (MA) networks do not include federally
recognized National Cancer Institute (NCI)-designated
comprehensive cancer centers (CCC), which are scientific
leaders meeting rigorous standards for their transdisciplinary
research across cancer prevention, management, and treatment.
These specialized cancer centers translate research into
advanced clinical care that has been proven to deliver the
highest survival rates for cancer patients.Effective treatment
relies on the accuracy of initial diagnosis, timeliness of
intervention, therapy selection, collaboration among multiple
experts, and access to appropriate clinical trials or novel
therapies. The Committee requests information in the fiscal
year 2027 congressional justification on beneficiary access to
NCICCCs in Medicare Advantage plans and in Medicare Parts A and
B.
Whole Child Health.--The Committee commends CMS for
establishing the Integrated Care for Kids Model and for CMS'
support of State flexibility to improve the quality of care for
children covered by Medicaid. The Committee encourages CMS to
design a next generation whole child health demonstration
program. The model would address the root causes of poor
physical and mental health in children served by Medicaid and
CHIP and would promote financially sustainable pediatric
payment and delivery models that support disease prevention and
improve health. Such models would focus on proven local
strategies to improve pediatric health in a variety of
settings, such as primary care and schools, including in rural
areas. The Committee requests an update from CMS within 120
days of enactment of this Act on efforts to design a whole
child health demonstration program, including cost estimates
for implementation.
State Survey and Certification
The Committee provides $407,334,000 for State Survey and
Certification activities. This program supports certifications
of Medicare and Medicaid certified health care facilities to
ensure that beneficiaries receive care at facilities that meet
health, safety, and quality standards as required by CMS.
Federal Administration
The Committee provides $744,061,000 for Federal
Administration activities related to the Medicare and Medicaid
programs. Federal Administration funding supports CMS staff,
along with operating and administrative expenses for
information technology, communication, utilities, rent and
space requirements, as well as administrative contracts.
HEALTH CARE FRAUD AND ABUSE CONTROL ACCOUNT
Appropriation, fiscal year 2025....................... $941,000,000
Budget request, fiscal year 2026...................... 941,000,000
Committee Recommendation.............................. 941,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Health Care Fraud and Abuse Control Account funds
support activities conducted by CMS, the HHS OIG, and the
Department of Justice (DOJ). This appropriation includes a base
amount of $311,000,000 and an additional $630,000,000 in budget
adjustment funding.
This funding is in addition to other mandatory funding
provided through authorizing legislation. The funding will
provide resources to continue efforts for Medicaid program
integrity activities, for safeguarding the Medicare
prescription drug benefit and the Medicare Advantage program,
and for program integrity efforts related to these programs
carried out by the DOJ.
Senior Medicare Patrol.--The Committee includes bill
language to enable the Secretary to provide a total of
$35,000,000 for the Senior Medicare Patrol program, which is
administered by the Administration for Community Living, from
either discretionary or mandatory funds provided to this
account.
Administration for Children and Families
PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT
PROGRAMS
Appropriation, fiscal year 2025....................... $3,924,000,000
Budget request, fiscal year 2026...................... 4,147,000,000
Committee Recommendation.............................. 4,147,000,000
Change from enacted level......................... +223,000,000
Change from budget request........................ - - -
The Committee also provides $1,800,000,000 in advance
funding, as requested, for the first quarter of fiscal year
2027 to ensure timely payments for Child Support Enforcement
programs. These formula and incentive grants to States foster
parental responsibility and promote family independence, self-
sufficiency, and child well-being through services such as
locating noncustodial parents, establishing and enforcing
support orders, and collecting and disbursing child support
payments.
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM
Appropriation, fiscal year 2025....................... $4,025,000,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 4,035,000,000
Change from enacted level......................... +10,000,000
Change from budget request........................ +4,035,000,000
The Low Income Home Energy Assistance Program provides
formula grants to States to support eligible families and
households through programs providing assistance with energy
costs. The Committee recognizes the positive impact LIHEAP has
on low-income families and encourages HHS to maintain this
program for eligible recipients.
LIHEAP Workforce.--The Committee encourages ACF to address
any vacancies that may affect program operations or its ability
to fulfill its statutory responsibility to provide home heating
and cooling assistance to low-income households Nationwide.
REFUGEE AND ENTRANT ASSISTANCE
Appropriation, fiscal year 2025....................... $6,327,214,000
Budget request, fiscal year 2026...................... 4,292,755,000
Committee Recommendation.............................. 4,292,755,000
Change from enacted level......................... -2,034,459,000
Change from budget request........................ - - -
ORR programs are designed to help refugees, asylees, Cuban
and Haitian entrants, and trafficking victims become employed
and self-sufficient. These programs also provide for the care
of unaccompanied alien children in Federal custody and
survivors of torture.
The Committee continues to direct ORR to provide monthly
updates of arrivals each month by category, including refugees,
asylees, Cuban and Haitian entrants, Special Immigrant Visas,
and unaccompanied alien children.
Within the total, the Committee includes the following:
------------------------------------------------------------------------
Budget Activity FY 2025 Enacted FY 2026 Committee
------------------------------------------------------------------------
Transitional and Medical Services. $564,000,000 - - -
Refugee Support Services.......... 307,201,000 - - -
Victims of Trafficking............ 30,755,000 $30,755,000
Unaccompanied Alien Children...... 5,406,258,000 4,243,000,000
Survivors of Torture.............. 19,000,000 19,000,000
------------------------------------------------------------------------
The Committee provides no funding for the Transitional and
Medical Services program (TAMS) and the Refugee Support
Services (RSS) programs. Under the previous administration,
TAMS and RSS incentivized unchecked migration through cash
handouts, medical assistance, and public welfare services. The
Committee recognizes the Trump Administration's efforts to curb
refugee border encounters and referrals by the Department of
Homeland Security (DHS) to ORR. The Committee encourages HHS to
continue processing credible refugee referrals made by the
Department of State and DHS through existing refugee assistance
programs.
Victims of Trafficking
The Victims of Trafficking program funds competitive grants
and contracts for services to foreign victims of trafficking
and potential victims in the United States.
Within the $30,755,000 provided for Victims of Trafficking
program, the Committee includes not less than $5,000,000 for
the National Human Trafficking Hotline (Hotline), which is the
same as the fiscal year 2025 enacted program level.
Education and Awareness in Health Care.--The Committee
recognizes that victims of trafficking often utilize the health
care system and medical professionals are in a unique position
to identify and respond to signs of abuse. The Committee
encourages ACF to continue funding the SOAR to Health and
Wellness Training Program (SOAR Program) to train health care
professionals to understand the risk factors of trafficking, to
recognize indicators of trafficking, to screen patients and
identify potential victims, and to work with relevant
stakeholders to deliver trauma-informed and person-centered
care. The Committee further encourages the agency to evaluate
the effectiveness of the SOAR Program, specifically its impacts
on identifying and reporting suspected trafficking cases in
health care settings. The evaluation should also include a
cost-benefit analysis of Federal spending on the SOAR Program.
The Committee requests ACF include an update in its fiscal year
2027 congressional justification detailing the findings of this
evaluation.
Hotline Mandatory Reporting.--The Committee is alarmed by
recent reports that the current Hotline grantee is no longer
sharing trafficking tips from concerned third parties and
distressed family members with law enforcement. The Committee
recognizes the Department's commitment to the goals and
operations of the Hotline, including the referral of actionable
tips to law enforcement. As outlined in the fiscal year 2025
Hotline Notice of Funding, an objective of the Hotline is to
notify law enforcement and child welfare agencies of potential
cases of human trafficking, as well as instances when a
trafficking victim is in imminent danger, and to document
emerging or common trafficking schemes to assist in the
detection and investigation of trafficking cases. However, the
Committee is concerned that the grantee's current policies may
be undermining the safety of trafficking victims. Therefore,
the Committee directs HHS to ensure the Hotline is compliant
with all Federal, State, and local laws, regulations, or
policies, that require mandatory reporting to law enforcement
for investigations into possible human trafficking. The
Committee further directs the Department to conduct robust
oversight of the Hotline to ensure accurate and timely
reporting of trafficking tips to law enforcement. The Committee
requests HHS include an update in its fiscal year 2027
congressional justification detailing the Hotline's compliance
with respect to these reporting requirements.
Public Awareness Campaign.--The Committee notes that HHS
currently coordinates with DHS on various national trafficking
prevention awareness activities, including the HHS Look Beneath
the Surface Campaign and the DHS Blue Campaign. Each campaign
is designed to educate and partner with the public, law
enforcement, grantees, and key industry stakeholders to
recognize the indicators of human trafficking, and how to
appropriately respond to possible cases. The Committee
encourages HHS, in coordination with DHS, to continue improving
the public health response to human trafficking, including
providing the necessary support services for survivors and
families, partnering with schools and community-based agencies
to raise awareness, and identifying and mitigating risk factors
for trafficking.
Youth Prevention Education and Awareness.--The Committee
recognizes the important role of educators in preventing human
trafficking and providing a safe and supportive school
environment for survivors. The Committee strongly encourages
ACF to continue funding the Human Trafficking Youth Prevention
Education (HTYPE) Demonstration Grant Program. HTYPE provides
funds to local educational agencies for the purpose of
partnering with law enforcement and non-governmental
organizations to develop and implement human trafficking
prevention education and training opportunities for students,
caregivers, teachers, and other school personnel. The Committee
notes the program's success in helping participants identify,
respond to, and support potential victims of trafficking. The
Committee urges ACF to expand education and training
opportunities to school nurses and other school-based health
care providers.
Unaccompanied Alien Children
The UAC program supports the care and placement of
unaccompanied children under the age of 18 apprehended by DHS.
These unaccompanied minors are at risk for human trafficking
and child exploitation. Costs to serve this population have
soared in recent years, leading to unsustainable growth and the
risk of increased illicit activities. The safety and well-being
of vulnerable children was jeopardized when ORR reduced its
vetting requirements for sponsors and adult members living in a
sponsor's household. Thousands of children were released to
improperly vetted sponsors and placed at increased risk of
trafficking, forced labor, and other forms of exploitation. In
2025, the Trump Administration prioritized child safety by
strengthening ORR's vetting process for UAC households,
including enhancements to its mandated background checks, DNA
testing, and home study requirements. ORR also implemented
other UAC policies such as requiring proof of income for all
sponsors and denying the release of children when a sponsor
provides false information or refuses biometric screening. The
Committee notes that the Trump Administration's immigration
enforcement measures have reduced the number of UAC border
encounters and UAC-associated costs. Therefore, the Committee
proposes reduced funding consistent with the historical needs
of the account.
Care and Placement Report.--The Committee directs ORR to
continue to submit biannual reports to the Committee that
include the number of UACs that remain in HHS care for longer
than one year and the number of UACs that HHS has released to
sponsors. The report should also include an explanation of the
methods ORR uses to follow-up with unaccompanied children after
releasing them to a sponsor, including the follow-up method
used and number of attempts made. The Department shall include
the total number of UACs that ORR has been unable to contact
successfully for follow-up for fiscal years 2021-2025 and shall
make such a report available on its website.
Case Management.--The Committee directs the Department, in
coordination with DHS, to continue its implementation of a new
case management system that can be integrated with the Unified
Immigration Portal (UIP) for improved UAC placement and release
decisions. The UIP helps with real-time data collection and
tracking of UACs at the time of apprehension and through the
referral, placement, and repatriation process.
Facility Occupancy Rates.--The Committee notes that HHS
publishes updated data on its website on occupancy rates in
facilities, average length of care in HHS custody, UAC
demographics, and releases to sponsors by category.
Fair and Open Contracting and Grant Making.--The Committee
directs the agency to conduct all public solicitations for
grants or contracts in a manner that is fair, open,
transparent, and free from ideological bias and conflict of
interest. All Federal laws, regulations, and guidelines on
communications with outside vendors should be rigorously
adhered to with appropriate internal controls in place to avoid
undue risk of favoritism or other bias in making selections.
Home Studies.--The Committee notes that the Trafficking
Victims Protection Reauthorization Act requires home studies of
potential sponsors when the child is a victim of trafficking,
special needs/disabled, a victim of physical or sexual abuse,
or if the sponsor clearly presents a risk of abuse,
maltreatment, exploitation, or trafficking. ORR additionally
mandates home studies if a potential sponsor is seeking to
sponsor two or more children and at least one of the children
is unrelated to the potential sponsor, if a potential sponsor
has previously been the sponsor of two or more children and is
now seeking to sponsor an additional child, or if a potential
sponsor is seeking to sponsor an unrelated child who is 12
years or under. The Committee notes ORR's recent updates to the
UAC Policy Guide Section 2.4.2 Home Study Requirement,
including mandating a home study in cases where a potential
sponsor claims a biological relationship with the child but
refuses to conduct a DNA test or when a potential sponsor is
unrelated to a child. The updated policy also requires a home
study for cases where a potential sponsor is unable to provide
the required documentation. The Committee encourages ORR to
continue prioritizing the safety and security of UACs by
providing a home study when necessary.
Interagency Information Sharing.--The Committee directs the
Department and DHS to finalize an interagency information
sharing agreement to address long-standing information sharing
gaps identified in a February 2020 GAO report (GAO-20-245). The
Committee requests the Department and DHS brief the
congressional committees of jurisdiction on the implementation
of a final interagency agreement on information sharing for
UACs within 180 days of enactment of this Act.
Know Your Rights Presentations.--The Committee encourages
the Department to continue providing Know Your Rights
presentations for UACs in custody, consistent with the William
Wilberforce Trafficking Victims Protection Reauthorization Act
of 2008 (P.L. 110-457). The Committee further encourages HHS to
continue providing information on resources to prevent child
labor exploitation as part of ORR's notice of rights.
Notification of Fatalities in ORR Care.--The Committee
directs ORR to continue to report the death of any UAC in its
custody within 24 hours, including relevant details regarding
the circumstances of the fatality.
ORR Employee Vetting.--The Committee encourages ORR to
continue working with influx care facilities (ICFs) and
emergency intake sites (EISs) to conduct all required
background checks for employees, volunteers, and contractors
who may have contact with children in ORR care. The Committee
further encourages ORR to maintain and enforce monitoring
requirements for ICFs and EISs, including reviewing compliance
with all background check requirements and conducting quarterly
on-site monitoring visits.
Referrals Related to Trafficking.--The Committee directs
ORR to submit quarterly reports to the Committee that includes
the number of referrals that ORR has made to the DHS's Homeland
Security Investigations Division.
Spend Plan.--The Committee continues to direct the
Secretary to submit a comprehensive spend plan to the Committee
every 90 days.
Survivors of Torture
The program funds competitive grants to nonprofit
organizations providing services to refugees, asylees, and
asylum seekers to address the effects of torture.
PROMOTING SAFE AND STABLE FAMILIES
Appropriation, fiscal year 2025....................... $417,515,000
Budget request, fiscal year 2026...................... 482,515,000
Committee Recommendation.............................. 482,515,000
Change from enacted level......................... +65,000,000
Change from budget request........................ - - -
The Committee provides $420,000,000 in mandatory funds and
$62,515,000 in discretionary funds for the Promoting Safe and
Stable Families program. This program enables each State to
operate a coordinated program of family preservation services,
community-based family support services, time-limited
reunification services, and adoption promotion and support
services.
Within the discretionary total, the Committee provides
$2,750,000 for the Family First Clearinghouse and related
research and evaluation.
PAYMENTS TO STATES FOR THE CHILD CARE AND DEVELOPMENT BLOCK GRANT
Appropriation, fiscal year 2025....................... $8,746,387,000
Budget request, fiscal year 2026...................... 8,746,387,000
Committee Recommendation.............................. 8,746,387,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The childcare and development block grant provides formula
grants to States, territories, and Tribes to provide financial
assistance to help low-income working families and families
engaged in training or education activities pay for childcare.
The Committee includes new bill language increasing the
Tribal set-aside to not less than 6 percent.
Food Preparation Impacts.--The Committee notes that States
may assess whether regulations could result in limitations on
the preparation of fresh fruits and vegetables in child care
facilities.
SOCIAL SERVICES BLOCK GRANT
Appropriation, fiscal year 2025....................... $1,700,000,000
Budget request, fiscal year 2026...................... 1,700,000,000
Committee Recommendation.............................. 1,700,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Social Services Block Grant (SSBG) program provides
formula grants to the 50 States, the District of Columbia,
Puerto Rico, Guam, American Samoa, the U.S. Virgin Islands, and
the Commonwealth of the Northern Mariana Islands. SSBG funding
targets a broad set of goals, including reducing or eliminating
poverty, achieving or maintaining individual self-sufficiency,
preventing or remedying neglect, abuse, or exploitation of
children and adults, preventing or reducing inappropriate
institutional care, and supporting institutional care, when
appropriate.
Family Resource Centers.--The Committee recognizes that
Family Resource Centers provide direct assistance to families
through parenting support and education, navigation of care and
social services, mental health counseling, early learning and
afterschool activities, family financial planning, and job
training. The Committee supports States' investments in Family
Resource Center services and programs at school and community-
based Family Resource Centers to strengthen families through a
localized, family-centered approach. The Committee encourages
HHS to evaluate how States are utilizing Federal funds to
support FRC activities and to measure the outcomes of such
investments.
CHILDREN AND FAMILIES SERVICES PROGRAMS
Appropriation, fiscal year 2025....................... $14,789,089,000
Budget request, fiscal year 2026...................... 13,657,693,000
Committee Recommendation.............................. 14,480,087,000
Change from enacted level......................... -309,002,000
Change from budget request........................ +822,394,000
The Children and Families Services programs fund activities
serving children, youth, families, the developmentally
disabled, Native Americans, victims of child abuse and neglect
and domestic violence, and other vulnerable populations.
The Committee provides the following amounts:
------------------------------------------------------------------------
Budget Activity FY 2025 Enacted FY 2026 Committee
------------------------------------------------------------------------
Programs for Children, Youth, and
Families:
Head Start.................... $12,271,820,000 $12,271,820,000
Preschool Development Grants.. 315,000,000 - - -
Runaway and Homeless Youth 125,283,000 125,283,000
Program......................
Prevention Grants to Reduce 21,000,000 21,000,000
Abuse of Runaway Youth.......
Child Abuse State Grants...... 105,091,000 105,091,000
Child Abuse Discretionary 36,000,000 36,000,000
Activities...................
Community Based Child Abuse 70,660,000 70,660,000
Prevention...................
Child Welfare Services........ 268,735,000 268,735,000
Child Welfare Research, 21,984,000 21,984,000
Training, and Demonstration..
Adoption Opportunities........ 53,000,000 53,000,000
Adoption and Legal 75,000,000 75,000,000
Guardianship Incentive
Payments.....................
Social Services Research and 35,012,000 30,010,000
Demonstration................
Native American Programs...... 60,500,000 65,500,000
Community Services Block Grant
Act Programs:
Community Services Block 770,000,000 775,000,000
Grant....................
Community Economic 22,383,000 22,383,000
Development..............
Rural Community Facilities 12,000,000 13,000,000
National Domestic Violence 20,500,000 20,500,000
Hotline......................
Family Violence Prevention and 240,000,000 240,000,000
Services.....................
Chafee Education and Training 44,257,000 44,257,000
Vouchers.....................
Disaster Human Services Case 1,864,000 1,864,000
Management...................
Program Direction............. 219,000,000 219,000,000
------------------------------------------------------------------------
Head Start
Head Start and Early Head Start (EHS) programs fund
competitive grants to promote school readiness of children
under 5 from low-income families through preschool services.
Early Head Start.--The Committee directs HHS to maintain
the EHS allocation of funds to at least the current proportion
of funding within the overall Head Start appropriations to
ensure that eligible pregnant women, infants and toddlers, and
families continue to benefit from EHS high-quality,
comprehensive services. The Committee directs HHS to prioritize
maintenance of current slots and then expand slots where
possible, including through Head Start to Early Head Start
(ES2EHS) slot conversion. Finally, the Committee continues to
direct HHS to include in future congressional justifications
the actual and estimated number of slots in each of Head Start,
EHS, EHS Child Care Partnerships, and slots converted from
ES2EHS.
Head Start Facilities.--The Committee recognizes that
repair, renovation, rebuilding, and replacement of Head Start
and EHS facilities is necessary to provide a safe, high-
quality, and developmentally appropriate environment for
children and families. The Committee notes that the last
comprehensive Head Start facilities report was conducted in
fiscal year 2015 and the last American Indian and Alaska Native
(AI/AN) Head Start facilities report was produced in 2020. The
Committee believes that updated assessments are necessary to
understand the current infrastructure needs. Therefore, the
Committee directs ACF to produce and make public on its website
new facilities reports on the Head Start and AI/AN Head Start
programs. The Committee further directs the agency to include
an analysis of the various funding mechanisms available within
ACF that grantees can use for construction, renovation, or
other capital improvement activities. The Committee encourages
ACF to ensure all grantees are aware of any funding
opportunities for facility improvements. Additionally, the
Committee urges the agency to provide the necessary technical
assistance to grantees for the purpose of navigating and
completing the application process.
Notice to Congressional Offices.--The Committee directs the
agency to notify a congressional office if a current Head Start
recipient in its congressional district will be required to re-
compete to continue its grant. The agency is directed to notify
the office when the grant forecast for the recipient's service
area and funding is published.
Tribal Colleges and Universities Head Start Partnership
Program.--The Committee includes $12,000,000 for the Tribal
Colleges and Universities Head Start Partnership program, which
is a $4,000,000 increase above the fiscal year 2025 enacted
program level.
Preschool Development Grants
The Committee does not provide funding for the Preschool
Development Grants (PDG) program. The Committee prioritizes
funding for early learning and care programs through Head
Start, EHS, the Child Care and Development Block Grant (CCDBG)
and TANF.
Runaway and Homeless Youth Program
This program funds competitive grants to provide street
outreach, emergency shelters, and longer-term transitional
living programs to protect and provide supportive services to
runaway and homeless youth.
Prevention Grants to Reduce Abuse of Runaway Youth
This program funds competitive grants to nonprofit agencies
for the purpose of providing street-based services to runaway,
homeless, and street youth who have been subjected to, or are
at risk of being subjected to sexual abuse, prostitution, human
trafficking, sexual exploitation, or other forms of
victimization. The Committee encourages the agency to continue
the Runaway and Homeless Youth Prevention Demonstration
Program, which has awarded funding to community-based
organizations focused on prevention services for youth at risk
of homelessness.
Child Abuse Prevention State Grants
This program provides Child Abuse Prevention and Treatment
Act formula grants to States to improve their child protective
service systems.
Child Abuse Discretionary Activities
This funding supports a variety of competitive grants,
including research and demonstration projects on the causes,
prevention, identification, assessment and treatment of child
abuse and neglect, the development and implementation of
evidence-based training programs, and technical assistance to
grantees and communities through national resource centers and
the Child Welfare Information Gateway.
Child Abuse Hotline.--The Committee supports ongoing
efforts to address and support youth and families impacted by
child abuse and neglect. Within the total, the Committee
continues to provide $2,000,000, which is the same as the
fiscal year 2025 enacted program level, for broad, ongoing
support for the national child abuse hotline in order to
provide resources and intervention through multiple modalities,
including chat, text, and call, to respond to the urgent needs
of youth and concerned adults facing these challenges.
Community Based Child Abuse Prevention
This program provides formula grants to States that then
disburse funds to local community-based organizations to
improve local child abuse prevention and treatment efforts.
Child Welfare Services
This program funds formula grants to State and Tribal child
welfare programs for research, monitoring, and special
initiatives to promote positive outcomes for children and
families involved in child welfare.
Child Welfare Research, Training, and Demonstration Projects
This program funds competitive grants to entities that
prepare personnel for work in the child welfare field and those
engaged in research around child welfare issues.
Strengthening State Indian Child Welfare Act Compliance.--
The Committee recognizes the important role State child welfare
agencies play in ensuring the safety of Indian children who
come into contact with the State child welfare system. The
Committee appreciates the work of the Children's Bureau to
support State compliance with the Indian Child Welfare Act
through technical assistance and through grants to develop
strong working relationships between States and Tribes. The
Committee continues to provide $3,000,000, which is the same as
the fiscal year 2025 enacted program level, for State-Tribal
partnership grants to build collaborations between States and
Tribes to better address the ongoing challenges Tribal
communities face. Moreover, the Committee directs the agency to
provide the guidance required in Senate Report 118-84 and
section 429B of the Social Security Act (42 U.S.C. 628d) to the
Committee and make such guidance available on its website.
Adoption Opportunities
This program funds competitive grants and contracts to
public and private organizations to remove barriers to adoption
and to provide permanent homes for children who would benefit
from adoption.
Adoption Agencies.--The Committee encourages HHS to
maintain a public list of licensed adoption agencies so that
birth mothers can make decisions based on verified and
trustworthy information. The list of agencies should include
adoption agencies with current State licenses who are in good
standing with the State.
Adoption-Sensitive Care Training.--The Committee continues
to provide $1,000,000, which is the same as the fiscal year
2025 enacted program level, for a competitive grant program to
improve access to adoption-sensitive care training for eligible
hospital staff as directed in the explanatory statement that
accompanied Division D of P.L. 118-47. The Committee encourages
the Department to provide grantees with resources that focus on
understanding the sensitivities regarding adoption in the
health care industry and the best practices for interacting
with prospective birth mothers and adoptive families, including
the use of non-directive education for expectant parents
considering adoption, parenting, and kinship care. Eligible
grantees should not provide or refer for abortion.
Family First Prevention Services Clearinghouse.--The
Committee continues to direct not less than $2,000,000, which
is the same as the fiscal year 2025 enacted program level, for
the evaluation of programs to support adoption arrangements at
risk of a disruption or dissolution, as directed in Senate
Report 118-84.
National Adoption Competency Mental Health Training
Initiative.--The Committee continues to provide $2,000,000 for
the National Adoption Competency Mental Health Training
Initiative, which is the same as the fiscal year 2025 enacted
program level.
National Training and Development Curriculum (NTDC).--The
Committee directs HHS to extend the current grant by 12 months
for the NTDC as directed in the explanatory statement that
accompanied Division D of P.L. 118-47.
Support for Birth Parents.--The Committee recognizes that
birth parents who voluntarily place their children for adoption
often benefit from post-adoption counseling, support, and
resources. Therefore, the Committee provides $1,000,000 for a
demonstration program to provide support groups, resources, and
services to birth parents. Eligible grantees should be
adoption-focused, nonprofit organizations with experience
working with parents who have placed their children for private
domestic adoption. The Committee directs HHS to brief the
Committee no later than 90 days after enactment of this Act on
its plans for carrying out this competition. In addition, the
Committee directs HHS to provide notice to the Committee at
least seven days before awards are announced.
Adoption and Legal Guardianship Incentive Payments
This program provides formula-based incentive payments to
States to encourage them to increase the number of adoptions of
children from the foster care system.
Social Services Research and Demonstration
The Social Services Research and Demonstration funds
research, evaluation, and demonstration efforts that focus on
preventing and reducing dependency on government programs and
improving the administration and effectiveness of services for
children and families.
Diaper Distribution Demonstration and Research Pilot.--
Within the total, the Committee continues to provide
$20,000,000, which is the same as the fiscal year 2025 enacted
program level, for the Diaper Distribution Demonstration and
Research Pilot (DDRP). The pilot helps address diaper needs and
supports economic mobility for low-income families. The
Committee encourages ACF to continue funding grants and to
support program evaluation activities, including the release of
the final DDRP evaluation report.
Affordable Housing and Supportive Services Demonstration.--
Within the total, the Committee continues to provide
$2,500,000, which is the same as the fiscal year 2025 enacted
program level, for grants to Community Action Agencies and
Tribes that own affordable housing for the purpose of
connecting residents to support services that improve housing
stability, economic mobility, and well-being.
Native American Programs
These programs fund competitive grants to assist Tribal
governments and Native American institutions and organizations
in their efforts to support and develop stable, diversified
local economies. Tribes and nonprofit organizations use funds
to develop and implement sustainable, community-based social
and economic programs and services to improve the wellbeing of
Native people.
Within the total, the Committee provides $15,000,000 for
Native American language preservation activities, including no
less than $6,000,000 for language immersion programs as
authorized by section 803C(b)(7)(A)-(C) of the Native American
Programs Act, as amended by the Esther Martinez Native American
Language Preservation Act of 2006.
Community Services Block Grant Act Programs
The Community Services Block Grant is a program that
provides formula grants to States, territories, and Tribes to
alleviate the causes and conditions of poverty in communities.
Community Economic Development.--Community Economic
Development is a competitive grant program, which funds
Community Development Corporations seeking to address the
economic needs of low-income individuals and families through
the creation of sustainable business development and employment
opportunities.
Rural Community Facilities.--Rural Community Development is
a competitive grant program that works with regional and Tribal
organizations to manage safe water systems in rural
communities. Under this program's technical assistance
authority, grant recipients can aid residents in unserved and
underserved populations, including isolated, unincorporated
communities, small, low-income communities that cannot afford
loan/grant financing, and those that lack central systems and
are therefore not regulated under the Clean Water Act or Safe
Drinking Water Act.
National Domestic Violence Hotline
The National Domestic Violence Hotline provides free and
confidential 24-hour, toll-free telephone, chat and text
services immediately connecting callers to local service
providers. The Committee encourages ACF to continue building
the Hotline's capacity and to support investments in technology
infrastructure and staffing to ensure a timely response to
requests for help.
Religious Communities.--Individuals in religious
communities experience unique challenges in assessing
appropriate domestic violence resources and support. The
Committee provides $250,000 for the domestic violence hotline
to evaluate and expand its list of resources for contacts from
religious communities.
Family Violence Prevention and Services
The FVPSA program provides funding to support the
prevention of incidents of family violence, domestic violence,
and dating violence, and provide immediate shelter and
supportive services for adult and youth victims. The Committee
recognizes that all forms of domestic violence is strongly
associated with poor mental health outcomes and substance
abuse. Therefore, the Committee encourages ACF to fund domestic
violence prevention programs that support individuals with co-
occurring health conditions linked to domestic violence while
ensuring families remain together through recovery and the best
interests of children exposed to violence in the home are
prioritized.
Within the total, the Committee provides $12,000,000, which
is an increase of $5,000,000 from the fiscal year 2025 enacted
program level, for supporting Native American Tribes and Tribal
organizations to fund immediate shelter and supportive services
for survivors of domestic violence and their dependents.
Within the total, the Committee provides $2,000,000 for the
Native Hawaiian Resource Center on Domestic Violence program,
which is the same as the fiscal year 2025 enacted program
level, to continue providing technical assistance, services and
supports for Native Hawaiian adults, children, and youth
experiencing domestic violence.
Addressing Domestic Violence in Religious Communities.--The
Committee recognizes the unique challenges experienced by
individuals in religious communities, especially populations
underserved because of their religious beliefs, in accessing
appropriate domestic violence services and supports. The
Committee supports the work that FVPSA Resource Centers are
doing to improve outreach to faith-based communities.
Chaffee Education and Training Vouchers
This program funds formula grants to States to provide
vouchers to youth who are, or were formerly, in foster care for
expenses related to post-secondary education assistance, and
vocational training.
Disaster Human Services Case Management
This funding supports work at HHS addressing human service
preparation for, response to, and recovery from, natural
disasters.
Program Direction
This funding supports Federal administrative costs
associated with administering the agency's programs.
Temporary Assistance for Needy Families Pilot Projects.--
The Committee recognizes the Department's commitment to
personal responsibility, self-sufficiency, strong families, and
State-led innovation in its redesigned TANF pilot program.
These projects are authorized under section 302 of the Fiscal
Responsibility Act (P.L. 118-5) and aim to build evidence to
evaluate if existing accountability mechanisms help improve
employment outcomes and reduce government dependency. The
Committee directs HHS to provide notice to the committees of
jurisdiction of the States selected to participate in the TANF
pilot projects at least seven days prior to public release.
PAYMENTS FOR FOSTER CARE AND PERMANENCY
Appropriation, fiscal year 2025....................... $6,768,000,000
Budget request, fiscal year 2026...................... 6,843,000,000
Committee Recommendation.............................. 6,843,000,000
Change from enacted level......................... +75,000,000
Change from budget request........................ - - -
The Committee also provides an advance appropriation of
$3,800,000,000 for the first quarter of fiscal year 2027 to
ensure timely completion of first-quarter grant awards.
Foster Youth and the Pediatric Care System.--The Committee
directs the agency to include information in its fiscal year
2027 congressional justification detailing its ongoing inter-
agency collaboration with CMS and SSA to ensure that youth
aging out of foster care with medically-complex or special
needs undergo a smooth transition out of the pediatric care
system.
Within the total, the Committee provides $5,517,000,000 for
the Foster Care program. This mandatory program provides funds
to States for foster care maintenance payments for children
living in foster care. These funds also reimburse States for
administrative costs to manage the program and training for
staff and parents.
Within the total, the Committee provides $4,397,000,000 for
Adoption Assistance. This mandatory program provides funds to
States to subsidize families who adopt children with special
needs, such as older children, a member of a minority or
sibling group, or children with physical, mental, and emotional
disabilities. In addition, the program provides training for
adoptive parents and State administrative staff. This annually
appropriated entitlement provides alternatives to long,
inappropriate stays in foster care by developing permanent
placements with families.
Within the total, the Committee provides $386,000,000 for
the Kinship Guardianship Assistance program. This mandatory
program provides subsidies to a relative taking legal
guardianship of a child for whom being returned home, or
adoption are not appropriate permanency options.
Finally, within the total, the Committee provides
$143,000,000 for the Independent Living program. This mandatory
program assists foster children age 16 or older make successful
transitions to independence. Funds support a variety of
services, including educational assistance, career exploration,
vocational training, job placement, life skills training, home
management, health services, substance abuse prevention,
preventive health activities, and room and board. Each State
receives funds based on the number of children on whose behalf
the State receives Federal Foster Care Payments.
Administration for Community Living
AGING AND DISABILITY SERVICES PROGRAMS
Appropriation, fiscal year 2025....................... $2,518,744,000
Budget request, fiscal year 2026...................... 2,443,100,000
Committee Recommendation.............................. 2,508,132,000
Change from enacted level......................... -10,642,000
Change from budget request........................ +65,032,000
Created in 2012, ACL brings together the efforts and
achievements of the Administration on Aging, the Administration
on Intellectual and Developmental Disabilities, and the HHS
Office on Disability to serve as the Federal agency responsible
for increasing access to community supports, while focusing
attention and resources on the unique needs of older Americans
and people with disabilities across the lifespan.
The Committee notes that the Department proposes to
integrate ACL functions into the Administration for Children
and Families. The Committee looks forward to working with the
authorizing committees of jurisdiction as they consider this
proposal.
The Committee continues to fund the Senior Medicare Patrol
Program through the Health Care Fraud and Abuse Control Account
under CMS.
Home and Community Based Supportive Services
The Committee provides $414,000,000 for Home and Community-
Based Supportive Services, which is a $4,000,000 increase above
the fiscal year 2025 enacted program level. This program
provides formula grants to States and territories to fund a
wide range of social services that enable seniors to remain
independent in their homes for as long as possible.
Preventive Health Services
The Committee provides $26,339,000 for Preventive Health
Services, which is the same as fiscal year 2025 enacted program
level. This program funds formula grants to States to help
seniors remain healthy and avoid chronic diseases. Funding
supports a variety of healthy aging programs aimed to reduce
disease and prevent injuries, including evidence-based programs
to address the risk of falls, chronic diseases, mental health,
and medication management.
Protection of Vulnerable Older Americans
The Committee provides $26,885,000 for activities to
protect vulnerable older Americans, which is a $227,000
increase above the fiscal year 2025 enacted program level.
These programs provide formula grants to States for protection
of vulnerable older Americans through the Long-Term Care
Ombudsman and Prevention of Elder Abuse and Neglect programs.
The Committee continues to provide $21,885,000 for the
Long-Term Care Ombudsman program. This program works to improve
the quality of life and care for individuals who reside in
long-term care facilities. Ombudsmen work to ensure residents
understand their care options and that strong beneficiary
support systems are in place in all settings.
Family Caregivers
The Committee provides $207,000,000 for the National
Caregiver Support program, which is the same as the fiscal year
2025 enacted program level. This program offers a range of
support services to family caregivers, including assistance in
accessing services such as respite care, counseling, support
groups, and caregiver training.
Native American Caregivers Support
The Committee provides $14,000,000 for the Native American
Caregivers Support program, which is a $2,000,000 increase
above the fiscal year 2025 enacted program level. This program
provides formula grants to Tribes for the support of American
Indian, Alaskan Native, and Native Hawaiian families caring for
older relatives with chronic illness or disabilities.
Nutrition
The Committee provides a total of $1,058,684,000 for senior
nutrition programs. This is the same overall funding level as
the fiscal year 2025 enacted program level. Funding for this
population is also available from the Department of
Agriculture. Within the overall amount, the Committee includes
$565,342,000 for Congregate Meals, $381,342,000 for Home
Delivered Meals, and $112,000,000 for the Nutrition Services
Incentives program. These programs provide older Americans with
meals and related services in a variety of settings (including
congregate facilities such as senior centers) and via home
delivery to older adults who are homebound due to illness,
disability, or geographic isolation.
Collaboration with the Department of Agriculture.--The
Committee encourages ACL to deepen collaborations directly with
the Department of Agriculture's Senior Farmers Market Nutrition
Program to ensure seniors can continue to access locally grown
fresh fruits and vegetables while also assisting local
agricultural producers.
Greatest Need Eligibility Assessment.--The Committee notes
that under section 305(a)(2)(E) of the OAA (P.L. 89-73), States
are required to provide assurance that preference will be given
to providing OAA services, including senior nutrition services,
to older adults with greatest social and economic need. In its
2019 OAA annual report to Congress, ACL noted ``. . . a third
of all (OAA) services were delivered to older adults with the
greatest social need and greatest economic need.'' The
Committee believes that senior nutrition services should fully
benefit older adults with the greatest economic and social
need. Therefore, the Committee directs ACL to produce and make
public on its website an updated OAA annual report that
includes information and an analysis of the methodology used by
States to determine the proportion of OAA participants that
meet the definition of greatest economic and social need, and
policies and procedures, including outreach efforts, that
States are implementing to improve the proportion of seniors
served with actual greatest need.
Grants for Native Americans
The Committee provides $40,264,000 for Native American
Nutrition and Supportive Services, which is a $2,000,000
increase above the fiscal year 2025 enacted program level. This
program provides formula grants to Tribes to promote the
delivery of nutrition and home and community-based supportive
services to Native American, Alaskan Native, and Native
Hawaiian elders.
Aging Network Support Activities
The Committee provides $30,461,000 for Aging Network
Support Activities, which is the same as the fiscal year 2025
enacted program level. This program supports activities that
expand public understanding of aging and the aging process.
The Committee does not provide funding for the Direct Care
Workforce Demonstration and the Older Adult Equity
Collaborative.
Care Corps.--Within the total amount, the Committee
continues to provide $5,500,000 for the Care Corps volunteer
program to support non-medical services for seniors,
individuals with disabilities and family caregivers. These
include respite care, transportation, meal preparation, minor
home cleaning and modifications, education, caring calls/
visits, and training.
Holocaust Survivor Assistance Program.--Within the total
amount, the Committee continues to provide $8,500,000 for the
Holocaust Survivor Assistance program. This program provides
supportive services for aging Holocaust survivors living in the
U.S. The Committee recognizes the program's success in serving
nearly 44,000 Holocaust survivors, more than 8,000 older adults
with a history of trauma, and over 7,000 family caregivers.
Interagency Coordinating Committee on Healthy Aging and
Age-Friendly Communities.--The Committee continues to provide
$1,000,000 for the coordination of healthy aging programs
across HHS, the Department of Housing and Urban Development,
the Department of Transportation, and other related agencies,
with a focus on falls prevention programs and safe living
environments for seniors.
Older Americans Act Funding Study.--The Committee
recognizes that due to progress in the treatment of HIV, the
majority of Americans living with this chronic disease will
soon be eligible for Social Security and Medicare. Older adults
living with HIV face unique challenges and barriers to
accessing services, particularly in smaller cities and rural
areas where availability of health care services is limited.
Therefore, the Committee encourages that the Administration on
Aging study how to better target Older Americans Act funding to
older adults living with HIV.
Research, Demonstration, and Evaluation Center for the
Aging Network.--The Committee continues to provide $5,000,000
for the Research, Demonstration, and Evaluation Center for the
Aging Network. The center researches best practices in the
field of falls prevention, it awards competitive grants to
Aging Network entities to implement best practices and
evaluates new and ongoing falls prevention programs.
Alzheimer's Disease Program
The Committee provides $31,500,000 for the Alzheimer's
disease program, which is the same as the fiscal year 2025
enacted program level. This program provides competitive
matching grants to a limited number of States to encourage
program innovation and coordination of public and private
services for people with Alzheimer's disease and their
families. Of the funds provided, $14,700,000 shall be
transferred from the PPHF.
Within this amount, the Committee provides no less than
$3,000,000 for the National Alzheimer's Call Center.
Lifespan Respite Care
The Committee provides $10,000,000 for Respite Care, which
is the same as the fiscal year 2025 enacted program level. The
program funds competitive grants to ease the burdens of
caregiving by providing grants to eligible State organizations
to improve the quality of, and access to, respite care for
family caregivers.
Chronic Disease Self-Management Program
The Committee provides $8,000,000 from the PPHF for the
Chronic Disease Self-Management program, which is the same as
the fiscal year 2025 enacted program level. This program funds
competitive grants and cooperative agreements to support
evidence-based prevention models that use state of the art
techniques to help those with chronic conditions address issues
related to the management of their disease.
Elder Falls Prevention
The Committee provides $7,500,000 for the Falls Prevention
program, which is the same as the fiscal year 2025 enacted
program level. Falls prevention competitive grants and
cooperative agreements support the promotion and dissemination
of prevention tools delivered in community settings. Of the
funds provided, $5,000,000 shall be transferred from the PPHF.
Elder Rights Support Activities
The Committee provides $34,005,000 for Elder Rights Support
Activities, which is a $131,000 increase above the fiscal year
2025 enacted program level. These programs support efforts that
provide information, training, and technical assistance to
legal and aging services organizations working to prevent and
detect elder abuse and neglect.
The Committee provides no funding for the State Adult
Protective Services formula grant program. This program was
first funded in the American Rescue Plan (P.L. 117-2).
Aging and Disability Resource Centers
The Committee provides $8,619,000 for Aging and Disability
Resource Centers (ADRCs), which is the same as the fiscal year
2025 enacted program level. These centers provide information,
counseling, and access for individuals to learn about the
services and support options available to seniors and the
disabled so they may retain their independence.
State Health Insurance Assistance Program
The Committee recommends $55,242,000 for the State Health
Insurance Assistance Program, which is the same as the fiscal
year 2025 enacted program level. The State Health Insurance
Assistance Program funds grants to provide Medicare
beneficiaries with information, counseling, and enrollment
assistance.
Paralysis Resource Center
The Committee provides $10,700,000 for the Paralysis
Resource Center, which is the same as fiscal year 2025 enacted
program level. The Paralysis Resource Center offers activities
and services aimed at increasing independent living for people
with paralysis and related mobility impairments and supporting
integration into the physical and cultural communities in which
they live.
Limb Loss Resource Center
The Committee provides $4,200,000 for the Limb Loss
Resource Center, which is the same as the fiscal year 2025
enacted program level. The Limb Loss Resource Center supports a
variety of programs and services for those living with limb
loss, including a national peer support program, educational
events, training for consumers and healthcare professionals,
and information and referral services.
Traumatic Brain Injury
The Committee provides $13,118,000 for the Traumatic Brain
Injury program, which is the same as the fiscal year 2025
enacted program level. The program provides grants to States
for the development of a comprehensive, coordinated family and
person-centered service system at the State and community level
for individuals who sustain a traumatic brain injury.
Developmental Disabilities State Councils
The Committee provides $81,000,000 for State Councils on
Developmental Disabilities, which is the same as the fiscal
year 2025 enacted level. This program provides formula grants
to States and territories to support State Councils, which work
to develop, improve, and expand the system of services and
supports for people with intellectual and developmental
disabilities.
The Committee provides not less than $800,000 for technical
assistance and training for the State Councils on Developmental
Disabilities.
Developmental Disabilities Protection and Advocacy
The Committee provides $45,000,000 for Developmental
Disabilities Protection and Advocacy, which is the same as the
fiscal year 2025 enacted level. This formula grant program
provides funding to States to establish and maintain protection
and advocacy systems to protect the legal rights of persons
with developmental disabilities.
The Committee notes that the Supreme Court decision in
Olmstead v. L.C. (1999) held that the Americans with
Disabilities Act (ADA) does not require removing individuals
from institutional settings when they are unable to handle or
benefit from a community-based setting and that the ADA does
not require the imposition of community-based treatment on
individuals who do not desire it. The Committee notes that
actions to undermine and close intermediate care facilities for
individuals with intellectual disabilities may impact some
individuals who do not meet the criteria for transfer to a
community-based setting. The Committee encourages HHS to ensure
that programs properly account for the needs and desires of
individuals with disabilities, their families, legal
representatives and caregivers, and the importance of affording
individuals the proper setting for their care. The Committee
further encourages the Department to prohibit an eligible
protection and advocacy system to use funds under this heading
to institute class action litigation against an intermediate
care facility in good standing with licensure requirements.
The Committee recognizes that the ADA encourages States to
administer services for people with Intellectual and
Developmental Disabilities (IDDs) in the most integrated
setting appropriate to the needs of qualified individuals with
IDDs. Further, the Committee understands that while center-
based work is not appropriate for every individual with a
disability, center-based adult work programs chosen by
individuals with severe IDDs and their families remain a viable
choice that can provide dignity and purpose for a significant
percentage of the IDD population. These work and service
settings have been determined to be rewarding and appropriate
by the individuals and family members directly involved in the
decision-making process, and the Committee is concerned that
some organizations receiving funding under the Developmental
Disabilities Assistance and Bill of Rights Act have targeted
these setting for closure. The Committee encourages ACL to
encourage stakeholders to coordinate to ensure that individuals
with IDDs appropriately suited to participate in center-based
work programs are not deprived of the opportunity to do so.
Developmental Disabilities Voting Access for Individuals With
Disabilities
The Committee provides $10,000,000 for Voting Access for
Individuals with Disabilities program, which is the same as the
fiscal year 2025 enacted program level. The Voting Access for
Individuals with Disabilities program authorized by the Help
America Vote Act provides formula grants to States ensure full
participation in the electoral process for individuals with
disabilities, including registering to vote, accessing polling
places, and casting a vote.
Developmental Disabilities Projects of National Significance
The Committee provides $12,250,000 for Developmental
Disabilities Projects of National Significance, which is the
same as the fiscal year 2025 enacted program level. This
program funds grants and contracts that develop new
technologies and demonstrate innovative methods to support the
independence, productivity, and integration of those living
with a disability into the community.
University Centers for Excellence in Developmental Disabilities
The Committee provides $43,119,000 for University Centers
for Excellence in Developmental Disabilities, which is the same
as the fiscal year 2025 enacted program level. The University
Centers for Excellence in Developmental Disabilities Education,
Research, and Service are a nationwide network of independent
but interlinked centers, funded via competitive grants,
representing a national resource for addressing issues, finding
solutions, and advancing research related to the needs of
individuals with developmental disabilities and their families.
Independent Living
The Committee provides $128,183,000 for the Independent
Living program, which is the same as the fiscal year 2025
enacted program level. Independent Living programs fund grants
to maximize the leadership, empowerment, independence, and
productivity of individuals with disabilities.
National Institute on Disability, Independent Living, and
Rehabilitation Research
The Committee provides $100,000,000 for the National
Institute on Disability, Independent Living, and Rehabilitation
Research (NIDILRR), which is a $19,000,000 decrease below the
fiscal year 2025 enacted program level. NIDILRR funds research
and development of new innovative technological devices,
prototypes, measurement tools, and interventions to help people
with disabilities live more independently.
The Committee continues to support the Traumatic Brain
Injury Model Systems National Data and Statistical Center at no
less than the fiscal year 2025 enacted program level.
Assistive Technology
The Committee provides $40,000,000 for Assistive Technology
(AT), which is the same as the fiscal year 2025 enacted program
level. AT supports programs providing formula grants to States
for addressing AT needs of individuals with disabilities. The
goal is to increase awareness of and access to AT devices and
services that may help with education, employment, daily
activities, and inclusion of people with disabilities in their
communities.
The Committee continues to provide $2,000,000 for
competitive grants to support existing and new alternative
financing programs that provide for the purchase of AT devices.
Veteran Mobility Pilot Program.--The Committee encourages
the Department to establish a Veteran Mobility Pilot Program
with the goal of identifying, procuring, distributing, and
evaluating enhanced mobility devices for use in VA nursing
homes and State veterans' homes. The pilot would prioritize
assistive technology that improve rehabilitation outcomes,
reduce fall risk, and restore mobility for veterans living with
age-related or service-connected mobility challenges.
Program Administration
The Committee provides $48,063,000 for Program
Administration, which is the same as the fiscal year 2025
enacted program level. This funding supports Federal
administrative costs associated with administering ACL's
programs.
Administration for Strategic Preparedness and Response
Appropriation, fiscal year 2025....................... $3,634,606,000
Budget request, fiscal year 2026...................... 2,825,880,000
Committee Recommendation.............................. 3,509,606,000
Change from enacted level......................... -125,000,000
Change from budget request........................ +683,726,000
This account supports the activities of the Administration
for Strategic Preparedness and Response (ASPR) to prevent,
prepare for, and respond to the health consequences of
chemical, biological, radiological, and nuclear threats and
other public health emergencies, including pandemic influenza.
ASPR is responsible for coordinating national policies and
plans for medical and public health preparedness and for
administering a variety of public health preparedness programs.
The Committee first funded ASPR as an operating division as
part of the Fiscal Year 2024 budget cycle. The Committee
included BARDA, Project BioShield, the associated Special
Reserve Fund, and the SNS within a single Treasury account to
better ensure the seamless transition of MCMs from development
to production and procurement to ensure the strongest possible
response partner from natural and man-made threats. The
Committee encourages HHS to recognize the significance of
ASPR's work combating chemical, biological, radiological and
nuclear (CBRN) threats as well as assistance in all efforts for
preparedness to face these threats. In their work, the
Committee recognizes the importance of maintaining the
Strategic National Stockpile, the Center for the Biomedical
Advanced Research and Development Authority, Project BioShield
and the Special Reserve Fund under ASPR's independent operating
body.
ASPR is uniquely positioned to support continued investment
and support for biomanufacturing and the onshoring of the
Medical Countermeasure supply chain essential to ensure the
health and security of the American public. To that end, the
Committee includes a series of provisions designed to support
the domestic manufacturing of active pharmaceutical
ingredients, antibiotics, diagnostics, essential medicines,
medical devices, personal protective equipment and other
pharmaceutical products critical to maintaining our MCM
capacity. The Committee includes a new provision prohibiting
ASPR, and the SNS in particular, from purchasing MCMs or other
goods and services, from China or China-owned companies unless
such services are otherwise not available.
Continued Support for Onshoring.--The Committee remains
concerned that the United States is dependent on foreign
sources for critical raw materials and manufacturing of
essential antivirals for infectious diseases. The Committee is
aware of the need to onshore critical raw materials and invest
in companies through public-private partnerships for domestic
manufacturing of essential MCMs and ancillary products.
Therefore, the Committee encourages ASPR to prioritize
funding for companies that are investing in domestic
manufacturing, especially for products that are currently
dependent on China for sourcing of raw materials. Additionally,
the Committee directs the ASPR to provide a briefing, within
180 days of the enactment of this Act, on the progress of
onshoring investments to establish a resilient domestic supply
chain for antivirals.
Diagnostics Manufacturing.--Diagnostics are critical for
the prevention, protection and surveillance of known and
unknown CBRN threat. The ability to rapidly develop and access
diagnostics is essential to ensure U.S. readiness and biohazard
preparedness. The Committee has previously encouraged ASPR to
promote policies for flexible contracting options between HHS
and diagnostic companies, which would provide incentives to
keep US manufacturing companies with warm production lines. The
Committee is aware that companies that HHS invested in during
COVID have closed or drastically reduced their domestic
footprint. Therefore, the Committee encourages ASPR to continue
to support the diagnostic domestic manufacturing
infrastructure.
Domestic Antibiotic Manufacturing.--The Committee
recognizes the importance of the domestic pharmaceutical
industrial base and the need to mitigate risks to the U.S.
pharmaceutical supply chain, which is heavily reliant on
foreign suppliers for critical drugs and active pharmaceutical
ingredients, including generic antibiotics. Therefore, the
Committee encourages ASPR, in coordination with the Secretary
of Defense, to jointly implement a plan to evaluate the end-to-
end supply chain for the biomanufacturing of fermentation-based
essential antibiotics to ensure necessary domestic
manufacturing capacity.
Domestic Manufacturing of Medical Countermeasures.--The
Committee supported BARDA's investments to accelerate the
expansion of domestic manufacturing capacity for ancillary
supplies like needles and syringes during the COVID pandemic.
However, to continue to ensure Americans have the essential
medical devices necessary, the Committee encourages a more
concerted effort to shore up domestic production and the U.S.
supply chain. The Committee encourages the Office of Industrial
Base Management and Supply Chain (IBMSC) to advance programs
and policies that preserve and protect U.S. based manufacturing
for essential medical devices.
Domestic Medicine & Active Pharmaceutical Ingredient
Manufacturing.--The Committee is concerned with the national
security risk of our reliance on foreign-based sources of
active pharmaceutical ingredients (APIs), their key starting
materials, and off-shore drug production. The Committee
recognizes the importance of domestic drug manufacturing and
onshore production of medicine to support increased U.S.-based
manufacturing capabilities. The Committee acknowledges the
impact of weather events on U.S.-based manufacturing
capabilities, and encourages intentional efforts to vary
manufacturing locations for active pharmaceutical ingredients
including their chemical precursors. The successful work of
BARDA in addressing public health vulnerabilities and securing
a national stockpile of drugs has unique potential to consider
program expansion to include at-risk drug ingredients. The
Committee encourages ASPR to engage in public-private
partnerships for U.S.-based advanced manufacturing for active
pharmaceutical ingredients including their chemical precursors
for the SNS. The Committee directs ASPR to provide a briefing,
to include the authorizing Committees, within 180 days of the
enactment of this Act detailing their efforts to promote
domestic drug and active pharmaceutical ingredient
manufacturing.
Development of Treatments for Nasal and Sinus Infections.--
The Committee supports the development of MCMs related to the
treatment of nasal and sinus infections that carry a material
threat determination from the PHEMCE.
Interagency Alignment of Biomedical Countermeasures
Research and Development.--The Committee has prioritized
investments in research and development of biodefense MCMs to
better prepare our country to detect and respond to biological
threats. While funding for such priorities currently is
allocated to different HHS agencies based on their missions and
areas of expertise, the Public Health Emergency Medical
Countermeasures Enterprise Advisory Committee (PHEMCE) is
responsible for ensuring the alignment of MCM requirements,
priorities, and projects across these agencies. To improve
alignment and efficiency of research and development
activities, the Committee encourages ASPR to establish a formal
mechanism to identify and track the alignment of medical
countermeasure research and development programs of each
relevant agency, while tracking them against prioritized
national biodefense countermeasure needs to ensure the end-to-
end development of needed products, technologies, or platforms;
track previous and future transitions of development projects
between agencies to ensure seamless and properly resourced end-
to-end development programs; and identify areas of continually
unmet research and development needs. The Committee further
encourages ASPR to coordinate with the departments of Defense,
Energy, and Homeland Security regarding similar research and
development programs.
The Committee further encourages ASPR to prioritize
research and development programs that focus on early-stage
development and innovative platform-based technologies that can
yield multiple products to address multiple threats. Finally,
the Committee directs ASPR to make public relevant information
on HHS-funded research and development programs, including
development stages and target disease area. The Committee
directs ASPR to provide a report on the status of this effort
within 180 days of enactment of this Act and to include such
information in the fiscal year 2027 congressional
justification.
Interagency Coordination.--The Committee encourages ASPR,
in coordination with DOD, to provide technical expertise to
FDA's Center for Biologics Evaluation and Research, as they
further the development of MCMs for combatting emerging
pathogens.
Medical Countermeasures Preparedness Review.--The most
recent Medical Countermeasures Preparedness Review, submitted
to Congress as part of the required annual threat-based review
of the SNS, found the Department has not met medical
countermeasure stockpiling requirements for numerous public
health threats. Furthermore, the review demonstrated how the
SNS often relies on decades-old products to fulfill other
stockpiling requirements. The SNS is a key pillar in the
nation's broader strategy to protect the American people. Gaps
in the stockpile's preparedness against these threats
jeopardizes national security. The Committee requests a
classified briefing within 180 days from ASPR regarding the
CBRN threat landscape and actions taken by the agency to
rectify stockpile shortfalls identified by the Medical
Countermeasures Preparedness Review.
Multiyear Budget.--The Committee notes that 42 U.S.C.
300hh-10 requires annual updates to the PHEMCE multiyear
budget. The Committee continues to direct ASPR to notify the
Committee and the Energy and Commerce Committee 14 days in
advance of any anticipated delay.
Public Health Emergency Medical Countermeasures Enterprise
Advisory Committee.--The Committee recognizes effective public-
private partnerships are the best way to support our nation's
preparedness and response capabilities, as these private sector
partners are the primary developers of critical MCMs such as
diagnostics, therapeutics, and vaccines which have no
commercial market. The Committee notes with concern that the
PHEMCE, which is chaired by ASPR, has not established an
advisory committee incorporating private sector and non-Federal
partners and stakeholders despite recommendations from Congress
and NASEM. The Committee encourages ASPR to establish this
advisory committee with urgency to ensure timely and
transparent communication with the government's private sector
partners. The Committee requests a briefing within 180 days of
enactment on efforts to engage and include industry partners in
the MCM development efforts and supporting activities.
Rapid Detection of Bioterrorism Agents.--The Committee is
concerned that the nation is not prepared to rapidly detect
biological agents, such as anthrax, tularemia, melioidosis,
glanders, and plague, even though Biomedical Advanced Research
and Development Authority (BARDA) has successfully supported
development of diagnostic technologies that detect such
biothreats, in some cases simultaneously. Consistent The
Committee encourages ASPR, in coordination with CDC, to
prioritize partnerships with domestic manufacturers capable of
producing rapid diagnostics that can detect such threats and
develop a diagnostic testing preparedness plan for use during
public health emergencies, disasters, and other serious public
health threats.
Reporting.--The Committee directs ASPR to brief the
Committee monthly regarding activities funded by this Act and
other available appropriations. The agency is directed to
notify the Committee at least 24 hours in advance of any
obligation greater than $25,000,000 from any appropriation
available to ASPR. Such notification is directed to include the
source of funding, including the applicable legislative
citation, and a description of the obligation. In addition,
ASPR is directed to submit a monthly obligation report in
electronic format summarizing the details of these obligations
to the Committee. ASPR is further directed to provide the
report no later than 30 days after the end of each month and it
is directed to be cumulative for the fiscal year with the most
recent obligations listed at the top.
RESEARCH, DEVELOPMENT, AND PROCUREMENT
Appropriation, fiscal year 2025....................... $3,135,000,000
Budget request, fiscal year 2026...................... 2,437,402,000
Committee Recommendation.............................. 3,265,000,000
Change from enacted level......................... +130,000,000
Change from budget request........................ +827,598,000
Biomedical Advanced Research and Development Authority
The Committee includes $1,100,000,000 for the Biomedical
Advanced Research and Development Authority, which is
$85,000,000 above the fiscal year 2025 enacted level. BARDA
supports the advanced development of vaccines, therapeutics,
diagnostics, and devices for potential serious public health
threats, including chemical, biological, radiological, and
nuclear threats, pandemic influenza, and emerging and
reemerging infectious diseases.
Acceleration of Antibiotic Combination Drug Development.--
The Committee is concerned about the increasing public health
threat of antimicrobial resistance and the lack of new
antibiotics entering the market. The Committee is encouraged
that BARDA has invested in combination antibiotic drug
development for both oral and intravenous administration.
Therefore, the Committee encourages BARDA to continue to
prioritize the development of combination drugs, particularly
those with activity against CDC urgent threat pathogens which
can offer increased efficacy, reduced costs, and reduce the
emergence of AMR infections.
Antifungal Research and Development.--The Committee
continues to support the research and development of novel
antifungal therapies, particularly for multi-drug resistant
fungal pathogens, to bolster national health security and
minimize their impact on public health. Antifungal development
faces similar challenges to antibacterial development and
BARDA's Advanced Research and Development program support will
be critical to generate additional antifungal products,
including for endemic fungal diseases. The Committee requests a
report within the 180 days of the date of enactment of this Act
on actions taken.
Antimicrobial Resistance.--The Committee continues to
support advanced research and development of broad-spectrum
antimicrobials, particularly for multi-drug resistant
pathogens, and next-generation therapeutics that address the
increasing incidence of antimicrobial resistance.
Biodosimetry.--The Committee continues to support ASPR's
research and investment in biodosimetry technologies to improve
the nation's preparedness for a large-scale radiological or
nuclear incident.
Chemical, Biological, Radiological, and Nuclear Threats.--
The Committee notes with concern the elevated risk posed by
chemical, biological, radiological, and nuclear (CBRN) weapons
across the globe and provides robust funding for BARDA's core
national security mission to protect Americans against
deliberate, man-made threats. The Committee directs ASPR to
provide, within 180 days of enactment of this Act, a report on
the Rapid Response Partnership Vehicle (RRPV). The Committee
encourages ASPR and BARDA to engage more frequently with
private sector partners via the RRPV process to ensure adequate
prioritization, timely development of new MCMs and stockpiling
of existing MCMs against CBRN threats.
Diagnostic Rapid Response Initiative.--The Committee is
aware that biological threats remain a persistent and evolving
danger, requiring robust and proactive preparedness measures.
The committee is encouraged by HHS and BARDA's leadership in
developing the Diagnostic Rapid Response Initiative (DxR2).
Continued investment in DxR2 has the potential to enhance our
national ability to rapidly respond to biothreat incidents.
BARDA is encouraged to maintain this important program as a
priority within the PHEMCE portfolio.
Drug Resistant Tuberculosis.--Drug resistant TB is
identified as a serious threat level pathogen to the U.S. by
CARB-X. As drug resistant TB cases are on the rise globally,
the threat to the U.S. also grows and BARDA's investment in new
TB diagnostics, drugs, and vaccines is critical. The Committee
directs ASPR to provide a briefing on BARDA's investments in
drug resistant diseases including TB within 180 days of the
enactment of this Act.
Infectious Disease Outbreaks With Pandemic Potential.--The
Committee supports BARDA's engagement in public-private
partnerships to support advanced research and development of
innovative platform technologies and medical countermeasure
programs focused on vaccines, therapeutics, and other MCMs for
emerging infectious diseases, including novel pathogens and
viral families with pandemic potential. The Committee
encourages ASPR to prioritize the identification and
development of promising technologies that can be leveraged to
address a range of future pathogens, including virus families
with significant pandemic potential.
Multidrug Resistance.--The Committee recognizes the urgent
global health threat posed by multidrug resistant organisms and
the need for innovative, engineering-based solutions that can
be deployed across diverse clinical settings. The Committee is
aware of the early development of novel anti-microbial drug
resistance platforms and supports their ongoing research. The
Committee continues to support the development of platforms
designed for broad application, from hospitals to community
medical offices, and encourages ASPR to support research and
development activities that make use of existing safety and
effectiveness data from a reference listed drug, as well as
innovative approaches to new classes of antimicrobial
technologies.
Pathogen Reduction Technologies.--The Committee encourages
BARDA to continue investments in red blood cell pathogen
reduction technology to ensure the completion of urgently
needed nucleic acid targeted pathogen reduction technology to
significantly improve red blood cell transfusion safety for all
blood products in the nation's blood supply.
Sustainable Blood Supply and National Blood Response
Capability.--The Committee remains concerned regarding the
continued vulnerability of the blood supply after the peak
COVID shortages and receiving the report from the HHS Advisory
Committee on Blood and Tissue Safety and Availability. That
report indicated that, ``the continued availability of a robust
blood supply faces significant threats and challenges in the
current environment,'' and recommended the ``implementation of
new technologies to improve the safety and reliability of the
blood supply.'' The Committee recognizes that next-generation
cryo-preserved platelet products, currently in clinical trials,
align with BARDA's strategic objectives for blood products. The
Committee encourages BARDA to meet its strategic objective of
developing next generation blood products by including products
that can be used regardless of the patient's blood group,
expand availability to all hospitals, prevent shortages, and
are suitable for use throughout the continuum of care,
including first responders. The Committee encourages ASPR to
rapidly expand the development of freeze-dried hemostatic
products, especially platelet-derived products, to include a
wide range of indications encompassing treatment of hemorrhagic
disease, use in general surgery, obstetrics and trauma.
Strengthening Domestic Supply Chain Resiliency.--The
Committee appreciates ASPR taking steps to strengthen our
nation's medical countermeasure enterprise, including through
BioMaP and BARDA's Pharmaceutical Countermeasures
Infrastructure (PCI) Division, and supports efforts to expand
domestic manufacturing infrastructure for medical
countermeasures. Given the global nature of certain clinical
research, development, and manufacturing activities, it is
critical for BARDA to strengthen, expand, and make progress in
onshoring these programs. Within 180 days of enactment of this
Act, ASPR is directed to brief the Committee on ASPR's fiscal
year 2025 plans to support the onshoring of medical
countermeasure development activities, including actions taken
by BioMAP and PCI.
Project BioShield
The Committee provides $850,000,000 for Project BioShield,
which is $25,000,000 above the fiscal year 2025 enacted level.
These funds support the acquisition of promising MCMs developed
through BARDA contracts for the most serious public health
threats.
Strategic National Stockpile
The Committee provides $1,000,000,000 for the Strategic
National Stockpile, which is $20,000,000 above the fiscal year
2025 enacted level.
Antimicrobial Resistance.--The Committee encourages the
ASPR, in coordination with FDA and CDC, to implement a review
system to regularly assess the safety, efficacy, and
vulnerability to antimicrobial resistance of existing SNS
assets that could be used to respond to CBRN and public health
threats and to support efforts to maintain an inventory of MCMs
appropriate to respond to the continued evolution of
antimicrobial resistant organisms.
Guidance to State and Local Jurisdictions.--The Committee
recognizes that SNS focuses on chemical, biological,
radiological, and nuclear threats, and therefore the Committee
supports the efforts of State and local jurisdictions to secure
additional drugs, vaccines, and other biological products,
medical devices, and other medical supplies necessary to
respond to a public health emergency or a major disaster. The
Committee recognizes the importance of guidance to States on
how best to establish, expand, procure, replenish, maintain,
and manage their own State stockpile, while ensuring
appropriate collaboration with the SNS. ASPR is directed to
provide a briefing to the committees of jurisdiction within 180
days of enactment of this Act on guidance and technical
assistance related to State stockpiles.
Influenza MCM Diversification.--The Committee remains
concerned about the perennial threat of pandemic influenza,
which could be exacerbated by expiring antivirals in the SNS.
The Committee encourages HHS to diversify and replenish its
stockpile of emergency influenza antivirals to ensure the
nation has multiple current treatment options in the event of
an influenza pandemic.
Made in America Strategic National Stockpile.--The
Committee is concerned about the nation's limited
infrastructure to produce essential products such as MCMs and
personal protective equipment (PPE). The Committee recognizes
the COVID pandemic highlighted both the vulnerability and
necessity of maintaining a robust domestic supply of PPE. It is
critical the U.S. maintain a robust domestic production base.
Doing so is vital for both the national security interests and
protection of public health in the face of international
infectious disease threats. The Committee directs the ASPR to
develop a long-term sustainable procurement plan that gives
preference to and results in purchases directly from domestic
manufacturers to the maximum extent practicable.
Nuclear Threat Preparedness.--The Committee notes with
concern that the SNS faces potential shortfalls regarding the
stockpiling of MCMs necessary in the event of a nuclear event
to counter the potential release of radioactive iodine. The
Committee encourages ASPR to prioritize investments in the MCMs
necessary for such a response and directs the agency to provide
a briefing on measures taken to prepare for a nuclear threat
within 180 days of the enactment of this Act.
Persistent Procurement Challenges.--The Committee is
concerned about the SNS's procurement process that has been
mired by successful bid protests, repeated unanswered sources
sought notices, and misuse of sole source awards under GAO
determined faulty pretexts. The Committee has invested in
efforts to bolster that nation's medical countermeasure
preparedness against health security threats, especially for
those CBRN countermeasures that lack a traditional marketplace.
Therefore, the Committee directs ASPR, within 180 days of the
enactment of this Act, to provide a report on processes put in
place to better ensure adherence to all Federal contracting
requirements.
Poxvirus Countermeasures.--The Committee notes that
Administration decisions, including the decision to ship
vaccine oversees, has depleted MCMs that were previously
developed, purchased, and stockpiled for domestic smallpox
preparedness. The Committee is concerned there may now be an
insufficient supply of poxvirus vaccine for immunocompromised
individuals as well as poxvirus treatments in the stockpile,
especially considering the continued national security threat
of an intentional or accidental release of smallpox. Therefore,
the Committee encourages ASPR to prioritize replenishment of
MCMs used during the monkey pox outbreak and directs ASPR to
provide a briefing within 90 days of the date of enactment of
this Act on the stockpiling requirements for poxvirus vaccine.
Reusable Respirators.--The Committee recognizes the
potential of reusable respirators to provide strategic long-
term value to the SNS due to their longer operational lifetime
and extended shelf life when compared with disposable masks.
The Committee encourages the SNS to consider reusable
respirators when planning personal protective equipment (PPE)
investments. The Committee continues to support warm-base surge
production capacity contracts with domestic PPE suppliers,
including reusable respirators. ASPR is encouraged to maintain
domestic manufacturing surge capabilities that can rapidly ramp
up large-scale PPE production in response to CBRN threats or
other public health crises that pose a significant national
security risk. ASPR is directed to provide a report, no later
than 180 days after enactment of this act, on specific steps it
has taken to support up warm-basing capabilities to include PPE
investments and an analysis of future products considered a
priority for future years.
Shelf-Life Extension Program.--The Committee acknowledges
the benefits of the Shelf-Life Extension Program (SLEP) and
takes into consideration public skepticism of certain
countermeasures in the program. In the annual SNS threat-based
review, the Committee encourages ASPR to include the quantity
of each countermeasure that is beyond the initial FDA
expiration date and the number of these aged products in the
SLEP program.
Pandemic Influenza Preparedness
The Committee includes $315,000,000, for the pandemic
influenza preparedness program. This funding supports efforts
to modernize influenza research and development of vaccines and
preparedness testing and evaluation, as well as critical
domestic vaccine manufacturing infrastructure.
The Committee encourages ASPR to support the development of
pandemic influenza therapeutics and vaccines to ensure a robust
pipeline of influenza countermeasures.
OPERATIONS AND EMERGENCY RESPONSE
Appropriation, fiscal year 2025....................... $499,606,000
Budget request, fiscal year 2026...................... 388,478,000
Committee Recommendation.............................. 244,606,000
Change from enacted level......................... -255,000,000
Change from budget request........................ -143,872,000
Office of Administration & Preparedness and Emergency Operations
The Committee includes $80,407,000 for activities within
the Assistant Secretary's Immediate Office; the Office of the
Chief Operating Officer; the Office of Acquisitions Management,
Contracts, and Grants; the Office of Financial Planning and
Analysis; and for Preparedness and Emergency Operations. The
Preparedness and Emergency Operations account also funds the
Office of Emergency Management, which supports a full spectrum
of emergency management responsibilities, including planning,
coordination, logistics, training, and responding to planned
events and unplanned incidents.
Addressing Emergency Medical Services Workforce Shortages
and Readiness.--The Committee is keenly aware of the
significant challenges the emergency medical services (EMS)
community faces. Across the Federal government, there are a
host of resources available to assist public, private, and
nonprofit EMS agencies. Within 180 days of enactment of this
Act, the Committee directs ASPR, in consultation with SAMHSA
and the National Highway Traffic Safety Administration, to
provide an overview of its resources available to address EMS
readiness and workforce shortages; any actions taken to address
EMS readiness and the workforce shortage; and recommendations
on what additional resources and authorities are necessary to
support EMS and community access to emergency healthcare
services. Such overview shall be made available on the agency's
website.
Health Preparedness and Response Center of Excellence.--The
Committee encourages ASPR to consider the establishment of a
Center of Excellence for Health Preparedness and Response in
alignment with the agency's mission. ASPR leads the nation's
medical and public health preparedness, response, and recovery
efforts for disasters and public health emergencies,
continuously scanning the horizon to anticipate both natural
and man-made threats. Such a center may serve as a national
resource to support ASPR's mission by leading a national
network providing technical support and advanced training and
education, research, and implementation actions for a resilient
national system for biothreat response.
Rural Medical Autonomy and Assessing the Use of Unmanned
Aircraft Systems in Disaster Response.-- The Committee is aware
of the challenges facing emergency medical response to natural
or man-made disasters in rural areas. Resources are often
limited and remote, leading to delays in treatment that result
in poor outcomes. The role of autonomous systems can be
invaluable, quickly providing life-saving tools across a range
of medical applications such as drone delivery of critical
medical supplies and drugs, as well as autonomous air and
ground systems that evaluate safety in a chem-bio, electrical
hazard or fire environment. Autonomous systems can be paired
with telemedicine capabilities to deliver real-time
connectivity between emergency responders and Level 1 trauma
centers and other emergency medicine professionals. Within 180
days of the enactment of this Act, ASPR is directed to publicly
release a report assessing the potential effectiveness of
unmanned aircraft systems for medical emergency response in
rural areas.
Remote Hospital Emergency Preparedness Activities.--The
Committee encourages ASPR to support contingency planning and
emergency preparedness training for the Guam Memorial Hospital
Authority (GMHA), the only public hospital serving the
territory. Given its remote location and strategic importance,
GMHA requires enhanced capabilities to maintain operations
during natural disasters and other emergencies. ASPR is further
encouraged to facilitate opportunities for GMHA to participate
in relevant Federal training programs and exercises, and to
consider GMHA's unique needs when designing or allocating
resources for emergency preparedness initiatives.
National Disaster Medical System
The Committee provides $78,904,000 for the National
Disaster Medical System (NDMS). NDMS deploys trained medical,
mortuary, victim identification and veterinarian teams to
communities impacted by public health and medical emergencies
due to natural and man-made incidents. The Committee provides
no funding for next generation air equipment.
Mission Zero.--The Committee provides $4,000,000, for
civilian trauma centers to train and incorporate military
trauma care providers and teams into care centers, the same as
the fiscal year 2024 enacted level.
Pediatric Disaster Care.--The Committee provides $7,000,000
for the pediatric disaster care program, the same as the fiscal
year 2024 enacted level.
Hospital Preparedness Program
The Committee provides $65,055,000 for the Hospital
Preparedness Program which supports a tiered system of care
prepared to respond to a special pathogen event. HPP supports a
variety of programs to strengthen the preparedness and response
of the health care sector. Due to funding constraints, the
Committee eliminates funding for formula grants while
continuing to fund the National Special Pathogen System and the
Regional Emerging Special Pathogen Treatment Centers.
Emergency Medical Service Preparedness and Response.--The
Committee encourages ASPR to clarify the extent to which the
hospital preparedness program can better integrate emergency
medical service operations, including both governmental and
nongovernmental emergency medical services, into regional
health care coalitions.
National Special Pathogen System.--The Committee provides
$28,500,000 for the National Special Pathogen System which is
the same as the fiscal year 2024 enacted level.
National Emerging Special Pathogens Training and Education
Center.--The Committee provides $7,500,000 for the National
Emerging Special Pathogens Training and Education Center.
Regional Emerging Special Pathogen Treatment Centers.--The
Committee provides $21,000,000 for Regional Emerging Special
Pathogen Treatment Centers program and Special Pathogen
Treatment Centers.
Portable Bio-Containment Units (PBCUs).--The Committee
supports ASPR's recent investment in Portable Bio-Containment
Units (PBCUs). The Committee recognizes the potential value of
such units for the repatriation and domestic transfer of
American's afflicted with high-consequence infectious diseases
to facilities able to safely meet patient needs. The Committee
directs ASPR to include an estimate of the funding needed to
maintain the two existing PBCUs as well as the estimated
procurement costs of two additional PBCUs in the fiscal year
2027 congressional justification.
Medical Reserve Corps
The Committee provides $6,240,000 for the Medical Reserve
Corps, which is the same as the fiscal year 2024 enacted level
and the fiscal year 2025 budget request.
Preparedness and Response Innovation
The Committee provides $4,000,000, which is the same as the
fiscal year 2024 enacted level and $4,000,000 above the fiscal
year 2025 budget request, for a bilateral cooperative program
with the Government of Israel for the development of health
technologies.
In the fiscal year 2027 congressional justification the
Committee requests an update on the investments this funding
has produced since the program's inception.
Industrial Base Management and Supply Chain
The Committee supports ASPR's ongoing work to build and
validate advanced manufacturing processes and facilities
capable of storing, producing, and deploying essential
medicines in the event of a national health emergency.
Improved Access to Intravenous Saline.--The Committee
recognizes the potential for natural disasters and other supply
chain disruptions to adversely affect the ability of hospitals
and other medical providers to access saline solutions. The
Committee directs ASPR, within 180 days of the enactment of
this Act, to evaluate and publicly release a supply chain
analysis of intravenous saline solution to include potential
measures to remediate potential disruptions to one or more
suppliers of such products.
Supply Chain Control Tower.--The Committee recognizes the
potential value of the Supply Chain Control Tower (SCCT)
program, a voluntary collaboration between industry partners
and ASPR, to provide end-to-end visibility for supply chain
monitoring and readiness. In addition to providing insights for
demand and supply forecasting, the Committee encourages ASPR to
coordinate with FDA and CDC to use SCCT to monitor the
availability of a broader list of essential health and medical
products.
Office of the Secretary
GENERAL DEPARTMENTAL MANAGEMENT (GDM)
Appropriation, fiscal year 2025....................... $710,955,000
Budget request, fiscal year 2026...................... 405,696,000
Committee Recommendation.............................. 607,189,000
Change from enacted level......................... -103,766,000
Change from budget request........................ +201,493,000
Of the funds provided, $58,028,000 shall be derived from
evaluation set-aside funds available under section 241 of the
PHS Act.
This appropriation supports activities that are associated
with the Secretary's roles as policy officer and general
manager of the Department of Health and Human Services (HHS).
The Office of the Secretary also implements Congressional
directives, and provides assistance, direction, and
coordination to the headquarters, regions, and field
organizations of the Department. In addition, this funding
supports the Office of the Surgeon General and several other
health promotion and disease prevention activities that are
centrally administered.
The Committee notes that HHS proposes to transfer various
functions within the Office of the Secretary. The Committee
looks forward to working with the authorizing committees of
jurisdiction as they consider the Department's proposal.
Within the total provided for GDM, the Committee provides
no less than the following amounts:
------------------------------------------------------------------------
Budget Activity FY 2026 Committee
------------------------------------------------------------------------
Children's Interagency Coordinating Council.......... $3,000,000
Embryo Adoption Awareness Campaign................... 2,000,000
Interagency Coordinating Committee on the Promotion 2,000,000
of Optimal Birth Outcomes...........................
KidneyX.............................................. 5,000,000
LymeX................................................ 5,000,000
Make America Healthy Again........................... 100,000,000
------------------------------------------------------------------------
Adoption Opportunities.--The Committee recognizes that much
has changed in adoption practices in the nearly two decades
since HHS conducted its seminal National Survey of Adoptive
Parents. The Committee is interested in obtaining additional
information from the Assistant Secretary for Planning and
Evaluation on the feasibility and projected cost to conduct a
large, nationally representative survey and report of findings
on adoptive families across adoption types and to include a
secondary sample focused on adopted children with special
healthcare needs. Such a survey and report should be modeled
after the prior HHS National Survey of Adoptive Parents and the
National Council for Adoption's ``Profiles in Adoption''
surveys. The Committee requests HHS provide a feasibility
assessment and cost estimate in its fiscal year 2027
congressional justification.
Automated Referral for Organ Donations.--Automated
electronic deceased organ donor referrals are used by hospitals
to refer patients who may become deceased organ donors.
Widespread use of automated electronic deceased organ donor
referral could increase patient safety and reduce the number of
Americans waiting for a lifesaving organ transplant. The
Committee directs ASPE to submit a report to the Committees on
Appropriations of the House of Representatives and the Senate,
and post such report on a publicly available website, within
one year of the enactment of this Act, that shall: (1) identify
savings in time, variation in timeliness to determine
eligibility for organ donation, as well as potential
improvement over human interaction for the identification of
potential organ donors, if any, attained through the use of
electronic referrals; (2) identify benefits, if any, in
identifying potential organ donors through the use of
electronic medical records and standardized clinical criteria;
(3) review the impact of such electronic automated referrals,
without the need for manual reporting, on donation volumes; (4)
assess published peer-reviewed clinical literature on such
electronic automated referrals; (5) review best practices for
using such electronic automated referrals; (6) review
information technology practices to ensure the secure
transmission of information for purposes of such referrals; (7)
develop recommendations related to the use of such electronic
automated referrals; and (8) identify what actions would be
needed to establish the use of such electronic automated
referrals nationwide.
Bill Wide Requirements.--The Committee notes the inclusion
of a bill wide requirements section of this report. This
section contains requirements that apply to all agencies funded
by this Act.
Brain Aneurysms.--The Committee recognizes that although
one in 50 Americans have a brain aneurysm, there are typically
no warning signs or symptoms unless they rupture. Currently, up
to 50 percent of patients will not survive such a hemorrhage.
Even when an aneurysm has ruptured, the symptoms are not widely
known among healthcare professionals, such as first responders
and emergency room physicians. The Committee continues to
support efforts by HHS to facilitate the development of best
practices on brain aneurysm detection and rupture for first
responders, emergency room physicians, primary care physicians,
nurses, and advanced practice providers. In doing so, the
Committee encourages the Secretary to consider incorporating
topics including, but not limited to, the symptoms of brain
aneurysms, evidence-based risk factors for brain aneurysms,
appropriate utilization of medical testing and diagnostic
equipment, and screening recommendations. The Secretary is
urged to develop and implement a strategy for disseminating
information about such best practices in consultation with
appropriate stakeholders.
Cancer Mobile Screening.--The Committee recognizes that
early detection of cancer significantly reduces mortality rates
and improves treatment outcomes, particularly for lung cancer.
Mobile screening units are a proven method of expanding access
to preventive care and addressing healthcare disparities in
rural and socioeconomically disadvantaged communities. The
Committee supports efforts by HHS to incorporate mobile cancer
screening into its health program portfolio where appropriate,
including within its rural health programs. The Committee
requests an update on implementation efforts and outcomes as
part of the fiscal year 2027 congressional justification.
Centrally Managed Projects (formerly Joint Funding
Arrangements).--The Committee directs the agency to include all
amounts assessed from any operating or staffing division and
the methodology used to determine such amounts for each project
funded.
Certificate of Need Requirements.--The Committee notes that
``certificate of need'' (CON) laws vary widely across State
jurisdictions. Such laws require healthcare providers to obtain
authorization from State authorities to construct or expand
health care facilities or offer health care services. The
Committee directs GAO to examine, to the extent that data are
available and reliable, how selected State CON laws may affect
Federal healthcare spending. The Committee directs GAO to
provide a preliminary briefing to the Committees on
Appropriations of the House of Representatives and the Senate
within 12 months of the enactment of this Act with a report to
follow.
Child Cancer Survivorship.--The Committee urges the
Secretary to convene a stakeholder group to develop best
practices to improve survivorship care as children and
adolescents transition from active oncological care to primary
care. The stakeholder group will evaluate the best mechanisms
and practices for every childhood cancer survivor to receive a
comprehensive care summary and follow-up plan, based on
guidelines, once they complete their cancer care. The Committee
directs the Secretary to make a report publicly available
online within 180 days of the date of enactment of this Act
based on the stakeholder group's recommendations.
Child-Placing Agency Liability Insurance.--The Committee
directs the Assistant Secretary for Planning and Evaluation to
conduct a review and provide a report on the availability and
affordability of professional liability insurance for child-
placing agencies, including private agencies that provide
foster care services, adoption from foster care services,
private domestic adoption services, and intercountry adoption
services. Such report shall include a review and analysis of
trends in costs for child-placing agencies to obtain adequate
insurance coverage. The report shall include recommended
policies or other actions to address limitations, barriers, or
shortage of access and affordability of professional liability
insurance. The Committee requests such report include policy
proposals that can be made at the Federal level as well as
policy solutions that can be implemented by States. The
Committee requests the report within one year of enactment of
this Act and directs HHS to make such report available on the
Department's website.
Children's Interagency Coordinating Council.--The Committee
continues to include $3,000,000 for the Children's Interagency
Coordinating Council.
Congressional Justifications.--The Committee directs HHS
and each subagency thereof to include citations to the relevant
authorizing legislation and authorization level for each
program, project, or activity for which funding is requested in
the fiscal year 2027 congressional justification.
Cybersecurity Threats in Grantmaking.--The Committee
supports efforts by the Department to adopt proactive measures
to strengthen its cybersecurity infrastructure against the
ever-evolving threat of social engineering attacks. As the
custodian of vast repositories of sensitive data, HHS is a
prime target for malicious actors seeking to exploit system
vulnerabilities. Implementing training programs to educate
staff about the tactics employed in social engineering attacks,
as well as bolstering technological defenses, are crucial steps
in safeguarding HHS' systems. The Committee urges HHS to
maintain robust communication channels with other Federal
grant-making agencies to promptly alert them of cybersecurity
incidents that may put their systems at risk. The Committee
supports efforts by HHS to take an interagency collaborative
approach to create a shared defense for grant-making agencies
and their IT systems, enabling them to share insights quickly
and effectively, and fortifying their defenses against ongoing
cybersecurity threats.
Drug Prices and Pharmacy Access.--The Committee recognizes
the critical role community pharmacies play in providing life-
saving prescription drugs and medications to our rural
communities and seniors. The Committee appreciates the
Secretary of HHS's cooperation with the Federal Trade
Commission and Department of Justice to investigate the
activity of pharmacy benefit managers and the impact on drug
prices and pharmacy access.
Drug Shortages.--The Committee notes that prescription drug
shortages persist as a pressing issue across various treatment
categories. While previous efforts have examined the frequency
of these shortages, there remains a gap in understanding their
full impact on consumer expenses and the healthcare system.
Increased out-of-pocket expenses, elevated insurance premiums,
and compromised health outcomes can result if shortages are not
addressed. The Committee urges ASPE to research options to
address drug shortages. In addition, the Committee notes that
certain generic drugs have consistently made up most drugs in a
shortage, and that the lowest cost generics are often the most
impacted. Additionally, some shortages have lasted for years,
and in some cases have risen to their highest levels in a
decade. The Committee is concerned about these persistent
generic drug shortages, particularly impacting generic sterile
injectables, which include cancer drugs, emergency medicines,
and anesthesiology medications. Accordingly, the Committee
directs HHS to provide a report to the Committees on
Appropriations of the House of Representatives and the Senate,
and to post such report on a publicly available website, within
18 months of enactment of this Act, examining how payment
policy can impact the supply chain, including economic dynamics
that influence market stability for generic drugs.
Electric Vehicle.--The Committee does not include funding
for an electric vehicle program.
Embryo Adoption Awareness Campaign.--The Committee
increases funding for the Embryo Adoption Awareness Campaign to
educate Americans about the existence of frozen human embryos
(resulting from in-vitro fertilization), which may be available
for donation/adoption to help other couples build their
families. The Committee includes bill language permitting these
funds to be used to provide medical and administrative services
to individuals adopting embryos, deemed necessary for such
adoptions, consistent with the Code of Federal Regulations.
Global Health Research.--The Committee requests an update
in the fiscal year 2027 congressional budget justification on
how CDC, FDA, BARDA, NIH--including the Fogarty International
Center--and other agencies jointly coordinate global health
research activities with specific metrics to track progress and
collaboration toward agreed upon health goals.
Graduate Psychiatry Education.--The Committee supports
efforts to expand Graduate Medical Education (GME) programs in
underserved areas and recognizes the critical role that public
universities and teaching hospitals play in meeting the
healthcare needs of rural communities, veterans, and other
high-need populations. Within the various GME programs
supported by HHS, the Committee encourages the Department to
expand opportunities for applications for residency positions
from academic institutions that demonstrate established and
sustained partnerships with community-based providers,
including Rural Health Centers, Community Health Centers,
Veterans clinics, VA hospitals, Women and Children's units, and
other community-based outpatient clinics.
Hospital Acquired Pneumonia.--The Committee notes concern
with the current rate of non-ventilator hospital acquired
pneumonia (NVHAP) with a recent study of over six million
hospital admissions finding that NVHAP may account for one in
14 hospital deaths. Regular oral care during inpatient stays
may help prevent such incidents according to results from the
Department of Veterans Affairs (VA) Hospital-Acquired Pneumonia
Prevention by Engaging Nurses initiative that has been
implemented at every VA medical center in the nation and showed
declines in NVHAP of 40 to 60 percent. The Committee urges the
Secretary to prioritize the prevention of NVHAP, including by
working with CDC and CMS to review such health system
initiatives and, building on CDC's recently issued Oral Health
in Healthcare Settings to Prevent Pneumonia Toolkit, establish
a concrete plan to reduce the prevalence and associated patient
harm from this potentially preventable hospital-acquired
condition.
Ileostomy Supplies.--The Committee encourages ASPE to
complete a report on ileostomy supplies, focusing on ostomy
bags and adherent tools, to better understand rates of
infection and ease of use, especially for senior patients. The
Committee further encourages ASPE to suggest ways to improve
the ease of use for ileostomy supplies, including possible new
materials for ostomy bags, and ways to reshore manufacturing of
these supplies.
Lyme and Other Tick-Borne Diseases Network.--The Committee
encourages the Office of the Secretary and the Director of NIH,
in consultation with CDC and FDA, to enter into discussions on
the potential benefits of establishing a National Network of
Academic Research and Clinical Centers of Excellence for Tick-
Borne Diseases.
LymeX.--The Committee includes $5,000,000 to continue the
LymeX Innovation Accelerator to advance public-private
partnerships and innovation in Lyme disease prevention
diagnosis.
Make America Healthy Again Initiative.--The Committee
includes $100,000,000 for the Secretary's Make America Healthy
Again (MAHA) initiative. This funding will allow the Secretary
to invest in prevention innovation programs for rural
communities as proposed in the fiscal year 2026 budget request.
Within the funding provided for this suite of innovation
programs, the Committee includes a 10 percent set-aside for
Tribes, Tribal organizations, urban Indian health
organizations, and health service providers to Tribes serving
rural communities. This funding is also available for the
Secretary to invest in telehealth resources for chronic care
and nutrition services, as proposed in the fiscal year 2026
budget request. Within such funding, the Committee encourages
the Secretary to support opportunities for advancing
telemedicine tools and remote monitoring technologies at
universities. This research should support studies on the
efficacy of virtual care for managing chronic illnesses,
development of AI-assisted telehealth platforms, and training
programs for healthcare providers on integrating remote
solutions into standard practice.
Maternal Healthcare in Rural Hospitals.--The Committee
recognizes the importance of rural hospitals in providing
maternal health care, educating patients, and ensuring maternal
safety. The continued closure of rural labor and delivery units
creates significant downstream economic burdens. When these
services close, costs shift to emergency transportation with
high costs per case for maternal emergency transfers, higher-
acuity care at distant facilities with an estimated 30 to 45
percent cost increase per delivery, and increased complications
from delayed care.
Measurements and Definitions for Loneliness and Social
Isolation.--The Committee recognizes the concerning trend of
individuals who are experiencing loneliness and social
isolation. The Committee notes that a 2024 Harvard University
study found that nearly one in four Americans between the age
ranges of 18-29 and 30-44, respectively, reported as
experiencing loneliness consistently. Therefore, the Committee
encourages the Secretary, in coordination with other relevant
Federal departments and agencies, to establish a national
working group to find consensus on definitions and measurements
for purposes of cohesive public and private research into these
matters.
Mental and Behavioral Health Surveys and Other Data
Products.--The Committee notes the proliferation of surveys and
other data products related to mental health and behavioral
health within CDC and across HHS. As part of the fiscal year
2027 congressional justification, the Committee directs HHS to
include a summary of all annual, biannual, and quadrennial
surveys or other data products related to mental and behavioral
health, including how these data are being used to inform
policies across the Department.
Mobile Stroke Unit Reimbursement.--The Committee directs
GAO to undertake a study to review and analyze data and
information, as available and reliable, on the public health
benefits of mobile stroke units, how the Medicare program
reimburses their services, and the financial barriers they face
that threaten their operations and prevent their expansion. The
Committee directs GAO to provide a preliminary briefing to the
Committees on Appropriations of the House of Representatives
and the Senate within 12 months of the enactment of this Act
with a report to follow.
Mobile Stroke Units.--The Committee recognizes that stroke
is a leading cause of death and long-term disability in the
United States, and that rapid intervention is critical to
improving outcomes and reducing long-term health care costs.
Mobile stroke units, which provide on-site imaging, diagnosis,
and treatment, have been shown to significantly reduce the time
to treatment and improve recovery prospects. The Committee
encourages the Secretary to evaluate the feasibility of
supporting the deployment and integration of mobile stroke
units through existing Departmental grant programs and to
identify strategies for broader implementation across the
country. The Committee requests an update on such efforts in
the fiscal year 2027 congressional justification.
Mycotic Disease Surveillance.--The Committee is concerned
by the spread of deadly fungal infections in the United States
in recent years and the associated economic burden of fungal
infections, particularly in western States. A Federal plan with
resources to address the threat of fungal infections holds the
potential to safeguard the health of Americans in the event of
a domestic pandemic or in foreign theaters of war. The Federal
government's recognition of fungal infections as a microbial
threat to human health can allow for existing planning
frameworks, mechanisms, and tools such as the U.S. National
Action Plan for Combating Antibiotic-Resistance Bacteria, the
Presidential Advisory Council on Combating Antibiotic-Resistant
Bacteria, and CDC reports on priority antimicrobial resistance
threats to better account for steps taken to respond to fungal
threats in the United States. Therefore, the Committee
encourages HHS to include fungal diseases under its priorities
for Federal funding sources and authorities intended to address
the public health threats caused by infectious diseases and
antimicrobial resistance. In so doing, the Department should
prioritize: National action plans or programs that seek to
increase disease surveillance and foster interagency
collaborations to combat fungal diseases, antimicrobial
stewardship that includes both antibiotics and antifungals, and
patient education and awareness activities; Biothreat readiness
or activities that deliver expedited and actionable results at
the point-of-care, provide potential to reduce unnecessary
hospitalizations or escalations of care, or aid the
government's ability to halt the spread of deadly fungal
infections nationally using a One Health approach; and Medical
products, such as diagnostics, drugs, and vaccines that work
against a priority fungal pathogen with particular attention
paid to products that are novel and create new classes of
products capable of spurring future product types.
National Action Plan on Medical Foods.--The Committee notes
the potential to improve patient care and lower healthcare
costs, particularly for individuals with chronic and costly
illness, through reinvigorated efforts to develop and provide
proper access to medical foods. The Committee encourages the
Secretary to convene a meeting with patient, professional, and
industry stakeholders and coordinate follow-up activities to
develop a national action plan on medical foods to help
increase access to medical foods and medical nutrition. The
Committee requests an update on these efforts in the fiscal
year 2027 budget justification.
Neurodegenerative Diseases Diagnostics.--The Committee
supports the Department's efforts to prevent and effectively
treat neurodegenerative diseases, including Parkinson's
disease, Lewy body dementia, and other related disorders. The
Committee also recognizes that early detection is imperative to
improving health outcomes and patient quality of life by
delaying or halting the progression of such diseases. To
improve the ability of health care providers to diagnose and
treat neurodegenerative diseases at an earlier stage, the
Committee encourages HHS to work with stakeholders to research,
develop, and improve access to novel diagnostic testing for
neurodegenerative diseases.
Nonrecurring Expenses Fund.--The Committee directs HHS to
provide quarterly reports for all ongoing projects. The report
shall include the following for each project: the agency each
project is funded under; a description for each project; the
date the project was notified to the Committee; total
obligations to date; obligations for the prior fiscal year;
anticipated obligations for the current fiscal year; and any
expected future obligations. For any project ongoing for more
than three years, the report should include a narrative
describing the cause of delay and steps being taken by the
agency to ensure prompt completion. In addition, the Committee
requests biannual reports on expired balances that are eligible
for transfer to the Nonrecurring Expenses Fund (NEF). Such
report shall include the Treasury Account Fund Symbol, program
name, unobligated balance, and unexpended balance. Such report
shall be transmitted 30 days after the close of the second
quarter and within 45 days after the close of the fourth
quarter of the fiscal year. To ensure appropriate Congressional
oversight into use of the NEF, the Committee includes a new
provision limiting the amount for additional notifications for
use of the NEF.
Orthopedics.--The Committee encourages ASPE to complete a
report on orthopedic foot care supplies, such as shoes and shoe
inserts, including a focus on diabetics and their unique needs
such as diabetic shoes. The Committee further encourages ASPE
to suggest ways to reshore manufacturing of orthopedic foot
care supplies.
Other Transaction Authority.--Congress has authorized HHS
and several offices within the Department, to use other
transaction authority (OTA). Under this authority, agencies may
develop agreements that are not required to follow a standard
format or include terms and conditions that are typically
required when using traditional mechanisms. Agreements executed
using traditional mechanisms, such as a contract, grant,
cooperative agreement, or cooperative research and development
agreement, contain terms and conditions to ensure compliance
with statutory requirements applicable to those mechanisms
(such as the Federal Acquisition Regulation (FAR)). Conversely,
OTA agreements are not generally subject to these requirements,
and the terms and conditions of each individual agreement may
be tailored to meet the specific situation and need. The
Committee notes, however, that GAO and others have previously
reported that agencies' use of OTA has caused reduced
accountability and transparency, in part because other
transaction agreements are usually exempt from the FAR and
government cost accounting standards. Recognizing these issues,
the Committee directs HHS to submit a consolidated report no
later than 120 days following enactment of this Act, that
details a comprehensive narrative of OTA usage within the
Department for the most recent fiscal year for which data is
available. The report shall include the following for each
active OTA award: agency the award is funded under; the OTA
authority cited for the award; the justification for using OTA
authority instead of a traditional acquisition mechanism; a
description for each award; the date of award; the anticipated
date of completion; and total obligations to date. For any
award ongoing for more than five years in excess of
$25,000,000, the report shall include a narrative describing
the status of the project.
Packaging and Transport of Life-Saving Medical Products.--
The Committee recognizes the critical importance of American-
made cold ship containers and protective packaging in
maintaining domestic supply chains of life-saving medical
products and supporting multiple missions central to HHS. Cold
ship containers are vital to maintaining the temperature
integrity of vaccines, as well as insulin, biologics, and
specialty drugs, requiring strict temperature controls from
manufacturing to administration sites. Similarly, protective
packaging is essential to the secure delivery of sensitive and
costly medical equipment including diagnostic and imaging
devices, laboratory and testing equipment, and electronic
health monitoring devices used in hospitals, community health
clinics, and other medical settings. The Committee urges HHS to
prioritize public health and safety in any review of materials
used to package, ship, and distribute temperature-sensitive
pharmaceuticals and medical equipment and devices used in a
health care setting.
PHS Act Evaluation Funding.--The Committee recommendation
includes amounts made available under section 241 of the PHS
Act, as specified in the bill language. The Committee continues
to assume an assessment of 2.5 percent. The Committee's
assumptions include the exclusion of certain program management
and related administrative costs and non-PHS Act authorized
programs for which funding is provided in the bill. In
addition, the bill continues to exclude biodefense programs
consistent with prior years.
Additionally, as part of the President's Budget Request,
HHS is directed to provide the Committee, in electronic format,
tables providing PHS evaluation funding exclusions,
assessments, and uses for the budget request year. Such tables
shall also include a column for the most recently executed full
fiscal year and most recently enacted appropriation. HHS is
also directed to provide the Committees an updated version of
this table on a quarterly basis.
Postmenopausal Osteoporosis.--Postmenopausal Osteoporosis
(PMO) is responsible for nearly 2,000,000 fractures every year
in the United States in women aged 65 and older and only one in
six women receive osteoporosis treatment in the months
following an osteoporotic fracture. Two out of three women with
PMO at high risk for fracture will break a bone in their
lifetime. Despite the U.S. Preventive Services Task Force
(USPSTF) recommending the use of bone measurement testing to
screen both women age 65 and older for osteoporosis and
postmenopausal women younger than 65 who are at increased risk
of osteoporosis, nationwide screening of this high-risk
population is lacking. The Committee directs the Secretary to
provide a report to the Committees on Appropriations of the
House of Representatives and the Senate no later than one year
after the enactment of this Act on the gap in post fracture
care for PMO and recommendations on how to improve care. The
report shall include information on the prevalence of bone
measurement testing nationwide and how geography may impact
access; whether the primary care workforce is implementing the
USPSTF's recommendations and any barriers to implementation;
and whether implementing new or updated CMS reimbursement
policies would positively impact PMO care.
Primary Care Physician Shortages.--The Committee urges the
Assistant Secretary for Planning and Evaluation to conduct a
review of trends and factors contributing to the nation's
challenges with primary care physician recruitment and
retention and provide a related report. Such a report should
include a review and analysis of challenges to recruiting and
retaining primary care physicians; what Federal policies and
programs are effective in recruitment and retention, including
increased reimbursement, loan forgiveness and repayment
programs, and training programs serving underserved and diverse
patient populations; and geographic and demographic
characteristics of areas facing the greatest challenges or
shortages. The Committee encourages ASPE to make such report
available on the agency's website and to include recommended
policies to address primary care physician shortages, improve
primary care physician recruitment and retention, and enhance
primary care access for all Americans.
Protection of Innocent Life.--The Department of Health and
Human Services must prohibit any governmental discrimination
against any providers of health services on the basis that they
are not involved in abortion.
Psychiatric Hospitals.--The Trump Administration's
Executive Order 14321 on Ending Crime and Disorder on America's
Streets seeks to refocus Federal programs that have veered too
far in supporting vagrancy and drug use; these programs need to
refocus and adopt policies to help those who suffer from
serious mental illness. In order to support meaningful efforts
to address the needs of this population, the Committee
encourages efforts to expand access to psychiatric care. HHS
may consider establishing a working group to examine the
effectiveness of psychiatric hospitals, and other means of
supporting hospitals through funding mechanisms to assist in
caring for this population.
Public-Private Partnerships to Address Hygiene Poverty.--
The Committee supports nonprofit partnerships that ensure
access to hygiene products. Public-private partnerships that
provide access to basic hygiene products like soap, toothpaste,
and menstrual hygiene promote public health and human dignity
for many low-to-middle-income families. The Committee
encourages HHS to work with local and nonprofit organizations
to foster initiatives that close the needs gap and enhance
access to hygiene products in underserved areas.
Rare Diseases.--The Committee recognizes that multiple
Federal departments, agencies, and programs exist to address
the needs of people impacted by rare diseases and improve the
lives of members of the rare disease community. The Committee
encourages enhanced coordination and collaboration across the
Federal government and encourages the Secretary to develop a
framework for an Interagency Coordinating Committee (ICC) for
Rare Diseases. The ICC should focus on optimizing rare disease
activities across the Federal government and produce an annual
report assessing all Federal agency activities concerning rare
diseases, including but not limited to regulatory flexibilities
in rare disease therapy reviews, current and emerging
biomedical research opportunities, current and future rare
disease surveillance and epidemiological activities, programs
to support rare disease patients and caregivers, overall
programmatic funding, and other topics to be added by ICC
members.
Restorative Reproductive Medicine General Education.--
Restorative reproductive medicine (RRM) seeks to identify and
correct underlying causes and factors contributing to
infertility and reproductive dysfunction. RRM does not employ
methods that are inherently suppressive, circumventive, or
destructive and respects the integrity of the human person. The
Committee encourages HHS to explore opportunities to integrate
RRM into already existing and new Federal health programs. The
Committee further encourages OWH to develop and include RRM in
departmental programs.
Rural Hospital Closures and Financial Stability.--The
Committee is concerned about the ongoing crisis of rural
hospital closures, which jeopardize health care access in
medically underserved regions. Rural communities often face
compounding challenges, including older and sicker populations
and a higher reliance on public insurance or uncompensated
care. While the Committee supports continued investments in key
rural hospital designations--such as Critical Access Hospitals,
Rural Emergency Hospitals, and Medicare-Dependent Hospitals--
the Committee encourages HHS to evaluate and address the needs
of rural hospitals that do not fall within these existing
categories but still face persistent operational and financial
challenges.
Rural News Media and Advertising Campaigns.--The Committee
continues to recognize the critical role that local media plays
in delivering lifesaving messages to small and rural
communities. Therefore, the Committee urges the Secretary to
ensure that local media in small and rural markets are a key
component in the Department's public health advertising
campaigns which is critical to improving the delivery of public
health messages to these small and rural communities. To
further this goal, the Committee urges the Secretary, in
coordination with the Assistant Secretary for Public Affairs
and the Department's buyer contractors, to utilize local news
media in small and rural areas for public health advertising
campaigns for HHS and its related agencies to reach citizens
with key health messages. Local media includes newspapers,
specifically non-daily newspapers, television, and radio.
Within 90 days of enactment of this Act, the Committee directs
the Office of the Secretary to provide an update to the
Committee on the efforts of the Department in its utilization
of local media in small and rural areas as part of the
Department's public health advertising campaigns for the most
recent fiscal year for which data is available and plans for
subsequent fiscal years. The Committee also directs the
Assistant Secretary for Public Affairs, in consultation with
the CDC's Office of Rural Health, to undertake a review of the
use of local media in small and rural communities in an HHS
public health advertising campaign for the most recent fiscal
year for which data is available, in several States to better
understand their role as a key delivery system to reach small
and rural communities with critically important health
messages. The Committee requests an update from the Assistant
Secretary for Public Affairs within 180 days of enactment of
the Act on the status of this review and requests a final
report by the end of the fiscal year.
School Safety Grant Application Feedback Requisite.--The
Committee acknowledges the challenges that urban and rural
school districts encounter when applying for Federal funding
for school safety-related grants. The Committee recommends that
the Department of Education, Department of Homeland Security,
Department of Justice, and the Department of Health and Human
Services provide applicants with a detailed explanation of any
grant denials and explicit feedback on grant applications
within 30 days of the announcement of awardees. By implementing
a standardized feedback system through existing grant portals,
Federal agencies can assist districts in developing stronger
applications, resulting in more effective school safety
programs and improved outcomes for students overall.
Self-Governance.--For over forty years, Indian Tribes have
proven that utilizing self-governance through the Indian Self-
Determination and Education Assistance Act in Federal funding
is a successful approach for improving program performance. For
decades, Indian Tribes have requested the Department to expand
this authority beyond the Indian Health Service to other
critical HHS programs serving Tribes. Over twenty years,
multiple reports and workgroups have produced evidence of the
feasibility of the expansion of self-determination and self-
governance within the Department. The Committee directs HHS to
work with Tribal representatives to provide a plan for the
expansion of self-governance at HHS including specific actions
the Department can take to advance this process. Such plan is
due within 180 days of enactment of this Act. In addition, the
Department shall report to the Committee the amount of funding
that is going to Indian Tribes for the four largest block
grants administered by HHS within 90 days of enactment of this
Act.
Sleep and Circadian Disorders.--The Committee notes the
lack of dedicated sleep health and sleep disorders activities
across HHS despite the number of Americans affected, the
economic cost and burden of illness, and the connection between
sleep and serious chronic diseases, including obesity and heart
disease. The Committee encourages HHS to establish a
coordinating effort to promote sleep health and provider
education and awareness of sleep disorders.
Study on Models to Strengthen Supply Chain Resiliency.--The
Committee notes that stable and efficient pharmaceutical supply
chains are important strategic objectives for our nation. A key
finding from the 2019 Drug Shortages: Root Causes and Potential
Solutions Report was that the market does not recognize and
reward manufacturers for ``mature quality systems'' that focus
on continuous improvement and early detection of supply chain
issues. The Committee also appreciates that the 2019 Report
underscored the unique supply chain challenges for sterile
injectable generic drugs which play a critical role in patient
care across provider settings. The Committee recognizes that
despite the ongoing efforts to strengthen our nation's
medicines supply chain, drug shortages continue to threaten the
ability to provide American patients with the care they need
and more needs to be done to prevent and mitigate drug
shortages for our nation's patients. The Committee requests the
Department issue a supply chain resiliency report that assesses
and makes recommendations regarding potential market-based
solutions, such as ways to use available metrics and criteria
to evaluate the resilience and reliability of manufacturers to
incentivize changes in purchasing practices, that would provide
value to patients and our nation's health care providers by
enhancing supply chain predictability and reliability in the
marketplace for commonly used sterile injectable generic drugs.
Suspension and Debarment.--The Committee notes with concern
the infrequent utilization of suspensions and debarments, as
well as the associated timeliness challenges and the
underutilization of suspensions prior to debarment, within HHS.
These concerns were also noted in a 2022 report from the Office
of Inspector General, entitled, ``HHS's Suspension and
Debarment Program Helped Safeguard Federal Funding, But
Opportunities for Improvement Exist (Report No. OEI-04-19-
00570).'' As the largest grantmaking agency in the Federal
government, HHS awarded over $778 billion in grants during
fiscal year 2023. Federal suspension and debarment programs
play a critical role in maintaining the integrity of Federal
grant programs and ensure that the government conducts business
only with responsible individuals or entities. If recipients
lack honesty, integrity, or satisfactory business performance,
they can be suspended or debarred from receiving further
Federal grants. These mechanisms are essential for
accountability and proper allocation of taxpayer funds. The
Committee requests a report within 120 days of enactment of
this Act. Such report should include: (1) the number of
suspension or debarment referrals received by the HHS Office of
Recipient Integrity Coordination for each of the last 5 years;
(2) the number of final decisions issued by the Suspension and
Debarment Official for each of the last 5 years; (3) the number
of referrals and final decisions that were fact-based; (4) the
number of referrals and final decisions that were conviction-
based; and (5) the procedures the Department has in place to
ensure bad actors are timely listed as suspended or debarred on
SAM.gov.
Tuberculosis.--The Committee remains concerned regarding
the repeated instances of TB cases associated with viable bone
matrix material. The repeated contamination of the biologics
market and the failure to implement effective quality control
measures cost the lives of ten Americans. The Committee
continues to direct the Department to prioritize actions that
will improve the safety of the biologic supply chain from
mycobacterium tuberculosis, particularly reducing the risk of
exposure for immunocompromised Americans.
Veterinary Medicine.--According to the Bureau of Labor and
Statistics, at the national level the employment of
veterinarians is projected to grow 19 percent from 2021 to
2031, much faster than the average for all occupations. Not
surprisingly, the U.S. agriculture industry faces a serious
challenge due to the current and projected shortage of
veterinarians. According to the USDA, 500 counties in 46 States
reported a critical shortage of veterinarians in 2022. A high
demand exists in rural farming communities where there is an
acute shortage of large animal veterinarians. The development
of a large animal ambulatory rotation would train veterinary
students to address this critical shortage in rural communities
and have a positive economic impact on these communities.
Minority HIV/AIDS Fund
The Committee includes $20,000,000 for the Secretary's
Minority HIV/AIDS Fund (MHAF).
Tribal Set-Aside.--The Committee notes that according to
the CDC, HIV-positive status among Native Americans is
increasing and nearly one-in-five HIV-positive Native Americans
is unaware of their status. In addition, only three-in-five
receive care and less than half are virally suppressed. To
increase access to HIV/AIDS testing, prevention, and treatment,
the Committee reserves no less than $6,000,000 as a Tribal set-
aside within the MHAF.
Office of the Assistant Secretary for Health
Abortion Hotline.--The Committee includes a provision
prohibiting funds for an abortion hotline.
Food is Medicine.--The United States continues to face a
nutrition-related health crisis with rapid increases in the
incidence and prevalence of diet-related chronic conditions and
diseases and the negative impacts of these illnesses, including
poor health outcomes, increased risk of comorbid conditions
(e.g., cancer), premature deaths, and rapidly increasing health
care costs. The Committee continues to support the Food is
Medicine program focused on using healthy, nutritious, and
affordable foods to prevent, treat, and manage chronic health
conditions. The Committee continues to urge the Department to
include in its annual reports details on how community
pharmacies may be able to play a critical role in the Food is
Medicine model, specifically how they can help improve
nutrition-related outcomes. These reports should also be posted
on a publicly available website.
Lyme and Other Tick-Borne Diseases.--The Committee
encourages the Office of the Secretary to work with the
Director of NIH to evaluate the potential benefits of expanding
the Tick-Borne Diseases (TBD) portfolio to other Institutes and
Centers in addition to NIAID. Due to the profound neurologic
involvement of TBD, such as Lyme disease, NINDS and NIMH may
make major contributions to the study of TBD, such as
developing novel treatments for neurologic symptoms, including
severe neurologic symptoms in children. Due to the severe
impacts of TBD on children, the National Institute of Child
Health and Human Development (NICHD) may also greatly enhance
NIH accomplishments in developing tools to manage pediatric
cases of TBD. The Committee strongly encourages the Secretary
to establish within OASH a Tick-Borne disease coordinating
office to track, monitor and provide technical assistance on
TBD activities throughout HHS, including its operating
divisions, and to serve as an HHS-wide facilitator for TBD
activities. The coordinating office should monitor and report
to the Secretary on implementing ``The National Public Health
Strategy to Prevent and Control Vector-Borne Diseases in
People.'' The Committee further encourages the OASH TBD
Coordinating Office to establish a program for temporary
agency/stakeholder panels or commissions to address a need or
gap related to TBD goals and objectives in an HHS agency or
across agencies. Such panels should consist of a range of
stakeholders, similar to the TBD Working Group (TBDWG), except
on a smaller scale, to operate for a short period of time to
address a particular need or gap in the TBD knowledge base or
TBD activity. The overarching purpose is to facilitate
transitioning products to patients, health care practitioners,
researchers, academia--including VBD Centers of Excellence,
industry, and State and local governments. The Committee
commends OASH and CDC for building upon the six years of
dedication of numerous TBDWG participants. Although the TBDWG
is now sunset, the Committee sincerely thanks its participants
and other stakeholders, including patients, patient advocates,
researchers, clinicians, and Federal staff, who made sacrifices
from their professional and personal lives in the hope of
helping patients and their care providers.
Obesity.--The Committee notes that the CDC formally
recognizes obesity as a disease and recommends that it should
be treated with evidence-based therapies. Intensive behavioral
therapy, improved diet and nutrition, and medication, in
addition to surgical procedures, can lead to weight loss and
have the potential to improve health outcomes for those with
obesity-related health conditions including diabetes, coronary
heart disease, and hypertension. The Committee encourages HHS
to take a comprehensive approach to preventing and treating
obesity as a chronic disease and to find ways to improve access
to treatment options. The Committee also encourages HHS to
continue to collaborate with other Federal agencies that are
already treating obesity as a chronic disease as it considers
best practices to improve care for people with obesity.
Reproductive Rights.--No funds are provided for
www.reproductiverights.gov or any similar website.
Office of Climate Change and Health Equity
No funds are provided for the Office of Climate Change and
Health Equity.
Office of Minority Health
The Committee includes $45,000,000 for the Office of
Minority Health (OMH), which is equal to the fiscal year 2026
budget request.
OMH works with public health service agencies and other
agencies of the Department to address the health status and
quality of life for minority populations in the United States.
OMH develops and implements new policies; partners with States,
Tribes, and communities through cooperative agreements;
supports research, demonstration, and evaluation projects; and
disseminates information.
Within the total provided for OMH, the Committee provides
no less than the following amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity Committee
------------------------------------------------------------------------
Center for Indigenous Innovation and Health.......... $6,000,000
Improving Maternal Health Outcomes................... 7,000,000
National Lupus Training, Outreach, and Clinical Trial 3,000,000
Education...........................................
Promoting Language Access Services................... 4,000,000
------------------------------------------------------------------------
Center for Indigenous Innovation and Health.--The Committee
continues to recognize the importance of advancing Indigenous
solutions to achieve health excellence. The Committee includes
$6,000,000 to support the work of the Center for Indigenous
Innovation and Health. The Committee supports HHS in its
partnerships with universities with a focus on Indigenous
health research and policy among Native Americans and Alaska
Natives, as well as universities with a focus on Indigenous
health policy and innovation among Native Hawaiians/Pacific
Islanders.
National Lupus Training, Outreach, and Clinical Trial
Education.--The Committee continues to support the National
Lupus Outreach and Clinical Trial Education Program and the
goal of increasing participation in lupus clinical trials and
ensuring that trials are representative of the lupus
population. There are approximately 140 lupus clinical trials
underway in the United States and important progress has been
made in raising trial awareness. However, challenges remain in
identifying people with lupus from representative populations
who meet trial enrollment criteria, yet who may not be aware of
trial opportunities. Moreover, research continues to show that
patients who may be eligible for trials do not learn about
those opportunities from their physicians. Therefore, the
Committee encourages OMH to support efforts such as patient
registries, peer-to-peer education and training programs, and
provider outreach that will enable the community to more
effectively raise awareness of trial opportunities among
representative populations who are eligible to participate.
Promoting Language Access Services.--The Committee supports
the Department's efforts to improve external communications to
reach limited English proficient (LEP) communities. The
Committee encourages the Department to review communication
practices and create uniform applications across all HHS
agencies to strengthen communication practices to include
digital, television, and radio advertising when working with
LEP communities.
Office on Women's Health
The Committee includes $30,000,000 for the Office on
Women's Health (OWH), which is equal to the fiscal year 2026
budget request.
OWH provides consultation to the Secretary on women's
health and establishes short and long-range goals and
objectives for women's health within the Department. OWH
monitors activities regarding women's health and coordinates
across the Department on disease prevention, health promotion,
service delivery, research, public and health care professional
education, and other women's health concerns throughout their
lifespan. OWH leads the coordination of activities to promote
women's health programs and policies with the private sector
and to share information with the public. OWH also leads the
Coordinating Committee on Women's Health and the National
Women's Health Information Center.
Within the total provided for OWH, the Committee provides
no less than the following amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity Committee
------------------------------------------------------------------------
Combatting Violence Against Women.................... $10,100,000
Eating Disorders Research............................ 1,000,000
Pregnant and Lactating Women's Advisory Committee.... 200,000
Stillbirth Working Group............................. 2,000,000
------------------------------------------------------------------------
Eating Disorders Research.--The Committee remains concerned
that eating disorders have one of the highest fatality rates of
any psychiatric illness, with girls and women at heightened
risk for developing an eating disorder during their lifetime.
The Committee recognizes OWH's efforts to address the rise in
eating disorders among adolescent girls. The Committee
continues funding and urges focus on early detection and
treatment protocols for women and girls with or at-risk of
developing an eating disorder. The Committee encourages OWH to
prioritize projects to address the lack of pediatric and
adolescent screening in the primary care and pediatrics
settings. The Committee urges OWH to coordinate with outside
organizations, eating disorders specialists, and other groups
as necessary to identify research needs of eating disorders
among women and girls.
Increasing Diagnosis of Migraine Disease in Women.--The
Committee is aware of the substantial burden of migraine
disease on women's health given that migraine doubles the risk
of pre-eclampsia, confers a higher risk for cardiovascular
disease than either hypertension or hyperlipidemia, and is
closely co-morbid with chronic diseases such as anxiety and
depression. The Committee is concerned that migraine disease
affects nearly 40 million Americans and women are three times
more likely to experience migraine, leading to a significant
need for improved screening and diagnosis to prevent painful
and chronic disease progression. The Committee recognizes the
gaps that exist for migraine diagnosis in existing screening
and prevention guidelines for women and urges the inclusion of
migraine screening in the annual women's wellness visit in the
Medicare program.
Pregnant and Lactating Women's Advisory Committee.--The
Committee continues funding for the advisory committee to
continue activities within the 2020 Task Force on Research
Specific to Pregnant and Lactating Women (PRGLAC)
Implementation Plan. The Committee requests an update in the
fiscal year 2027 congressional justification on progress and
Federal activities undertaken to implement the PRGLAC
recommendations and suggestions for further implementation of
PRGLAC recommendations.
Stillbirth Working Group.--The Committee includes funding
for the Secretary to prioritize implementation of the
Stillbirth Working Group's recommendations across the
Department and to continue to engage in efforts to promote
evidence-based stillbirth awareness and prevention activities.
The Committee looks forward to reviewing the Department's
report on its progress, as requested in the joint explanatory
statement which accompanied the Further Consolidated
Appropriations Act, 2024 (P.L. 118-47). The Committee directs
the Secretary to continue to prioritize the Department-wide
implementation of the Stillbirth Working Group's
recommendations and engage in efforts to promote evidence-based
stillbirth awareness and prevention activities. The Committee
further directs the Department to prioritize (1) improved data
collection and surveillance systems including the modernization
of fetal death reporting and interstate data harmonization, (2)
identification of evidence-based risk reduction strategies,
especially in disproportionately affected populations, and (3)
initiatives to support maternal mental health and bereavement
care. The Committee directs the Department to provide a report
to the Committees on Appropriations of the House of
Representatives and the Senate on the progress made toward
these directives and the implementation of the Working Group's
recommendations and to make such report available on the
agency's website within 180 days of enactment of this Act.
Office of the Assistant Secretary for Administration
Cybersecurity
The Committee provides $100,000,000 for information
technology cybersecurity to strengthen the Department's
cybersecurity posture.
In addition, the Committee permits the transfer of
$30,000,000 from the Nonrecurring Expenses Fund.
Office of National Security
The Committee provides $8,983,000, the same as the fiscal
year 2026 budget request, for the Office of National Security
to maintain the security of the Department's personnel,
systems, and critical infrastructure.
Office of Global Affairs
The Committee provides $7,009,000 for the Office of Global
Affairs to coordinate HHS policy to strengthen U.S. health
security.
U.S.-Mexico Border Health Commission (USMBHC).--The
Committee remains concerned about the risks posed to border
communities from infectious disease outbreaks, given the
region's unique cross-border mobility and economic
interdependence. The Committee directs USMBHC, in coordination
with relevant agencies and local health agencies, to submit a
report to the Committee within 180 days of the date of
enactment of this Act outlining a comprehensive plan to enhance
preparedness and response to infectious diseases along the
U.S.-Mexico border. The plan should include: (a) an assessment
of the capacity of the United States-Mexico Border Area to
strengthen its response to infectious diseases, including
strategies for improving testing, contact tracing, and other
infection prevention and control measures; (b) an analysis of
how the economic conditions in the United States-Mexico Border
Area are impacted by such diseases and how the effects can be
mitigated through coordinated public health and economic
interventions; and (c) recommendations to improve the sharing
of relevant health data, including testing and positivity
rates, between health agencies operating within the United
States-Mexico Border Area to enhance binational coordination
and situational awareness. The Committee encourages the USMBHC
to engage stakeholders across all levels of government,
academia, and the nonprofit sector in the development of this
plan and to ensure that the unique needs of border communities
are reflected in national infectious disease preparedness
efforts.
MEDICARE HEARINGS AND APPEALS
Appropriation, fiscal year 2025....................... $196,000,000
Budget request, fiscal year 2026...................... 180,000,000
Committee Recommendation.............................. 180,000,000
Change from enacted level......................... -16,000,000
Change from budget request........................ - - -
This appropriation supports activities carried out by two
Office of the Secretary Staff Divisions. The Office of Medicare
Hearings and Appeals supports Medicare appeals at the
administrative law judge level, the third level of Medicare
claims appeals. The Departmental Appeals Board represents the
fourth level of the Medicare appeals process and provides
impartial, independent hearings and appellate reviews.
OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY
Appropriation, fiscal year 2025....................... $69,238,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 59,238,000
Change from enacted level......................... -10,000,000
Change from budget request........................ +59,238,000
The Office of the National Coordinator for Health
Information Technology is the principal Federal entity charged
with coordinating efforts to implement and use health
information technology and exchange electronic health
information. The fiscal year 2026 budget request amount does
not include funding requested for the proposed Office of the
Chief Technology Officer.
Information Blocking.--Given the significant penalties for
information blocking and the complexity of the rules for
regulated entities, the Committee encourages ASTP to provide
stakeholders with clear, practical guidance regarding
``reasonable and necessary activities'' which are not
information blocking as required by the 21st Century Cures Act
(P.L. 114-255). ASTP should focus any such guidance on
developing best practices for information sharing, which is its
mandate from Congress.
Patient Matching.--The Committee is concerned there is no
consistent and accurate way to link patients to their health
information as they seek care across the continuum. Health
information must be accurate, timely, and robust to inform
clinical care decisions for every patient. The recommendation
includes $3,000,000, the same as the fiscal year 2024 enacted
level, for ONC to work with industry to develop matching
standards that prioritize interoperability, patient safety, and
patient privacy.
Standards for Interoperability.--ONC and CMS have published
final rules to implement interoperability provisions contained
in the Cures Act, including the ONC final rule, ``21st Century
Cures Act: Interoperability, Information Blocking, and the ONC
Health IT Certification Program'' and the related CMS final
rule, including the adoption of Fast Healthcare
Interoperability Resources (FHIR) as the foundational standard
to support health information sharing without ``special
effort'' on the part of the user. FHIR-based application
programming interfaces are now required for all health
stakeholders that exchange data in compliance with the rules
that support the Act. The Committee's recommendation includes
no less than $5,000,000, the same as the fiscal year 2024
enacted level, to support interoperability and information
sharing efforts related to the implementation of such
standards.
OFFICE FOR CIVIL RIGHTS
Appropriation, fiscal year 2025....................... $39,798,000
Budget request, fiscal year 2026...................... 39,798,000
Committee Recommendation.............................. 39,798,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Office for Civil Rights (OCR) is responsible for
enforcing civil rights statutes that prohibit discrimination in
health and human services programs. OCR implements the civil
rights laws through a compliance program designed to generate
voluntary compliance among all HHS recipients.
Patient Health Information Regulation.--The Committee
recognizes that OCR has been working on matters pertaining to
regulatory barriers that impede the delivery of coordinated,
value-based care. The Notice of Proposed Rulemaking (NPRM)
published on January 21, 2021 (HHS-OCR-0945-AA00) was intended
to modify existing patient privacy regulations to support
coordinated care, case management, and value-based care while
protecting the privacy and security of electronic protected
health information (ePHI). However, the Committee is concerned
that this draft NPRM could have unintended consequences, such
as granting unprecedented access to valuable health information
by commercial entities as well as eroding patient privacy
protections through disclosure of more information than
necessary to third-party interests, most of whom operate
outside the bounds of HIPAA. The Committee is also concerned
that the NPRM, as drafted, could shift the growing economic
burden of fulfilling requests for ePHI securely and lawfully
from commercial requestors to the healthcare system. Therefore,
the Committee urges the Secretary to withdraw and rescind the
proposed ``HIPAA Privacy Rule: Changes to Support the Use of
Telecommunications Relay Services and Improve Information
Sharing for Uniformed Services Personnel.''
Report on Antisemitism in Health Care.--In accordance with
the Civil Rights Act of 1964 and the Affordable Care Act (ACA),
OCR investigates discrimination in institutions that receive
Federal funding, including antisemitism and other forms of
discrimination within healthcare settings based on (i) national
origin, including shared ancestry and other ethnic
characteristics, or (ii) citizenship or residency in a country
with a dominant religion or distinct religious identity,
impacting discrete communities such as Jews, Hindus, Sikhs, and
Muslims. For instance, in 2025, OCR investigated reviews of
four medical schools for alleged antisemitic incidents during
their 2024 commencement addresses. Despite ongoing efforts,
there remains a significant gap in the comprehensive tracking
of antisemitism and other forms of discrimination in healthcare
settings. This lack of data makes it difficult to fully
understand the extent of the problem and develop targeted,
effective interventions. The Committee directs OCR to use all
available resources to collect and analyze data related to
antisemitism and other civil rights violations in the
healthcare and medical education sectors. The Committee further
directs HHS to submit a report to the Committees on
Appropriations of the House of Representatives and the Senate
within 180 days of enactment of this Act summarizing and
detailing, without personally identifying information, all
pending and resolved civil rights complaints within the
healthcare and medical education sectors over the past two
years. This report should be disaggregated by type of
discrimination where appropriate, including those involving
antisemitic conduct, and must include the total number of
complaints received, the number of investigations initiated and
substantiated, and the outcomes of those investigations--
specifically indicating whether a violation was found and what
corrective actions, if any, were taken.
OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2025....................... $87,000,000
Budget request, fiscal year 2026...................... 87,000,000
Committee Recommendation.............................. 87,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Committee recommends $87,00,000 for the Office of
Inspector General, which is equal to the fiscal year 2026
budget request.
In addition, within the Health Care Fraud and Abuse Control
program discretionary appropriations for fiscal year 2026, the
Committee provides the OIG with $108,735,000, which is the same
as the fiscal year 2026 budget request. Mandatory
appropriations for this office are also contained in the HCFAC
program and the Health Insurance Portability and Accountability
Act of 1996.
The Committee supports the OIG as an independent and
objective entity charged with conducting oversight, preventing
waste, fraud and abuse, and promoting economy, efficiency, and
effectiveness in the Department's programs and operations.
The Committee commends the OIG and its Federal and State
law enforcement partners for the recently-announced 2025
National Health Care Fraud Takedown, which resulted in criminal
charges against 324 defendants, with intended losses exceeding
$14.6 billion. This amount doubled the previous record of $6
billion for such a Takedown. The Committee encourages OIG and
its law enforcement partners to disseminate best practices and
lessons learned from this action to prevent similar incidents
of fraud within Federal health care programs.
RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS
Appropriation, fiscal year 2025....................... $894,795,000
Budget request, fiscal year 2026...................... 947,182,000
Committee Recommendation.............................. 947,182,000
Change from enacted level......................... +52,387,000
Change from budget request........................ - - -
The Committee provides for retirement pay and medical
benefits of Public Health Service Commissioned Officers, for
payments under the Retired Serviceman's Family Protection Plan,
and for medical care of dependents and retired personnel.
General Provisions
Sec. 201. The Committee continues a provision to limit the
amount available for official reception and representation
expenses.
Sec. 202. The Committee continues a provision to limit the
salary of an individual through an HHS grant or other
extramural mechanism to not more than the rate of Executive
Level II.
Sec. 203. The Committee modifies a provision to prohibit
the Secretary from using evaluation set-aside funds in this or
any other Act until the Committees on Appropriations receive a
report detailing the planned use of such funds.
Sec. 204. The Committee continues a provision regarding the
use of PHS evaluation set-aside.
(TRANSFER OF FUNDS)
Sec. 205. The Committee continues a provision permitting
the Secretary of HHS to transfer up to one percent of any
discretionary funds between appropriations, provided that no
appropriation is increased by more than three percent by any
such transfer to meet emergency needs. Notification must be
provided to the Committees on Appropriations at the program,
project, and activity level in advance of any such transfer.
Sec. 206. The Committee modifies a provision providing 60-
day flexibility for National Health Service Corps contract
terminations.
Sec. 207. The Committee continues a provision to prohibit
the use of Title X funds unless the applicant for the award
certifies to the Secretary that it encourages family
participation in the decision of minors to seek family planning
services and that it provides counseling to minors on how to
resist attempts to coerce minors into engaging in sexual
activities.
Sec. 208. The Committee continues a provision stating that
no provider of services under Title X shall be exempt from any
law requiring notification or the reporting of child abuse,
child molestation, sexual abuse, rape, or incest.
Sec. 209. The Committee continues a provision related to
the Medicare Advantage program.
Sec. 210. The Committee continues a provision prohibiting
funds from being used to advocate or promote gun control.
Sec. 211. The Committee continues a provision limiting the
assignment of employees for work with certain organizations.
Sec. 212. The Committee modifies a provision to allow
funding for HHS international HIV/AIDS and other infectious
diseases, chronic and environmental disease, and other health
activities abroad to be spent under the State Department Basic
Authorities Act of 1956.
(TRANSFER OF FUNDS)
Sec. 213. The Committee continues a provision to provide
the Director of NIH, jointly with the Director of the Office of
AIDS Research, the authority to transfer up to three percent of
human immunodeficiency virus funds.
(TRANSFER OF FUNDS)
Sec. 214. The Committee continues a provision that makes
NIH funds for human immunodeficiency virus research available
to the Office of AIDS Research.
Sec. 215. The Committee continues a provision granting
authority to the Office of the Director of the NIH to enter
directly into transactions in order to implement the NIH Common
Fund for medical research and permitting the Director to
utilize peer review procedures, as appropriate, to obtain
assessments of scientific and technical merit.
Sec. 216. The Committee continues a provision clarifying
that funds appropriated to NIH institutes and centers may be
used for minor repairs or improvements to their buildings, up
to $5,000,000 per project with a total limit for NIH of
$100,000,000.
(TRANSFER OF FUNDS)
Sec. 217. The Committee continues a provision transferring
one percent of the funding made available for National
Institutes of Health National Research Service Awards to the
Health Resources and Services Administration.
Sec. 218. The Committee continues the Biomedical Advanced
Research and Development Authority ten-year contract authority.
Sec. 219. The Committee modifies a provision requiring HHS
to include information regarding full-time Federal employees
and contractors working on the Affordable Care Act in the
fiscal year 2027 budget request.
Sec. 220. The Committee modifies a provision for a report
on CMS's Health Insurance Exchange activities in the fiscal
year 2027 budget request.
Sec. 221. The Committee continues a provision prohibiting
the CMS Program Management account from being used to support
risk corridor payments.
(TRANSFER OF FUNDS)
Sec. 222. The Committee modifies a provision directing the
spending of the Prevention and Public Health Fund.
PREVENTION AND PUBLIC HEALTH FUND
In fiscal year 2026, the level appropriated for the fund is
$1,438,075,000 after accounting for sequestration. The
Committee includes bill language in section 222 of this Act
that requires that funds be transferred within 45 days of
enactment of this Act to the following accounts, for the
following activities, and in the following amounts:
----------------------------------------------------------------------------------------------------------------
Agency Budget Activity FY 2025 Enacted FY 2026 Committee
----------------------------------------------------------------------------------------------------------------
ACL........................................ Alzheimer's Disease Program.. $14,700,000 $14,700,000
ACL........................................ Chronic Disease Self- 8,000,000 8,000,000
Management.
ACL........................................ Falls Prevention............. 5,000,000 5,000,000
CDC........................................ Breast and Cervical Cancer... - - - 86,182,000
CDC........................................ Diabetes..................... 66,412,000 163,130,000
CDC........................................ Epidemiology and Laboratory 40,000,000 45,000,000
Capacity Grants.
CDC........................................ Heart Disease and Stroke 29,255,000 163,130,000
Prevention Program.
CDC........................................ Immunization Grants.......... 681,933,000 699,933,000
CDC........................................ Lead Poisoning Prevention.... 51,000,000 51,000,000
CDC........................................ Public Health Data - - - 185,000,000
Modernization.
CDC........................................ Early Care Collaboratives.... 5,000,000 5,000,000
SAMHSA..................................... Garrett Lee Smith--Youth 12,000,000 12,000,000
Suicide Prevention.
----------------------------------------------------------------------------------------------------------------
Sec. 223. The Committee modifies a provision related to
breast cancer screening.
(TRANSFER OF FUNDS)
Sec. 224. The Committee continues a provision permitting
transfer of funds within NIH, if such funds are related to
opioid and pain management research.
Sec. 225. The Committee continues a provision related to
certain Congressional notification requirements.
Sec. 226. The Committee continues a provision related to
funding for the Medicare program.
Sec. 227. The Committee continues a provision allowing HHS
to cover travel expenses when necessary for employees to obtain
medical care when they are assigned to duty in a location with
a public health emergency.
Sec. 228. The Committee continues a provision related to
donations for unaccompanied alien children.
Sec. 229. The Committee continues a provision related to
the notification requirements regarding the use of facilities
that are not State licensed for the care of unaccompanied alien
children.
Sec. 230. The Committee continues a provision related to
Members of Congress and oversight of facilities responsible for
the care of unaccompanied alien children.
Sec. 231. The Committee continues a provision requiring
monthly reporting on unaccompanied alien children who were
separated from their parents or legal guardians and transferred
to the care of the Office of Refugee Resettlement.
Sec. 232. The Committee continues a provision related to
primary and secondary school costs for eligible dependents of
personnel stationed in a U.S. territory.
Sec. 233. The Committee includes a new provision modifying
the Community Services Block Grant Act.
(RESCISSION)
Sec. 234. The Committee modifies a provision related to
unobligated balances in the Nonrecurring Expenses Fund.
Sec. 235. The Committee includes a new provision related to
facilities and administration costs.
Sec. 236. The Committee includes a new provision related to
fetal tissue.
Sec. 237. The Committee includes a new provision related to
physician training for abortions.
Sec. 238. The Committee includes a new provision
restricting funding to certain health care entities.
Sec. 239. The Committee includes a new provision related to
providing information on abortion.
Sec. 240. The Committee includes a new provision related to
referral for abortions.
Sec. 241. The Committee includes a new provision related to
executive orders addressing reproductive services.
Sec. 242. The Committee includes a new provision regarding
a CMS rule related to vaccination requirements.
Sec. 243. The Committee includes a new provision regarding
Executive Order 13988 (Executive Order on Preventing and
Combating Discrimination on the Basis of Gender Identity or
Sexual Orientation).
Sec. 244. The Committee includes a new provision limiting
funding for certain elective services.
Sec. 245. The Committee includes a new provision related to
rulemaking for section 1557 of the Affordable Care Act.
Sec. 246. The Committee includes a new provision related to
placement under Titles IV-E and IV-B of the Social Security
Act.
Sec. 247. The Committee includes a new provision related to
the unaccompanied alien children foundational rule.
Sec. 248. The Committee includes a new provision related to
placement of unaccompanied alien children.
Sec. 249. The Committee includes a new provision related to
nursing home staffing standards.
Sec. 250. The Committee includes a new provision related to
a final rule for short term, limited duration health plans.
Sec. 251. The Committee includes a new provision related to
a public health emergency and a citizen's Second Amendment
rights.
Sec. 252. The Committee includes a new provision related to
civil actions for certain designated violations of law.
Sec. 253. The Committee includes a new provision related to
a final rule for the Child Care and Development Fund.
Sec. 254. The Committee includes a new provision related to
placements of unaccompanied alien children.
Sec. 255. The Committee includes a new provision related to
research on firearm-related restrictions or policies.
Sec. 256. The Committee includes a new provision related to
restrictions on animal research.
Sec. 257. The Committee includes a new provision related to
a prior authorization pilot program.
Sec. 258. The Committee includes a new provision related to
continuing medical education grant programs.
TITLE III--DEPARTMENT OF EDUCATION
Appropriation, fiscal year 2025..................... $78,736,810,000
Budget request, fiscal year 2026.................... 66,702,839,000
Committee Recommendation............................ 66,681,178,000
Change from enacted level....................... -12,055,632,000
Change from budget request...................... -21,661,000
The U.S. Department of Education's discretionary spending
encompasses the budget allocated to various education programs,
determined through annual appropriations.
The Committee commends the Department for its forward-
thinking budget proposals aimed at ensuring better educational
outcomes for students, from K-12 education through education
and training opportunities beyond high school. In particular,
the Committee commends the renewed focus on literacy, which is
crucial for students' later academic success and a necessary
skill in life. Similarly, the Committee commends the budget's
consideration of ideas to create efficiencies in Federal
programs and empower States. The Committee also commends the
Department for prioritizing the return to repayment for the
country's 43 million borrowers with Federally held student
loans, including by providing a clear message to borrowers,
providing resources to assist borrowers in becoming current on
payments, and safeguarding taxpayer dollars.
This bill provides $66.7 billion in discretionary budget
authority for the Department of Education, a reduction of 15
percent over fiscal year 2025 enacted level. The Department of
Education comprises 33 percent of the total 302(b) allocation
for this subcommittee.
Office of Elementary and Secondary Education
EDUCATION FOR THE DISADVANTAGED
Appropriation, fiscal year 2025..................... $19,107,790,00
Budget request, fiscal year 2026.................... 18,406,802,000
Committee Recommendation............................ 13,912,224,000
Change from enacted level....................... -5,195,566,000
Change from budget request...................... -4,494,578,000
This appropriation account includes compensatory education
programs authorized under title I and subpart 2 of part B of
title II of the Elementary and Secondary Education Act of 1965
(ESEA) and section 418A of the Higher Education Act (HEA).
Of the total amount available, $3,780,313,000 is
appropriated for fiscal year 2026 for obligation on or after
July 1, 2026, and $10,841,177,000 is appropriated for fiscal
year 2027 for obligation on or after October 1, 2026.
Grants to Local Educational Agencies
For fiscal year 2026, the Committee provides
$14,626,490,000, for Title I grants to Local Educational
Agencies (LEAs or school districts), which is $3,780,312,000
below the fiscal year 2025 enacted level.
The Committee proposes reduced formula funding for public
schools. The Committee notes that despite annual increases in
funding for Title I formula grants, student test scores
continue to decline. The latest test scores published by the
Department showed that overall math and reading scores continue
to remain below pre-pandemic levels.
Federal tax dollars have not been shown to result in
meaningful improvement in student achievement. Moreover, the
partisan American Rescue Plan (P.L. 117-2) invested more than
$150,000,000,000 into American schools. Despite the
unprecedented direct Federal support for schools, U.S. student
achievement continues to lag other industrialized nations.
Moreover, public school enrollment continues on its downward
trend since the pandemic.
Basic Grants
Of the amounts provided for Title I programs, the Committee
provides $3,614,089,000 for Basic Grants to LEAs, which is
$2,845,312,000 below the fiscal year 2025 enacted level. Of
this amount, $763,776,000 is available for fiscal year 2027.
Basic grants are awarded to school districts with at least
10 low-income children who make up more than 2 percent of the
school-age population.
High-Quality Tutoring.--The Committee encourages the
Department to promote and provide technical assistance to LEAs
and support partnerships between LEAs and education-related
community-based organizations to implement evidence-based
tutoring models.
Concentration Grants
The Committee provides $1,362,301,000, the same as the
fiscal year 2026 budget request and fiscal year 2025 enacted
level for Title I Concentration Grants.
These grants target funds to school districts in which the
number of low-income children exceeds 6,500 or 15 percent of
the total school-age population.
Targeted Grants
The Committee provides $4,825,050,000, which is
$467,500,000 below the fiscal year 2026 budget request and the
fiscal year 2025 enacted level for Title I Targeted Grants.
Within this amount, $4,357,550,000 is available for fiscal year
2027.
Targeted Grants provide higher payments to school districts
with high numbers or percentages of low-income students.
Education Finance Incentive Grants
The Committee provides $4,825,050,000, which is
$467,500,000 below the fiscal year 2026 budget request and the
fiscal year 2025 enacted level for Title I Education Finance
Incentive Grants. Within this amount, $4,357,550,000 is
available for fiscal year 2027.
These funds are allocated according to one of the four
allocation formulas authorized under ESEA Title I, Part A for
providing Federal education funding to the States for the
education of disadvantaged students.
Innovative Approaches to Literacy
The Committee provides $30,000,000 for the Innovative
Approaches to Literacy program, which is $30,000,000 above the
fiscal year 2026 budget request and the same as the fiscal year
2025 enacted level. This program provides competitive grants to
support school libraries.
Comprehensive Literacy Development Grants
The Committee provides $194,000,000 for the Innovative
Approaches to Literacy program, which is $194,000,000 above the
fiscal year 2026 budget request and the same as the fiscal year
2025 enacted level. This program supports competitive grants to
States to subgrant to school districts and/or early education
programs to improve literacy instruction for disadvantaged
students.
State Agency Programs: Migrant
The Committee does not provide funding for the State Agency
Program for Migrant Education, which is the same as the fiscal
year 2026 budget request and $375,626,000 below the fiscal year
2025 enacted level.
This formula grant program supports special educational and
related services for children of migrant agricultural workers
and fishermen, including: (1) supplementary academic education;
(2) remedial or compensatory instruction; (3) English for
limited English proficient students; (4) testing; (5) guidance
counseling; and (6) other activities to promote coordination of
services across States for migrant children whose education is
interrupted by frequent moves.
The Committee has chosen to prioritize funding for local
school districts to improve student outcomes in the core
curriculum of writing, reading comprehension, and math.
State Agency Programs: Neglected and Delinquent/High Risk Youth
The Committee does not provide funding for the State Agency
Program for Neglected and Delinquent Children, which is the
same as the fiscal year 2026 budget request and $49,239,000
below the fiscal year 2025 enacted level.
This formula grant program supports educational services
for children and youth under age 21 in State-run institutions,
attending community day programs, and in correctional
facilities. A portion of these funds are provided for projects
that support the successful reentry of youth from the criminal
justice system into postsecondary and vocational programs.
The Committee has chosen to prioritize funding for local
school districts to improve student outcomes in the core
curriculum of writing, reading comprehension, and math.
Special Programs for Migrant Students
The Committee does not provide funding for the Special
Programs for Migrant Students, which is the same as the fiscal
year 2026 budget request and $52,123,000 below the fiscal year
2025 enacted level.
These programs make competitive grants to colleges,
universities, and nonprofit organizations to support
educational programs designed for students who are engaged in
migrant and other seasonal farm work. The High School
Equivalency Program recruits migrant students aged 16 and over
and provides academic and support services to help those
students obtain a high school equivalency certificate and
subsequently to gain employment or admission to a postsecondary
institution or training program. The College Assistance Migrant
Program provides tutoring and counseling services to first-
year, undergraduate migrant students and assists those students
in obtaining student financial aid for their remaining
undergraduate years.
The Committee has chosen to prioritize funding for local
school districts to improve student outcomes in the core
curriculum of writing, reading comprehension, and math.
IMPACT AID
Appropriation, fiscal year 2025....................... $1,625,151,000
Budget request, fiscal year 2026...................... 1,625,151,000
Committee Recommendation.............................. 1,630,151,000
Change from enacted level......................... +5,000,000
Change from budget request........................ +5,000,000
This account supports payments to school districts affected
by Federal activities, such as those that educate children
whose families are connected with the military or who live on
Indian land.
Basic Support Payments
The Committee provides $1,477,000,000 for Basic Support
Payments to LEAs, which is an increase of $3,000,000 from the
fiscal year 2026 budget request and the fiscal year 2025
enacted level.
Basic Support Payments compensate school districts for lost
tax revenue and are made on behalf of Federally connected
children, such as children of members of the uniformed services
who live on Federal property.
Special Education Needs at Impact Aid Schools.--In the
fiscal year 2027 congressional justification, the Committee
requests data and analysis on special education needs at Impact
Aid schools. This includes comparison data on the percentage of
students at Impact Aid schools who receive special education
services versus the percent of such students at non-Impact Aid
schools.
Payments for Children with Disabilities
The Committee provides $49,316,000 for Payments for
Children with Disabilities, which is an increase of $1,000,000
from the fiscal year 2026 budget request and the fiscal year
2025 enacted level.
These payments compensate school districts for the
increased costs of serving Federally connected children with
disabilities.
Facilities Maintenance
The Committee provides $4,835,000 for Facilities
Maintenance, which is the same as the fiscal year 2026 budget
request and the fiscal year 2025 enacted level.
Capital payments are authorized for maintenance of certain
facilities owned by the Department.
Construction
The Committee provides $19,000,000 for the Construction
program, which is the same as the fiscal year 2026 budget
request and the fiscal year 2025 enacted level.
This program provides formula grants for building and
renovating school facilities to school districts that educate
Federally connected students or have Federally owned land.
Payments for Federal Property
The Committee provides $80,000,000 for payments for Federal
property, which is the same as the fiscal year 2026 budget
request and the fiscal year 2025 enacted level.
Funds are awarded to school districts to compensate for
lost tax revenue as the result of Federal acquisition of real
property since 1938.
SCHOOL IMPROVEMENT PROGRAMS
Appropriation, fiscal year 2025..................... $5,776,178,000
Budget request, fiscal year 2026.................... 2,000,000,000
Committee Recommendation............................ 4,840,964,000
Change from enacted level....................... -935,214,000
Change from budget request...................... +2,840,964,000
The School Improvement account includes programs authorized
under Titles I, II, IV, VI, and VII of the ESEA; the McKinney-
Vento Homeless Assistance Act; Title IV-A of the Civil Rights
Act; and section 203 of the Educational Technical Assistance
Act of 2002.
Supporting Effective Instruction State Grants
The Committee does not provide fiscal year 2026 funding for
these formula grants to States. This funding has not been shown
to improve teacher quality or advance student achievement.
Additionally, the Committee notes that according to the
Department's August 2023 report (``State and District Use of
Title II, Part A Funds in 2021-2022''), professional
development was the most popular use of Title II-A funds among
school districts. Seventy-five percent of districts reported
funding professional development for teachers, and 56 percent
of districts reported funding professional development for
principals and other school leaders. Among districts that
invested Title II-A funds in teacher professional development,
78 percent funded topics related to ``content knowledge.'' The
Committee is concerned that school districts are using these
Federal funds to train teachers in divisive ideologies.
For these reasons, the Committee urges the Department to
publish a report on the agency's website on the specific uses
of these funds.
State Assessments
The Committee does not provide funding for this program.
The Committee believes that other sources of educational
funding can cover these activities.
Education for Homeless Children and Youth
The Committee provides $129,000,000 for the Education for
Homeless Children and Youth program, which is $129,000,000
above the fiscal year 2026 budget request and the same as the
fiscal year 2025 enacted level.
Formula grants are allocated to States in proportion to the
total each State receives under the Title I program.
Training and Advisory Services
The Committee does not provide funding for this program.
The Committee is concerned that this funding is used to push
divisive training and ideologies on public school teachers and
other officials by training them how to address racial and
sexual bias in teaching materials, school discipline policies,
and school climates.
Nita M. Lowey 21st Century Community Learning Centers
The Committee provides $1,329,673,000 for the Nita M. Lowey
21st Century Community Learning Centers program, which is
$1,329,673,000 below the fiscal year 2026 budget request and
the same as the fiscal year 2025 enacted level. This program
awards formula grants to States, which in turn distribute funds
on a competitive basis to local school districts, nonprofit
organizations, and other public entities. Funds may be used to
provide activities that complement and reinforce the regular
school-day program for participating students and may also fund
local activities that are included as part of an expanded
learning time program.
The Committee is aware of the unique barriers students with
disabilities face in accessing after-school programs, which
include identifying an appropriate program and experiencing
higher-than-average costs. These barriers prevent students from
experiencing the many benefits of afterschool programs, such as
improved academic performance, social competence, and improved
motor skills. The Committee encourages the Department of
Education to prioritize funds awarded under the Nita M. Lowey
21st Century Community Learning Centers program to applicants
that increase accessibility to high-quality and inclusive
after-school programs for students with disabilities.
The Committee notes there are reports of some States adding
unnecessary barriers to applying and accessing funds through
this program. The Committee encourages the Department to
provide guidance to States to ensure their competitive grant
and reporting process is streamlined, adheres to congressional
intent, is void of additional regulations, and does not
disadvantage rural schools. States should encourage partnership
with non-profit organizations. The Department is directed to
report to the Committee within 180 days of enactment of this
Act on its progress and findings and any additional measures
taken to address the program's overall standards. Such report
shall be made available on the agency's website.
Student Support and Academic Enrichment Grants
The Committee provides $1,385,000,000 for Student Support
and Academic Enrichment State Grants, which is an increase of
$5,000,000 from the fiscal year 2026 budget request and the
fiscal year 2025 enacted level.
The Every Student Succeeds Act eliminated several narrowly
focused competitive grant programs and replaced them with this
formula grant program. States and school districts have
flexibility to focus these resources on locally determined
priorities to provide students with access to a well-rounded
education, including rigorous coursework, and to improve school
conditions and the use of technology.
Rural Education
The Committee provides $225,000,000 for Rural Education
programs, which is an increase of $5,000,000 from the fiscal
year 2026 budget request and the fiscal year 2025 enacted
level.
There are two dedicated programs to assist rural school
districts with improving teaching and learning in their
schools: the Small, Rural Schools Achievement program, which
provides funds to rural districts that serve a small number of
students; and the Rural and Low-Income Schools program, which
provides funds to rural districts that serve concentrations of
poor students, regardless of the number of students served by
the district. Funds appropriated for Rural Education shall be
divided equally between these two programs.
Native Hawaiian Education
The Committee provides $45,897,000 for the Education for
Native Hawaiian program, which is $45,897,000 more than the
fiscal year 2026 budget request and the same as the fiscal year
2025 enacted level. These funds are used to provide competitive
grants for supplemental education services to the Native
Hawaiian population.
The Committee is supportive of resources to public
elementary and secondary schools that serve Native Hawaiian
students, including activities for construction, renovation,
and modernization of any public elementary school, secondary
school, or structure related to a public elementary school or
secondary school, as authorized under part B of Title VI. The
Committee encourages the Department to prioritize funding to
organizations with construction needs that have experience
providing supplemental education services to Native Hawaiian
children and youth. In addition, the Committee continues to
support the Native Hawaiian Education Council.
Alaska Native Education
The Committee provides $44,953,000 for the Alaska Native
Education program, which is $44,953,000 more than the fiscal
year 2026 budget request and the same as the fiscal year 2025
level. These funds are used to provide competitive grants for
supplemental education services to the Alaska Native
population.
Comprehensive Centers
The Committee does not provide funding for this program.
The Committee is concerned that the Department is providing
technical assistance via comprehensive centers on social and
emotional learning rather than on efforts to improve academic
achievement.
SAFE SCHOOLS AND CITIZENSHIP EDUCATION
Appropriation, fiscal year 2025....................... $457,000,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 190,000,000
Change from enacted level......................... -267,000,000
Change from budget request........................ +190,000,000
This appropriation account includes programs authorized
under parts of Title IV of the ESEA.
Promise Neighborhoods
The Committee does not provide funding for these
competitive grants, which is the same as the fiscal year 2026
budget request and $91,000,000 below the fiscal year 2025
enacted level.
The Committee notes that this program provides neighborhood
social services such as healthcare, counseling, and job
training that are duplicative of other free and subsidized
government programs that serve the same population. The
Committee believes the core role of the Department should be to
support schools and districts in educating children in areas
such as reading, writing, and math. The Committee also believes
that these initiatives to broaden the role and influence of
schools in a child's upbringing, in some cases, can present a
negative impact on parental rights and decrease parental
responsibility.
School Safety National Activities
The Committee provides $190,000,000 for the School Safety
National Activities program, which is $190,000,000 below the
fiscal year 2026 budget request and $26,000,000 below the
fiscal year 2025 enacted level.
The Committee's recommendation provides up to $10,000,000
for the Project School Emergency Response to Violence (Project
SERV) program, which is an increase of $5,000,000 from the
fiscal year 2025 enacted level. The Project SERV program
provides counseling and referral to mental health services as
well as other education-related services to LEAs and
Institutions of Higher Education (IHEs) in which the learning
environment has been disrupted by a natural disaster or violent
crisis.
The Committee notes that funds made available through the
Bipartisan Safer Communities Act (P.L. 117-159), for the
Stronger Connections Grant program may be used for information
technology to improve the safety of the school environment in
high need LEAs, including LEAs in rural and geographically
underserved areas. Guidance documentation published by the
Department also includes information regarding other related
eligible uses of funds including equipment and minor
remodeling.
Grants to Schools for Federal Law Enforcement Training.--
The Committee recognizes that highly trained School Resource
Officers (SROs) play a crucial role in ensuring the safety and
well-being of students, faculty, and staff within K-12 schools.
Their specialized training equips them with the skills to
effectively handle various situations, including emergencies,
conflicts, and other potential threats. Beyond security, SROs
also serve as mentors, mediators, and positive role models,
fostering a sense of trust and community within schools.
However, many K-12 schools do not have the necessary funding
available to provide continued training to their SROs. As such,
the Committee provides $20,000,000 for a new competitive grant
program for K-12 schools to provide SROs with enhanced training
at the Federal Law Enforcement Training Centers (FLETC). The
FLETC offers a variety of training courses that focus on
maintaining a safe K-12 school environment. These types of
specialized training are vital in supporting the unique,
important, and varied roles that SROs must fulfill to ensure
the safety and well-being of K-12 school communities. The
Committee directs the Department to provide a briefing within
90 days of enactment of this Act to the Committee on its plans
for carrying out these competitive grants. In addition, the
Committee directs the Department to provide notice to the
Committee at least seven days before any notice of funding
opportunity is published or any grantee is announced.
Parental Consent.--The Committee encourages the Department
to provide technical assistance and guidance to School-Based
Mental Health Services grantees to ensure that they are
following all applicable district, State, and Federal laws and
policies regarding parental consent.
Rural Grant Applications.--The Committee is concerned with
the difficulties that underserved and rural communities face by
accessing and applying for Federal school safety grants. The
Committee encourages the Department to prioritize technical
assistance to rural and underserved grant applicants.
School Infrastructure.--The Committee provides $20,000,000
for a new competitive grant program to help schools implement
best practices to improve school safety. This includes several
things that were recommended in the Department of Justice's
January 18, 2024, report, ``Critical Incident Review: Active
Shooter at Robb Elementary School,'' such as updated doors and
locks that can be locked from the inside, metal detectors, or
other deterrent measures; wi-fi to ensure emergency alerts are
received in a timely manner; universal master key access boxes;
school resource officers and security personnel; and training
and preparedness exercises coordinated between students, school
personnel, local law enforcement and first responders, and
local government agencies. The Committee directs the Department
to provide a briefing within 90 days of enactment of this Act
to the Committee on its plans for carrying out these
competitive grants. In addition, the Committee directs the
Department to provide notice to the Committee at least seven
days before any notice of funding opportunity is published or
any grantees for a new competition are announced.
School Safety Grant Application Feedback.--The Committee
acknowledges the challenges that urban and rural school
districts encounter when applying for federal funding for
school safety-related grants. The Committee encourages the
Department to provide applicants with a detailed explanation of
any grant denials and explicit feedback on grant applications
within 30 days of the announcement of awardees.
Student Mental Health Grants.--The Committee provides
$25,000,000 for the Mental Health Services Professional
Demonstration Grants program. The Committee also provides
$25,000,000 for the School-Based Mental Health Services Grants
program with the requirements established in the explanatory
statement accompanying P.L. 116-94, including that no less than
50 percent of grants support LEA recipients, that awards
include a 25 percent match from grantees, and that the awards
do not supplant existing mental health funding. The Committee
notes that the Bipartisan Safety and Communities Act (P.L. 117-
159) provides $100,000,000 each fiscal year over fiscal years
2022-2026 to support each program. The Department is directed
to provide quarterly obligation and expenditure reports to the
Committee for each program funded in such Act.
Full Service Community Schools
The Committee does not provide funding for Full-Service
Community Schools program, which is the same as the fiscal year
2026 budget request and a decrease of $150,000,000 from the
fiscal year 2025 enacted level. This program makes competitive
grants to support comprehensive school-based services for
students, families, and communities, such as mental health and
nutrition services.
The Committee believes the core role of the Department
should be to support local school districts in educating
children in areas such as reading, writing, and math. Some of
the services provided by community schools are duplicative of
other free and subsidized government programs that serve the
same population.
Indian Education
Appropriation, fiscal year 2025....................... $194,746,000
Budget request, fiscal year 2026...................... 194,746,000
Committee Recommendation.............................. 199,746,000
Change from enacted level......................... +5,000,000
Change from budget request........................ +5,000,000
This account supports programs authorized by part A of
title VI of the ESEA.
The Office of Elementary and Secondary Education has
recognized that the Federal government has a unique political
and legal relationship with Federally recognized Indian Tribes
and has committed to continuing to deliver on all statutory
grant programs that support American Indian, Alaska Native, and
Native Hawaiian students. Over 90 percent of AI/AN students
attend public schools, and the dedicated funds to serve this
population are an essential part of meeting our Federal trust
and treaty obligations to Tribal nations.
Grants to Local Educational Agencies
The Committee provides $110,381,000 for Grants to Local
Educational Agencies, which is the same as the fiscal year 2026
budget request and the fiscal year 2025 enacted level. This
program provides formula grants to school districts and schools
supported or operated by the Bureau of Indian Education. The
purpose of this program is to improve elementary and secondary
school programs that serve American Indian students, including
preschool children. Grantees must develop a comprehensive plan
and ensure that the programs they carry out will help American
Indian students reach the same challenging standards that apply
to all students. This program supplements the regular school
program to help American Indian children sharpen their academic
skills, bolster their self-confidence, and participate in
enrichment activities that would otherwise be unavailable.
Special Programs for Indian Children
The Committee provides $72,000,000 for Special Programs for
Indian Children, which is the same as the fiscal year 2026
budget request and the fiscal year 2025 enacted level. These
programs make competitive grants to improve the quality of
education for American Indian students.
National Activities
The Committee provides $17,365,000 for National Activities,
which is an increase of $5,000,000 from the fiscal year 2026
budget request and the fiscal year 2025 enacted level.
Funds under this authority support: (1) research,
evaluation, and data collection to provide information about
the educational status of Indian students and the effectiveness
of Indian education programs; (2) grants to support Native
language immersion schools and programs; and (3) grants to
Tribes for education administrative planning, development, and
coordination.
Native American Language Programs.--Within the amount for
national activities, the Committee includes not less than
$5,000,000 for language immersion programs authorized by
section 803C(b)(7)(A)(c) of the Native American Programs Act,
as amended by the Esther Martinez Native American Language
Preservation Act of 2006.
Native American Language Resource Centers.--Within the
amount for national activities, the Committee provides no less
than $3,500,000 to support American Indian, Alaska Native, and
Native Hawaiian language activities for the Native American
Language Resource Center program established in the explanatory
statement accompanying the Department of Education
Appropriations Act, 2022.
State-Tribal Education Partnerships.--Within the amount for
national activities, the Committee provides no less than
$4,000,000 to State-Tribal Education Partnerships. This program
is designed to improve educational opportunities and
achievement for Indian students. The program focuses on
promoting Tribal self-determination in education, improving
academic outcomes, and fostering collaboration between Tribal,
State, and local educational agencies.
INNOVATION AND IMPROVEMENT
Appropriation, fiscal year 2025....................... $1,115,000,000
Budget request, fiscal year 2026...................... 500,000,000
Committee Recommendation.............................. 891,000,000
Change from enacted level......................... -224,000,000
Change from budget request........................ +391,000,000
This appropriation account includes programs authorized
under portions of Titles II and IV of the ESEA.
Civics Knowledge.--The Committee is aware of interests in
increasing Americans' knowledge of foundational civics matters
including the structure of the U.S. government and
constitutional ideas. The 2022 NAEP Civics Assessment found
that average civics scores in eighth grade remained below the
proficient level, and they had decreased by two points since
2018. Moreover, the scores had not changed significantly since
the assessment began in 1998. The Committee highlights the
Department's announcement of a grant program for IHEs and
organizations, to support seminars that examine integral
elements of the American constitutional government and American
history as well as commemorate the 250th anniversary of the
nation's founding. Further, the Committee encourages efforts by
IHEs to strengthen civics knowledge and understanding.
American History and Civics Academies
The Committee provides $3,000,000 for this program, which
is the same as the fiscal year 2025 enacted level.
This program supports academies for teachers and high
school students to strengthen their knowledge on American
history, Civic, and government education.
American History and Civics National Activities
The Committee provides $20,000,000 for this program, which
is the same as the fiscal year 2025 enacted level.
National Activities grants promote evidence-based
instructional methods and professional development programs in
American history, civics and government, and geography,
particularly those methods and programs that benefit students
from low-income backgrounds and underserved students. Grant
projects may include civic engagement activities and
educational programs on the history and principles of the
Constitution and Bill of Rights. The Department makes
competitive grants to institutions of higher education and
other nonprofit or for-profit organizations with demonstrated
expertise.
Teacher and School Leader Incentive Grants
Due to funding constraints, the Committee does not provide
funding for these competitive grants.
Supporting Effective Educator Development
The Committee does not provide funding for these
competitive grants. The Committee is unaware of research
demonstrating that these grants have improved teacher quality
or student achievement.
Charter Schools Grants
The Committee provides $500,000,000 for Charter School
Program (CSP) Grants, which is the same as the fiscal year 2026
budget request and an increase of $60,000,000 from the fiscal
year 2025 enacted level.
The Charter Schools Grants program awards competitive
grants to State Educational Agencies (SEAs) or, if a State's
SEA chooses not to participate, to charter school developers to
support the development and initial implementation of public
charter schools. State Facilities Incentive Grants and Credit
Enhancement for Charter School Facilities awards help charter
schools obtain adequate school facilities. These programs work
in tandem to support the development and operation of charter
schools.
Facilities Grants.--The Committee provides an increase of
$5,000,000 for State Charter School Facilities Incentive Grants
and the Credit Enhancement for Charter School Facilities
Program. The Committee is supportive of construction and
renovation of charter school facilities, including storm
shelters, safe rooms, and other infrastructure improvements
such as fortified roof and wall construction to improve
windstorm, tornado, and hurricane resilience.
Magnet Schools Assistance
The Committee provides $139,000,000 for this program, which
is $139,000,000 above the fiscal year 2026 budget request and
the same as the fiscal year 2025 enacted level. This program
makes competitive grants to support the establishment and
operation of magnet schools that are a part of a court-ordered
or Federally-approved voluntary desegregation plan.
Ready to Learn Television Programming
The Committee does not provide funding for these
competitive grants, which is the same as the fiscal year 2026
budget request and $31,000,000 below the fiscal year 2025
enacted level. This program supports the development and
distribution of educational video programming for preschool and
elementary school children and their parents, caregivers, and
teachers. The Committee has chosen to prioritize funding for
local school districts to improve student outcomes in the core
curriculum of writing, reading comprehension, and math.
Arts in Education
The Committee does not provide funding for these
competitive grants, which is the same as the fiscal year 2026
budget request and $36,500,000 below the fiscal year 2025
enacted level. The Committee believes that considering the
continued decline of public-school performance and student
achievement across the country, funding provided by the
Department should be focused on core education such as reading,
writing, and math.
Javits Gifted and Talented Education
The Committee does not provide funding for these
competitive grants, which is the same as the fiscal year 2026
budget request and $16,500,000 below the fiscal year 2025
enacted level. The Committee is concerned that the Department's
prior focus on equity within the gifted and talented program
further divides American students and leaves them less prepared
to compete in a challenging global economy. The Committee
believes this program should be merit based.
Statewide Family Engagement Centers
The Committee does not provide funding for these
competitive grants, which is the same as the fiscal year 2026
budget request and $20,000,000 below the fiscal year 2025
enacted level. The Committee is concerned that despite the
millions of dollars appropriated for these grants in recent
years, there is no evidence that the grants have fostered
trusting relationships between families and schools.
Education Innovation and Research
The Committee provides $229,000,000 for the Education
Innovation and Research (EIR) program, which is $229,000,000
above the fiscal year 2026 budget request and $30,000,000 below
the fiscal year 2025 enacted level. This program makes
competitive grants to support the replication and scaling-up of
evidence-based education innovations.
Grant Priorities.--The Committee notes there is significant
demand from the field to test many types of strategies and to
examine promising techniques that can be scaled up in different
settings. The Committee encourages the Department to continue
to support diverse and field-initiated interventions, rather
than a single nationwide program or award focused solely on one
area of educational innovation.
Publicizing Research Findings.--The Committee continues to
be supportive of efforts by the Department to publicize
research findings from the EIR program as described in House
Report 117-96. The Committee encourages the Department to take
additional steps to publicly release, widely publicize, and
support the use of research findings from this critical program
and its predecessor, the Investing in Innovation program, to
stakeholders at the Federal, State, and local levels. The
Committee specifically encourages the Department to showcase
those programs that have demonstrated, through rigorous
research as required by the ESEA, that their innovations show
specific evidence of achievement in educational outcomes. The
Committee directs the Department to submit a report to the
Committee no later than 120 days after enactment of this Act,
with an update on the Department's goals, outcome measures, and
corrective measures for achieving the widest possible
dissemination and use of this information in SEA and LEA
decision making.
Rural Set-Aside.--The Committee supports the required 25
percent set-aside within the EIR program for rural areas and
encourages the Department to invest in rural, high-need
communities by ensuring grants are awarded to a diverse set of
institutions, affecting varied geographic locations, including
areas with substantial minority students, which have submitted
high-quality applications meeting EIR program requirements.
School Readiness.--The Committee encourages the Department
to support EIR awards that promote evidence-based school
readiness programming in preschool, elementary, and secondary
education.
STEM and Computer Science Grants.--In addition, within the
total for EIR, the Committee provides $90,000,000 for STEM
education, including computer science.
Technology Access and Engagement.--The Committee recognizes
that STEM workforce shortages in emerging sectors are
increasing at an alarming rate and that K-12 schools can be a
critical pipeline in recruiting younger people into key
industry sectors. The Committee also recognizes that providing
learning experiences to students that incorporate innovative
technologies, such as mobile education technology labs and
industry-aligned curriculum and experiences, improves STEM
learning outcomes and equips students with vital skills for
high demand STEM fields. The Committee encourages the
Department to facilitate technology-focused experiences that
strengthen STEM education and employment opportunities for
students living in underserved or economically disadvantaged
areas.
Tutoring.--The Committee notes the importance of high-
dosage tutoring in accelerating student learning and supporting
student success. As States and districts are implementing and
scaling up tutoring programs aligned with research-based
components, the Committee encourages the Department to support
high-dosage tutoring through new EIR awards.
Office of English Language Acquisition
ENGLISH LANGUAGE ACQUISITION
Appropriation, fiscal year 2025....................... $890,000,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. - - -
Change from enacted level......................... -890,000,000
Change from budget request........................ - - -
Due to funding constraints, the Committee does not provide
funding for these formula and competitive grants.
Office of Special Education and Rehabilitative Services
SPECIAL EDUCATION
Appropriation, fiscal year 2025....................... $15,467,264,000
Budget request, fiscal year 2026...................... 15,467,264,000
Committee Recommendation.............................. 15,493,264,000
Change from enacted level......................... +26,000,000
Change from budget request........................ +26,000,000
These grants help States and localities pay for a free,
appropriate education for students with disabilities aged 3
through 21.
Teachers of Blind or Visually Impaired Children.--The
Committee encourages the Department to support continuing
education opportunities for teachers of blind or visually
impaired children, enrichment projects to improve the capacity
of blind or visually impaired children to learn and live
independently, programs within institutions of higher education
for the preparation of teachers of children who are blind or
visually impaired, and facilitate cooperation with nonprofit
organizations with expertise and experience serving children
who are blind or visually impaired.
Intervener Services.--The Committee encourages the
Department to make technical assistance available to SEAs and
LEAs in matters related to supporting students who are
deafblind to address the unique needs of these students. In
addition, the Committee encourages the Department to assist
SEAs and LEAs seeking to facilitate the availability of
intervener services at State and local levels, so students who
are deafblind have access to information, communication, and
interaction in educational environments.
Grants to States
The Committee provides $14,233,704,000 for Part B Grants to
States, which is $657,560,000 below the fiscal year 2026 budget
request and an increase of $20,000,000 from the fiscal year
2025 enacted level.
This program provides formula grants to assist States in
meeting the costs of providing special education and related
services to children with disabilities. States generally
transfer most of the funds to LEAs; however, they can reserve
some funds for program monitoring, technical assistance, and
other related activities. To be eligible for funds, States must
make free appropriate public education available to all
children with disabilities.
The Committee recognizes the central importance of the
Individuals with Disabilities Education Act programs for the
well-being of American schools and youth. This program supports
the most vulnerable students, families, teachers, and schools.
The Committee continues to fund this critical program to ensure
necessary opportunities and support for students.
Preschool Grants
The Committee provides $420,000,000 for Preschool Grants,
which is $420,000,000 above the fiscal year 2026 budget request
and the same as the fiscal year 2025 enacted level.
These funds provide additional assistance to States to help
them make free, appropriate public education available to
children with disabilities aged 3 through 5.
Grants for Infants and Toddlers with Disabilities (Part C)
The Committee provides $540,000,000 for Grants for Infants
and Toddlers with Disabilities, which is the same as the fiscal
year 2026 budget request and the fiscal year 2025 enacted
level.
These funds provide additional assistance to States to help
them make free, appropriate public education available to
children with disabilities from birth through age 2. The
Committee continues bill language to promote the continuity of
services for eligible infants and their families.
IDEA National Activities
The Committee provides $258,560,000 for IDEA National
Activities, which is $258,560,000 more than the fiscal year
2026 budget request and $1,000,000 above the fiscal year 2025
enacted level.
The IDEA National Activities programs support State efforts
to improve early intervention and education results for
children with disabilities.
State Personnel Development.--The Committee provides
$38,630,000 for State Personnel Development, which is
$38,630,000 above the fiscal year 2026 budget request and the
same as the fiscal year 2025 enacted level. This program
supports grants to States to assist with improving personnel
preparation and professional development related to early
intervention and educational and transition services that
improve outcomes for students with disabilities.
Technical Assistance and Dissemination.--The Committee
provides $39,345,000 for Technical Assistance and
Dissemination, which is $39,345,000 above the fiscal year 2026
budget request and the same as the fiscal year 2025 enacted
level. Funding supports technical assistance, demonstration
projects, and information dissemination. These funds support
efforts by State and local educational agencies, IHEs, and
other entities to build State and local capacity to improve
results for children with disabilities.
Personnel Preparation.--The Committee provides $115,000,000
for Personnel Preparation, which is $115,000,000 above the
fiscal year 2026 budget request and the same as the fiscal year
2025 enacted level. This program supports competitive grants to
help address State-identified needs for qualified personnel to
work with children with disabilities, and to ensure that those
personnel have the necessary skills and knowledge to serve
children with special needs. Awards focus on addressing the
need for leadership and personnel to serve low-incidence
populations.
Parent Information Centers.--The Committee provides
$33,152,000 for Parent Information Centers, which is
$33,152,000 above the fiscal year 2026 budget request and the
same as the fiscal year 2025 enacted level. This program makes
awards for parent organizations to support Parent Training and
Information Centers, including community parent resource
centers. These centers provide training and information to meet
the needs of parents of children with disabilities living in
the areas served by the centers, particularly underserved
parents and parents of children who may be inappropriately
identified. Technical assistance is also provided under this
program for developing, assisting, and coordinating centers
receiving assistance under this program.
Educational Technology, Media, and Materials.--The
Committee recommends $32,433,000, which is an increase of
$1,000,000 over the fiscal year 2026 budget request and the
fiscal year 2025 enacted level, for the Educational Technology,
Media and Materials program. This program makes competitive
awards to support the development, demonstration, and use of
technology and educational media activities of value to
children with disabilities. The Committee recognizes the
ongoing progress made with the tools and services provided
under the Educational Technology, Media and Materials program
that have allowed more than 1.1 million students with
disabilities free access to more than 1.36 million books in
digitally accessible formats while creating systemic change in
the publishing industry by equipping publishers with tools and
processes to make their product ``Born Accessible,'' ensuring
all students, with and without disabilities, can use the same
educational materials.
The Committee recognizes that to meet the educational needs
of more students with print disabilities, new investments are
required to develop technology and expand capacity so that the
growing diversity of educational materials, such as teacher
curated educational materials not included in standard
textbooks, are also available to eligible students in a timely
manner. Additionally, the Committee recognizes the benefit of
making more accessible educational materials available to pre-K
and post-secondary students in addition to the K-12 student
population, which requires additional resources and greater
capacity to process and convert a larger volume of educational
materials into accessible formats. The Committee continues
funding for the Educational Technology, Media and Materials
program to support the efforts required to make a broader range
of educational materials available to students and to meet the
needs of all eligible students, including pre-K and
postsecondary students.
Special Olympics Education Programs
The Committee provides $41,000,000 for Special Olympics
Education Programs, which is an increase of $5,000,000 from the
fiscal year 2026 budget request and fiscal year 2025 enacted
level, to support activities authorized by the Special Olympics
Sport and Empowerment Act.
This funding supports efforts to expand Special Olympics
programs and the design and implementation of Special Olympics
education programs that can be integrated into classroom
instruction and are consistent with academic content standards.
REHABILITATION SERVICES
Appropriation, fiscal year 2025....................... $4,533,156,000
Budget request, fiscal year 2026...................... 4,556,413,000
Committee Recommendation.............................. 4,648,295,000
Change from enacted level......................... +115,139,000
Change from budget request........................ +91,882,000
The programs in this account are authorized by the
Rehabilitation Act of 1973 and the Helen Keller National Center
Act.
With the funding provided to Rehabilitation Services, the
Committee urges the Department to update applicable data,
guidance, and policies to be consistent with 41 U.S.C. 8501-
8506; the Rehabilitation Act of 1973, P.L. 93-112; and the
Workforce Innovation and Opportunity Act, Pub. L. 113-78, to
ensure employment through a nonprofit organization
participating in the AbilityOne program is a positive
employment outcome for those who are blind and or disabled.
Vocational Rehabilitation State Grants
This program supports vocational rehabilitation services
through formula grants to States. These grants support a wide
range of services designed to help persons with physical and
mental disabilities prepare for and engage in gainful
employment to the extent of their capabilities. Emphasis is
placed on providing vocational rehabilitation services to
persons with the most significant disabilities.
Randolph-Sheppard Program.--The Committee encourages the
Department to provide participants in the Randolph-Sheppard
program with technical assistance and support in applying for
funding opportunities available under the Office of Special
Education and Rehabilitative Services. In the fiscal year 2027
congressional justification, the Committee requests an update
on such efforts from fiscal year 2025 and planned efforts in
fiscal years 2026 and 2027.
Client Assistance State Grants
The Committee provides $13,000,000 for Client Assistance
State Grants, which is $13,000,000 above the fiscal year 2026
budget request and the same as the fiscal year 2025 enacted
level.
Client Assistance State Grants support services for
eligible individuals and applicants of the vocational
rehabilitation State Grants program, and other programs,
projects, and services funded under the Rehabilitation Act.
These formula grants are used to help persons with disabilities
overcome problems with the service delivery system and improve
their understanding of services available to them under the
Rehabilitation Act.
Training
The Committee provides $29,388,000 for the Training
program, which is $29,388,000 above the fiscal year 2026 budget
request and the same as the fiscal year 2025 enacted level.
The program supports long-term and short-term training, in-
service personnel training, and training of interpreters for
deaf persons. Projects in a broad array of disciplines are
funded to ensure that skilled personnel are available to serve
the vocational needs of persons with disabilities.
Demonstration and Training Programs
The Committee provides $5,796,000 for Demonstration and
Training Programs, which is $5,796,000 above the fiscal year
2026 budget request and the same as the fiscal year 2025
enacted level.
These programs authorize competitive grants to public and
private organizations to support demonstrations, direct
services, and related activities for persons with disabilities.
Protection and Advocacy of Individual Rights
The Committee provides $20,150,000 for Protection and
Advocacy of Individual Rights, which is $20,150,000 above the
fiscal year 2026 budget request and the same as the fiscal year
2025 enacted level.
Grants are awarded to entities that have the authority to
pursue legal, administrative, and other appropriate remedies to
protect and advocate for the rights of persons with
disabilities.
Supported Employment State Grants
The Committee provides $22,548,000 for Supported Employment
State Grants, which is $22,548,000 above the fiscal year 2026
budget request and the same as the fiscal year 2025 enacted
level.
These formula grants assist States in developing
collaborative programs with public agencies and nonprofit
agencies for training and post-employment services leading to
supported employment. In supported employment programs, persons
with the most significant disabilities are given special
supervision and assistance to enable them to work in integrated
settings.
Services for Older Blind Individuals
The Committee provides $33,317,000 for Services for Older
Blind Individuals, which is $33,317,000 above the fiscal year
2026 budget request and the same as the fiscal year 2025
enacted level.
Funds are distributed to States according to a formula
based on the population of individuals who are 55 or older and
provide support for services to persons 55 years old or over
whose severe visual impairment makes gainful employment
extremely difficult to obtain, but for whom independent living
goals are feasible.
Helen Keller National Center
The Committee provides $20,000,000 for the Helen Keller
National Center for DeafBlind Youth and Adults, which is
$1,000,000 above the fiscal year 2026 budget request and the
fiscal year 2025 enacted level.
These funds are used for the operation of a national center
that provides intensive services for deafblind individuals and
their families at Sands Point, New York, and a network of ten
regional offices that provide referral, counseling, transition
services, and technical assistance to service providers.
The Committee recognizes the need to ensure delivery of
high-quality special education and related services to children
and youth who are blind or visually impaired, deaf, hard of
hearing, deaf disabled, or deafblind through specialized
instructional services and methodologies designed to meet their
unique language and learning needs. The Committee also
recognizes the need to support the development of personnel
serving children and youth who are blind or visually impaired,
deaf, hard of hearing, deaf disabled, or deafblind. The
Committee includes an increase of $1,000,000 for grants to
provide support to eligible deafblind schools, or other
applicable entities, to expand the capacity to work with
medically complex students.
SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES
Appropriation, fiscal year 2025....................... $303,292,000
Budget request, fiscal year 2026...................... 303,292,000
Committee Recommendation.............................. 307,292,000
Change from enacted level......................... +4,000,000
Change from budget request........................ +4,000,000
AMERICAN PRINTING HOUSE FOR THE BLIND
Appropriation, fiscal year 2025....................... $43,431,000
Budget request, fiscal year 2026...................... 43,431,000
Committee Recommendation.............................. 44,431,000
Change from enacted level......................... +1,000,000
Change from budget request........................ +1,000,000
This funding supports the production of educational
materials for legally blind persons enrolled in pre-college
programs. The American Printing House for the Blind (APH),
which is chartered by the Commonwealth of Kentucky,
manufactures, and maintains an inventory of educational
materials in accessible formats that are distributed free of
charge to schools and States based on the number of blind
students in each State. The APH also conducts research and
field activities to inform educators about the availability of
materials and how to use them.
The Committee provides $44,431,000 for continued support
and development of assistive technology products and
educational materials for students who are blind or visually
impaired.
Center for Assistive Technology Training.--Within the
amounts provided for APH, the Committee includes up to
$6,000,000, which is the same as the fiscal year 2025 enacted
level, for the Center for Assistive Technology Training,
including regional partnerships to provide instruction and
technical assistance throughout the United States. The
Committee believes training on a national level is essential to
ensure teachers and families have the resources necessary to
fully utilize APH products and technologies.
Monarch.--Within amounts provided for APH, the Committee
includes up to $6,000,000, which is an increase of $1,000,000
from the fiscal year 2025 enacted level, to support production
and distribution of an innovative braille and tactile display
product developed by APH and its partners.
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF (NTID)
Appropriation, fiscal year 2025....................... $92,500,000
Budget request, fiscal year 2026...................... 92,500,000
Committee Recommendation.............................. 94,500,000
Change from enacted level......................... +2,000,000
Change from budget request........................ +2,000,000
Congress established the National Technical Institute for
the Deaf (Institute) in 1965 to provide a residential facility
for postsecondary technical training and education for deaf
persons with the purpose of promoting the employment of these
individuals. The Institute also conducts applied research and
provides training related to various aspects of deafness. The
Secretary of Education administers these activities through a
contract with the Rochester Institute of Technology in
Rochester, New York.
Regional STEM Center.--The Committee includes up to
$9,500,000, which is equal to the fiscal year 2025 enacted
level, to continue NTID's current Regional STEM Center
partnership. The STEM Center program expands NTID's
geographical reach and improves access to postsecondary STEM
education and employment for students who are deaf or hard of
hearing in underserved areas. This has included professional
development for teachers, developing relationships with
business and industry to promote employment opportunities, and
preparing students to be successful in STEM fields.
GALLAUDET UNIVERSITY
Appropriation, fiscal year 2025....................... $167,361,000
Budget request, fiscal year 2026...................... 167,361,000
Committee Recommendation.............................. 168,361,000
Change from enacted level......................... +1,000,000
Change from budget request........................ +1,000,000
Gallaudet University is a private, nonprofit educational
institution Federally chartered in 1864 providing elementary,
secondary, undergraduate, and continuing education for deaf
persons. In addition, the University offers graduate programs
in fields related to deafness for deaf and hearing students,
conducts research on deafness, and provides public service
programs for deaf persons.
Early Learning Acquisition Project (ELAP).--The Committee
includes $8,500,000, which is equal to the fiscal year 2025
enacted level, to continue the national expansion of ELAP
through the Gallaudet University regional centers, of which the
current partner is a regional center. ELAP supports early
language acquisition for children from birth through age three
who are deaf or hard of hearing. This program also supports
activities to improve early language acquisition training for
early educators, caretakers, and other professionals and allows
Gallaudet to expand and build on its current research in this
area, and test and evaluate interventions in diverse geographic
areas.
Office of Career, Technical, and Adult Education
CAREER, TECHNICAL, AND ADULT EDUCATION
Appropriation, fiscal year 2025....................... $2,181,436,000
Budget request, fiscal year 2026...................... 1,450,000,000
Committee Recommendation.............................. 1,475,000,000
Change from enacted level......................... -706,436,000
Change from budget request........................ +25,000,000
This account includes vocational education programs
authorized by the Carl D. Perkins Career and Technical
Education Act of 2006, as recently reauthorized by the
Strengthening Career and Technical Education for the 21st
Century Act, and the Adult Education and Family Literacy Act.
The Committee supports skilled workforce education in
schools and recognizes what it brings to America's skilled
professions through educating a new generation of pride,
progress, and professionals.
The Committee notes Congress' intent for Perkins funding to
provide career and technical education for the ``middle
grades,'' which may include 5th and 6th graders in some States.
Where applicable, the Committee supports efforts to limit
barriers of Federal support not reaching all eligible
populations.
Dual Enrollment.--The Committee urges the Department to
recommend pathways to expand dual enrollment for technical
work, such as welding and shop class, and encourages the
Department to offer additional technical assistance to schools
to support this use.
Career and Technical Education: State Grants
The Committee provides $1,464,848,000 for Career and
Technical Education (CTE) State Grants, which is an increase of
$25,000,000 from the fiscal year 2026 budget request and the
fiscal year 2025 enacted level.
State Grants support a variety of career and technical
education programs developed in accordance with a State's
submitted plan. This program focuses Federal resources on
institutions with high concentrations of low-income students.
The populations assisted by State Grants range from secondary
students in prevocational courses to adults who need retraining
to adapt to changing technological and labor markets.
Career and Technical Education: National Programs
The Committee provides $10,152,000 for National Programs,
which is the same as the fiscal year 2026 budget request and a
decrease of $2,269,000 from the fiscal year 2025 enacted level.
This program supports the conduct and dissemination of research
in career and technical education.
Adult Education State Grants
The Committee does not provide funding for Adult Basic and
Literacy Education State Grants, which is the same as the
fiscal year 2026 budget request and $715,455,000 below the
fiscal year 2025 enacted level. State formula grants,
authorized under the AEFLA, support programs to enable adults
to acquire basic literacy skills, to enable those who so desire
to complete secondary education, and to make available to
adults the means to become more employable, productive, and
responsible citizens.
Due to funding constraints, the Committee has focused
limited resources on programs working directly with local
school districts.
Adult Education National Leadership Activities
The Committee does not provide funding for National
Leadership Activities, which is the same as the fiscal year
2026 budget request and $13,712,000 below the fiscal year 2025
enacted level. This program supports applied research,
development, dissemination, evaluation, and program improvement
efforts to strengthen the quality of adult education services.
Due to funding constraints, the Committee has focused
limited resources on programs working directly with local
school districts.
Office of Postsecondary Education
HIGHER EDUCATION
Appropriation, fiscal year 2025....................... $3,080,952,000
Budget request, fiscal year 2026...................... 949,671,000
Committee Recommendation.............................. 2,714,241,000
Change from enacted level......................... -366,711,000
Change from budget request........................ +1,764,570,000
Aid for Institutional Development
Strengthening Institutions
The Strengthening Institutions program under Part A of
title III of the HEA supports competitive grants for general
operating subsidies to institutions with below average
educational and general expenditures per student and
significant percentages of low-income students. Funds may be
used for faculty and academic program development, management,
joint use of libraries and laboratories, acquisition of
equipment, and student services.
The Committee provides $107,070,000 for the Strengthening
Institutions program, which is $5,000,000 below the fiscal year
2024 enacted level.
Developing Hispanic-Serving Institutions
The Committee provides $228,890,000 for the Developing
Hispanic-Serving Institutions (HSI) program, which is the same
as the fiscal year 2025 enacted level.
The Developing HSIs program provides operating subsidies to
schools that serve at least 25 percent Hispanic students. Funds
may be used for faculty and academic program development,
management, joint use of libraries and laboratories,
acquisition of equipment, and student services.
Hispanic-Serving Institutions Support.--The Committee
requests an update in the fiscal year 2027 congressional
justification on the Department's activities and efforts
related to supporting HSIs.
New Hispanic-Serving Institutions.--The Committee
encourages the Department to provide technical assistance to
newly designated HSIs on Federal resources and grants available
to them.
Promoting Postbaccalaureate Opportunities for Hispanic Americans
The Committee provides $27,451,000 for the Promoting
Postbaccalaureate Opportunities for Hispanic Americans program,
the same as the fiscal year 2025 enacted level. This program
provides expanded postbaccalaureate educational opportunities
for the academic attainment of Hispanic and low-income
students. In addition, it expands academic offerings and
enhances program quality at IHEs educating the majority of
Hispanic college students.
Hispanic-Serving Institutions Funding.--The Committee
directs that no funds provided in this Act may be used to
freeze, delay, or cancel funding for Hispanic-Serving
Institutions. The Committee further expects the Department to
distribute funds in a timely manner to ensure continuity of
support for HSIs.
Strengthening Historically Black Colleges and Universities
The Committee provides $406,966,000 for Strengthening
Historically Black Colleges and Universities (HBCUs), which is
$6,000,000 more than the fiscal year 2025 enacted level. This
program provides operating subsidies to accredited HBCUs that
were established prior to 1964, with the principal mission of
educating Black Americans. Funds are distributed through a
formula grant based on the enrollment of Pell Grant recipients,
number of graduates, and the number of graduates entering
graduate or professional schools in which Black students are
underrepresented.
The Committee seeks to support educational opportunities
for students at these schools. The Committee is aware that many
students choose to pursue their academic and career goals by
enrolling in programs offered by two-year HBUCs. These students
may attain an associate's degree or other certification and
enter the workforce directly or choose to transfer to complete
a bachelor's degree at a four-year IHE. The Committee
recognizes the important role of two-year HBCUs, given that
community colleges can provide students with opportunities to
more quickly and affordably obtain the learning and skills
required for their chosen field. The Committee continues
language providing supplemental awards to junior or community
colleges that are eligible under the Historically Black
Colleges and Universities program.
Reducing Recidivism.--The Committee supports the
Department's coordination and collaboration with Historically
Black Colleges and Universities to provide educational programs
for individuals engaged with the criminal justice system, to
assist them in obtaining skills that will help them
successfully transition back into their communities.
Strengthening Historically Black Graduate Institutions
The Committee provides $101,286,000 for the Strengthening
Historically Black Graduate Institutions program, which is the
same as the fiscal year 2025 enacted level. The program
provides five-year grants to postsecondary institutions that
are specified in section 326(e)(1) of the HEA. Institutions may
use funds to build endowments, provide scholarships and
fellowships, and to assist students with the enrollment and
completion of postbaccalaureate and professional degrees.
Strengthening Predominantly Black Institutions
The Committee provides $22,412,000 for the Strengthening
Predominantly Black Institutions (PBIs) program, which is the
same as the fiscal year 2025 enacted level. This program
provides grants to PBIs to increase their capacity to serve the
academic needs of students.
Strengthening Asian American and Native American
Pacific-Islander-Serving Institutions
The Committee provides $18,682,000 for the Strengthening
Asian American and Native American Pacific-Islander-Serving
Institutions program, which is the same as the fiscal year 2025
enacted level. This program provides grants to undergraduate
institutions that have an undergraduate student enrollment of
at least 10 percent Asian American or Native American Pacific
Islander.
Strengthening Alaska Native and Native Hawaiian-Serving
Institutions
The Committee provides $24,555,000 for the Strengthening
Alaska Native and Native Hawaiian-Serving Institutions program,
which is the same as the fiscal year 2025 enacted level.
Through the Strengthening Alaska Native and Native Hawaiian-
Serving Institutions program, the Department provides grants to
assist institutions of higher education in serving Alaska
Native and Native Hawaiian students.
Strengthening Native American Serving Non-Tribal Institutions
The Committee provides $12,462,000 for the Native American
Serving Non-Tribal Institutions program, which is the
$1,000,000 more than the fiscal year 2025 enacted level. This
program makes grants to IHEs at which enrollment is at least 10
percent Native American students and that are not Tribally
Controlled Colleges or Universities.
Strengthening Tribally Controlled Colleges and Universities
The Committee provides $56,807,000 for the Strengthening
Tribally Controlled Colleges and Universities (TCCUs) program,
which is $5,000,000 more than the fiscal year 2025 enacted
level. This program makes grants to TCCUs to increase their
capacity to serve the academic needs of students.
Strengthening HBCU Masters Program
The Committee provides $20,037,000 for the Strengthening
HBCU Masters Programs, which is the same as the fiscal year
2025 enacted level. This program provides grants to specified
colleges and universities making a substantial contribution to
graduate education opportunities at the Master's level in
mathematics, engineering, the physical or natural sciences,
computer science, information technology, nursing, allied
health, or other scientific disciplines.
International Education and Foreign Language Studies
Authorized by Title VI of the HEA, these programs include
National resource centers, foreign language and area studies
fellowships, undergraduate international studies and foreign
language programs, international research and studies projects,
business and international education projects, international
business education centers, language resource centers, American
overseas research centers, and technological innovation and
cooperation for foreign information access.
Domestic Programs
The Committee does not include funding for the Domestic
Programs of the International Education and Foreign Languages
Studies program. The Committee prioritizes limited resources
for other programs providing financial aid to students and aid
to institutions and supports efforts by States, localities, and
institutions of higher education to conduct the activities
supported by the Domestic Programs according to their policy
priorities.
Overseas Programs
The Committee does not include funding for the Overseas
Programs. The Committee prioritizes limited resources for other
programs providing financial aid to students and aid to
institutions and supports efforts by States, localities, and
institutions of higher education to conduct the activities
supported by the Overseas Programs according to their policy
priorities.
Model Comprehensive Transition and Postsecondary Programs for Students
With Intellectual Disabilities
The Committee provides $13,800,000 for the Model
Comprehensive Transition and Postsecondary Programs for
Students with Intellectual Disabilities (TPSID) program, which
is the same as the fiscal year 2025 enacted level. TPSID
supports grants to create model transition programs into
postsecondary education for students with intellectual
disabilities.
Minority Science and Engineering Improvement
The Committee provides $16,370,000 for the Minority Science
and Engineering Improvement Program, which is the same as the
fiscal year 2025 enacted level. This program awards grants to
improve mathematics, science, and engineering programs at
institutions serving primarily minority students and to
increase the number of minority students who pursue advanced
degrees and careers in those fields.
Tribally Controlled Postsecondary Career and Technical
Institutions
The Committee provides $15,953,000 for the Tribally
Controlled Postsecondary Career and Technical Institutions
program, which is $4,000,000 more than the fiscal year 2025
enacted level. This program awards competitive grants to
Tribally controlled postsecondary career and technical
institutions to provide career and technical education to
Native American students.
Federal TRIO Programs
The Committee provides $1,191,000,000 for the Federal TRIO
programs, which is the same as the fiscal year 2025 enacted
level. TRIO provides a variety of outreach and support services
to encourage low-income, first-generation college students and
individuals with disabilities to enter and complete college.
Discretionary grants of up to four or five years are awarded
competitively to IHEs and other nonprofit organizations. At
least two thirds of the eligible participants in TRIO must be
low-income, first-generation college students.
The Department is directed to allocate funding for each of
the individual TRIO programs at no less than the following
levels: Talent Search $190,182,000; Upward Bound $380,830,000;
Veterans Upward Bound $22,253,000; Upward Bound Math-Science
$79,614,000; EOCs $59,450,000; Student Support Services
$380,816,000; Ronald E. McNair Postbaccalaureate Achievement
Program $61,357,000; and TRIO Training Grants $4,150,000.
The Department is also directed to ensure that the notices
inviting applications for new awards for the Talent Search and
Educational Opportunity Centers grant competitions are
published no later than December 1, 2025. The Department is
further directed to take steps necessary to issue grant award
notifications for all TRIO programs (both new and non-competing
continuation award notices) no later than June 30, 2026.
Gaining Early Awareness and Readiness for Undergraduate
Programs
The Committee provides $388,000,000 for Gaining Early
Awareness and Readiness for Undergraduate Programs (GEAR UP),
which the same as the fiscal year 2025 enacted level. GEAR UP
provides grants to States and partnerships of low-income middle
and high schools, IHEs, and community organizations to target
entire grades of students and give them the skills,
encouragement, and scholarships to pursue successfully
postsecondary education.
The Committee continues bill language allowing the
Department to maintain the GEAR UP evaluation set-aside at 1.5
percent to work with the GEAR UP community and grantees to
standardize data collection, including through the use of
third-party data systems. Additionally, the Committee continues
to direct the Department to ensure that no request from a State
Grant applicant to receive an exception to the GEAR UP
scholarship (as described in section 404E(b)(2) of the HEA)
shall be denied on the basis of 34 CFR 694.14(c)(3).
Gaining Early Awareness and Readiness for Undergraduate
Programs (GEAR UP) Funding.--The Committee directs that no
funds provided in this Act may be used to freeze, delay, or
cancel funding for GEAR UP. The Committee further expects the
Department to distribute funds without interruption to ensure
the program continues to expand educational opportunity for
lowincome students.
Graduate Assistance in Areas of National Need
The Committee does not provide funding for the Graduate
Assistance in Areas of National Need program. This program
funds fellowships for students pursuing a doctoral degree or
the highest degree in the field available at their institution,
and who are studying in areas considered to be of national
need. The Committee recommendation prioritizes other programs
providing support to students and recognizes that institutions
of higher education or non-Federal sources of postsecondary
funding are alternative sources of support for such graduate
fellowships. The Committee is concerned that the program
performance is not meeting its targets. The target completion
rate for fellows to finish their degree is only 65 percent, but
the actual completion rate in 2023 was 56 percent, down from 63
percent in 2021. Additionally, the program's cost per PhDs and
for students who pass preliminary exams exceeded the target of
$68,0000 in both 2023 and 2021, for which data is most recently
available.
Teacher Quality Partnership Grants
The Committee does not provide funding for the Teacher
Quality Partnerships program. The Committee notes this
program's purpose duplicates those of other Federal programs
related to teacher preparation and development. The Committee
recognizes that K-12 education is inherently local in nature,
and therefore States and districts are most able to be
responsive to needs regarding teacher recruitment and
development in local schools. Therefore, they are best
positioned to make funding decisions for such activities.
Child Care Access Means Parents in School
The Committee does not provide funding for the Child Care
Access Means Parents in School program. The Committee notes
that this program has a duplicative function of programs such
as Head Start and the Child Care and Development Block Grant,
which provide early learning and care programs for low-income
families and for which the Committee has included funding.
Fund for the Improvement of Postsecondary Education
The Committee recommendation includes $47,500,000 for the
Fund for the Improvement of Postsecondary Education.
------------------------------------------------------------------------
Budget Activity FY 2026 Committee
------------------------------------------------------------------------
Increasing Hispanic PhDs Pilot...................... $2,500,000
Rural Postsecondary and Economic Development Grant 45,000,000
Program.............................................
------------------------------------------------------------------------
Increasing Hispanic-Serving Institutions PhDs Pilot.--The
Committee includes $2,500,000 for competitive grants to HSIs or
consortiums of HSIs that award PhDs. The Department is directed
to make awards to at least four institutions of higher
education, as defined by section 101 of the HEA, to support
programs that seek to bolster Ph.D. attainment. Grant priority
will go to institutions with 25 percent or higher Pell
enrollment. Funding should be used to develop and test new
models of cross-institutional partnerships that facilitate the
mutually reinforcing activities such as resource-sharing
learning communities, mentorship programs for PhD students,
graduate research experiences, faculty mentor capacity-
building, and other associated uses.
Rural Postsecondary and Economic Development Grants.--The
Committee provides $45,000,000, the same as the fiscal year
2024 enacted level, for the Rural Postsecondary and Economic
Development Grants (RPED) program. The Committee is aware that
although rural students graduate from high school at rates that
may exceed their urban and suburban peers, they are
significantly less likely than their peers in other areas to
pursue post-secondary education opportunities. The Committee
recognizes that rural-serving institutions and communities face
unique challenges and barriers when compared to their urban and
suburban counterparts. Smaller, rural-serving colleges,
universities and nonprofit organizations may have significantly
fewer staff and less prior experience in preparing to respond
to Federal grant opportunities. The Committee encourages the
Department of Education to consider ways to better support
rural applicants by recognizing the unique challenges facing
rural communities, including but not limited to providing more
flexibility, longer application timelines, and targeted
technical assistance for RPED grants and other funding
opportunities.
Augustus F. Hawkins Centers of Excellence
The Committee continues $15,000,000 for the Hawkins Centers
of Excellence program. The Hawkins program is intended to
support teacher education programs at Minority Serving
Institutions, Historically Black Colleges or Universities,
Historically Black Graduate Institutions, Hispanic-Serving
Institutions, Tribally Controlled Colleges, Alaska Native-
Serving Institutions, Native Hawaiian-Serving Institutions,
Predominantly Black Institutions, Asian American and Native
American Pacific Islander-Serving Institutions, and Native
American-Serving Nontribal Institutions. The program provides
competitive grants for up to five years for IHEs to improve or
expand their teacher education programs through the
establishment of centers of excellence.
HOWARD UNIVERSITY
Appropriation, fiscal year 2025....................... $304,018,000
Budget request, fiscal year 2026...................... 240,018,000
Committee Recommendation.............................. 240,018,000
Change from enacted level......................... -64,000,000
Change from budget request........................ - - -
The Committee provides $240,018,000 for Howard University,
which is $64,000,000 less than the fiscal year 2025 enacted
level. Howard University is a leading research university
located in the District of Columbia and provides undergraduate
liberal arts, graduate, and professional instruction to
students. Of the amounts provided, the Committee recommendation
includes no less than $3,405,000 for the matching endowment
grant, which is the same as the fiscal year 2025 enacted level.
Howard University Hospital.--Within the funds provided for
Howard University, the Committee recommends $13,325,000 for the
Howard University Hospital for ongoing hospital operations,
which is the same as the budget request. The Committee does not
provide additional funding for construction for the new Howard
University Hospital, following appropriations in fiscal years
2021 through 2025 that completed the University's request for
funding to support construction of the new hospital.
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM
Appropriation, fiscal year 2025....................... $298,000
Budget request, fiscal year 2026...................... 298,000
Committee Recommendation.............................. 298,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
Previously, these programs helped to ensure that
postsecondary institutions were able to make necessary capital
improvements to maintain and increase their ability to provide
a high-quality education. Since 1994, no new loans have been
made, and the Department's role has been to manage the
outstanding loans.
HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING PROGRAM
ACCOUNT
Appropriation, fiscal year 2025....................... $20,678,000
Budget request, fiscal year 2026...................... 20,678,000
Committee Recommendation.............................. 20,678,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Committee provides $20,678,000 for the HBCU Capital
Financing program, which is the same as the fiscal year 2025
enacted level. This program is authorized under part D of Title
III of the HEA and makes capital available for repair and
renovation of facilities at HBCUs.
Within the total provided for this program, the Committee
recommendation includes $528,000 for administrative expenses to
carry out the program and $20,150,000 for loan subsidy costs,
which will support an estimated $500,000,000 in new loan volume
in fiscal year 2026.
Office of Federal Student Aid (FSA)
90/10 Rule.--The 90/10 rule under the HEA requires
proprietary IHEs to derive at least 10 percent of their tuition
and fee revenue from non-Title IV sources. Under the prior
Administration, the Department issued a rule in October 2022 to
include other Federal education assistance funds from other
Federal agencies, not just Title IV funds, as required by P.L.
117-2, as well as other changes. The rule was effective July 1,
2023, for institutional fiscal years that begin on or after
January 1, 2023, requiring some institutions to comply as of
January 1, 2023. The Committee is aware that commenters
questioned this timing for compliance and sought clarification
on what statutory authority the Department used as a basis for
that determination. The Committee also notes strong concerns
that the preamble to the rule purported to interpret the rule
to penalize institutions for utilizing distance learning. The
Committee understands that the Department issued an
interpretive rule, ``Classification of Revenue Under Title
IV,'' published in the Federal Register on July 7, 2025,
stating that this preamble language is non-binding, because the
Department did not incorporate it through changes to the
regulatory text. The interpretive rule further rescinded that
non-binding language in the preamble and made clear that the
Department believes ineligible distance education program
revenue may be included in the 90/10 revenue calculation.
Additionally, the Committee encourages efforts by the
Department to provide clear communication and information on
this rule, given its complexities and significant impact on
students and proprietary institutions.
Consolidation Loans.--The Committee is concerned that under
the previous Administration, the Department of Education did
not have adequate processes and safeguards in place to ensure
it upholds the statutory and regulatory requirements regarding
the consolidation of Federal Family Education Loan (FFEL)
Consolidation Loans into the Direct Loan program under the HEA,
and that any incorrect consolidation can adversely impact those
involved including students and student loan organizations. The
HEA permits borrowers who consolidated their loans into a
single Consolidation Loan to receive a subsequent consolidation
loan only under specified circumstances. The Department is
directed to provide an update in the fiscal year 2027
congressional justification on the processes and safeguards in
place to ensure that FFEL Consolidation Loans are consolidated
into the Direct Loan program for a legally permitted purpose.
Federal Financial Aid Fraud.--The Committee is aware of
concerns about fraud in Federal financial aid. The Department
and institutions of higher education have roles related to
flagging potentially fraudulent financial aid applicants and
verifying applicant information, and the Department of
Education's Office of Inspector General investigates reports of
waste, fraud, and abuse. Any fraudulent activity misuses
taxpayer dollars and is unfair to law-abiding individuals and
institutions of higher education. In December 2024, the
Department of Education Office of Inspector General reported
that over fiscal year 2019 through 2024 it closed 128
investigations stemming from institutional fraud, the use of
falsified data for ineligible students, identity theft, and
discharge or repayment fraud. It noted that fraud rings
accounted for a substantial share of these identify theft and
ineligible student cases. OIG reported ways FSA could
strengthen its risk-based verification procedures, monitoring,
and other internal controls to mitigate fraud. Given the
substantial amount of financial aid the Department oversees--
$120.8 billion in grants, loans, and work-study funding
disbursed in fiscal year 2024 alone, according to Federal
Student Aid's annual report--the Committee commends the
Department for its renewed focus on stewarding taxpayer dollars
in Federal financial aid. In June 2025, the Department
announced it will implement new efforts to combat identify
theft and fraud in Federal student aid programs in fall 2025,
as well as require certain verification changes in the near-
term. The Committee requests an update in the fiscal year 2027
congressional budget justification on efforts the Department
has made, including in coordination with IHEs, to mitigate
Federal financial aid fraud.
Public Service Loan Forgiveness.--The Committee appreciates
existing Federal Student Aid reporting on the Public Service
Loan Forgiveness (PSLF) program portfolio, applications, and
processed discharges but remains interested in the fiscal and
distributional impact associated with the program. The
Committee requests a report be provided to the Committee and
the Committee on Education and the Workforce of the House of
Representatives, the Committee on Health, Education, Labor, and
Pensions and the Committee on Appropriations of the Senate
within 120 days of enactment of this Act and published on the
Department's website describing the distributional impact of
the PSLF program. The report shall include information on the
amounts forgiven under PSLF based on borrower characteristics,
which shall include to the extent possible: type of employment,
household income, highest level of degree obtained, and amount
borrowed. The Secretary shall develop employment categories for
purposes of meeting this requirement, which may include using
information from the Department's eligible employer database,
aligning categories with the Bureau of Labor Statistics
standard occupation classification system, or other methods.
Responsiveness to GAO Information Requests.--The Committee
notes that under the prior Administration, the Department of
Education unnecessarily delayed the routine production of
information to GAO in response to GAO information requests
regarding ongoing reviews of the rollout of the simplified Free
Application for Federal Student Aid (FAFSA) (engagement code
107407) and the FAFSA processing system launch (engagement code
107396). This was consistent with the prior Administration's
disastrous rollout of the 2024-25 FAFSA, which caused delays
and confusion among students and their families and
institutions of higher education. Such information is necessary
for GAO to complete its work. Recognizing that the Department
is now under new leadership, the Committee urges FSA to comply
with ongoing and future GAO information requests related to the
two FAFSA reviews, in keeping with GAO's statutory authority to
access agency records under 31 U.S.C. Sec. 716(a). The
Committee encourages GAO to provide the Committee periodic
updates on the Department's responsiveness to GAO's information
requests on the two FAFSA reviews. The Committee requests the
Department include in the fiscal year 2027 congressional
justification the status of any outstanding recommendation, not
fully implemented, from any prior GAO publication.
STUDENT FINANCIAL ASSISTANCE
Appropriation, fiscal year 2025....................... $24,615,352,000
Budget request, fiscal year 2026...................... 22,725,352,000
Committee Recommendation.............................. 23,254,221,000
Change from enacted level......................... -1,361,131,000
Change from budget request........................ +528,869,000
Pell Grants
The Committee provides $22,475,352,000 in discretionary
funding for the Pell Grant program, which is the same as the
fiscal year 2025 enacted level. These funds will support Pell
Grants to students for the 2026-2027 award year.
The Committee recommendation includes $6,335 for the
discretionary portion of the maximum Pell grant award, the same
as the fiscal year 2025 enacted level. Combined with mandatory
funding under current law, this would continue to support a
total maximum award of $7,395 for the 2026-2027 award year.
Pell Grants are the foundation of Federal postsecondary
student aid programs, increasing access to educational and
economic opportunities for lower-income students by providing
need-based financial assistance. Grants are determined
according to a statutory formula, which considers income,
assets, household size, cost of attendance, and full-time or
part-time enrollment status, among other factors.
Second Chance Pell.--The Committee understands that the
FAFSA Simplification Act authorized Federal Pell Grants for
students who are incarcerated and enrolled in a prison
education programs (PEPs), which are offered by eligible IHEs.
The Committee recognizes the value in evaluating outcomes of
such students enrolled in PEPs. The Committee strongly
encourages the Department, in coordination with IHEs offering
PEPs and/or IHEs that participated in the PEP experimental
site, to evaluate the outcomes of such programs on incarcerated
students' enrollment, retention, completion, earnings, and
similar outcomes metrics, and to make such an evaluation
publicly available on the Department's website.
Federal Supplemental Educational Opportunity Grants
The Federal Supplemental Educational Opportunity Grant
(FSEOG) program provides need-based grant aid to eligible
undergraduate students to help reduce financial barriers to
postsecondary education. Federal funding allocations are
awarded to qualifying postsecondary institutions under a
statutory formula. The Committee does not provide funding for
FSEOG. Given limited Federal resources, the Committee
prioritizes funding for other assistance to students, primarily
through the Pell Grant program which is the foundation of
Federal student aid and goes directly to students. The
Committee is aware of concerns that the program's statutory
formula allocates funding in part based on an institution's
historical participation in the program and therefore may not
optimize the delivery of grant aid to institutions with the
greatest shares of students with financial need.
Federal Work Study
The Federal work study (FWS) program provides funds for
part-time employment to help low-income students to finance the
costs of postsecondary education. Students can receive FWS
funds at approximately 3,400 participating postsecondary
institutions. The Committee provides $778,869,000 for this
program, which is $451,131,000 below the fiscal year 2025
enacted level.
The Committee encourages the Department to continue support
in fiscal year 2026 for the Work Colleges program authorized
under section 448 of the HEA at $11,053,000, the same rate
provided in fiscal year 2024.
Marine Environment Opportunities.--The Committee is aware
that FWS jobs are intended to complement or reinforce the
student's educational program or vocational goals as much as
possible, and that a broad range of jobs can be eligible under
the FWS program. FWS community service jobs opportunities, for
example, may include programs focused on animal habitats and
marine environments, including but not limited to the
rehabilitation and the improvement of wildlife habitats, fish
culture, and other fishery assistance. The Committee encourages
such opportunities related to marine science and conservation,
consistent with the FWS program requirements, and notes the
benefits for participants in providing valuable experience in a
students' chosen field, especially to the extent there are
projected increases in workforce demands in such field.
STUDENT AID ADMINISTRATION
Appropriation, fiscal year 2025....................... $2,058,943,000
Budget request, fiscal year 2026...................... 2,058,943,000
Committee Recommendation.............................. 2,058,943,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
Programs administered under the Student Aid Administration
(SAA) include Pell Grants, campus-based aid programs, Teacher
Education Assistance for College and Higher Education grants,
and Federal student loan programs.
Salaries and Expenses
Within the total provided for SAA, the Committee provides
$1,058,943,000 for salaries and expenses, which is the same as
the fiscal year 2024 enacted level.
Servicing Activities
Within the total provided for SAA, the Committee provides
$1,000,000,000 for Loan Servicing Activities, which is the same
as the fiscal year 2024 enacted level.
Borrower Repayment Information.--In monthly briefings to
the Committees and to the Committees on Education and Workforce
of the House of Representatives and on Health, Education,
Labor, and Pensions of the Senate on student aid administrative
activities during fiscal year 2026, the Committee requests the
Department include information related to borrower status,
including on the number of borrowers for whom processing of
income-driven repayment (IDR) applications is paused, updates
on borrower progress related to IDR repayment requirements, and
communications to borrowers regarding such repayment progress.
Free Application for Federal Student Aid (FAFSA).--The
Committee is encouraged by the Department's efforts to minimize
disruptions and ensure proper performance of the 2025-2026
FAFSA process. This progress is welcome after the highly
problematic rollout of the 2024-2025 FAFSA under the prior
Administration, during which financial aid applicants and IHEs
experienced numerous delays and technical problems. The
Committee appreciates the Department's regular communication
with the Committee on administration of the current FAFSA cycle
and looks forward to continued updates, including preparations
for the upcoming 2026-2027 FAFSA.
Reprogramming of Funds.--Any reallocation of funds between
administrative costs and servicing activities within this
account should be treated as a reprogramming of funds, and the
Department is directed to notify the Committee in advance of
any such changes, pursuant to section 516 of this Act.
Return to Repayment.--The Committee commends the Department
for a strong commitment to returning borrowers to repayment.
This is a welcome departure from the irresponsible policies and
unnecessarily tumultuous return to repayment under the prior
Administration. The Committee is aware that many borrowers are
making payments for the first time in several years. In April
2025, the Department stated that out of about 43 million
borrowers, only 38 percent were in repayment and current on
their loans. More than 5 million were in default, having not
made a payment in more than 360 days. Another 4 million were in
late-stage delinquency of nonpayment for 91 to 180 days. The
Department projected that potentially 10 million borrowers
could be in default within a few months, which would amount to
about 1 in four borrowers in the portfolio being in default.
The new Administration is charged with fixing the problems left
by the prior Administration, and the Committee is encouraged by
the Department's efforts to responsibly steward the student
loan program. The Committee underscores the Department's
efforts to provide clear communication to borrowers, including
assisting them in how to become current on their loans and
avoid default. As the Department undertakes this important work
the Committee directs the Department to continue providing
monthly briefings to the Committees on Appropriations,
Education and Workforce, and Health, Education, Labor, and
Pensions on progress related to Federal student loan servicing
and repayment. The Committee also encourages the Department to
provide periodic updates to the Committee regarding the
performance of the Unified Servicing and Data Solution (USDS).
Spend Plans.--The Committee directs the Department to
provide a detailed spend plan of the planned uses of funds in
this account for fiscal year 2026, within 45 days of enactment
of this Act, and to provide quarterly updates on this plan no
later than 10 days prior to the start of such quarter. This
shall include contracts awarded, change orders, bonuses paid to
staff, reorganization costs, and any other activity carried out
using amounts provided under this heading for fiscal year 2026.
The Department is encouraged to provide a comparison to the
prior fiscal year in such spend plan, as well as include a
description of planned activities and any notable comparisons
to the prior fiscal year. Such spend plans should include
details of major activities, including the Unified Servicing
and Data Solution and initiatives related to the implementation
of recent legislation, as applicable.
Institute Of Education Sciences
INSTITUTE OF EDUCATION SCIENCES
Appropriation, fiscal year 2025....................... $793,106,000
Budget request, fiscal year 2026...................... 261,300,000
Committee Recommendation.............................. 740,373,000
Change from enacted level......................... -52,733,000
Change from budget request........................ +479,073,000
This account supports education research, statistics,
dissemination, evaluation, and assessment activities.
Research, Development, and Dissemination
The Committee provides $245,000,000 for Research,
Development, and Dissemination, which is $245,000,000 above the
fiscal year 2026 budget request and the same as the fiscal year
2025 enacted level.
This account supports research, development, and national
dissemination activities that are aimed at expanding
fundamental knowledge of education and promoting the use of
research and development findings in the design of efforts to
improve education.
Innovative Learning Model Development Program.--To ensure
students maximize their potential and meet the needs of the
21st century economy, a portion of these funds should be
directed to support a new funding opportunity to develop
innovative learning models that improve student outcomes.
Innovative learning models are bundles of integrated tools,
resources, systems, and teaching practices that enable schools
to provide their students with individualized learning
experiences through different learning modalities. The Director
shall make awards for both early-phase and mid-phase
development, implementation, feasibility testing, and rigorous
evaluation of an innovative learning model. Eligible entities
for the award include innovative learning model providers that
partner with schools and school communities to support the
implementation of such models, while sharing accountability for
student outcomes. The Committees direct IES to provide a
briefing on plans for making new awards not less than two weeks
before the publication of a funding opportunity notice. In
addition, the IES shall provide a briefing and notice of awards
to the Committees at least seven days before grantees are
announced.
National Center for Special Education Research.--The
Committee supports the National Center for Special Education
Research, which provides high quality and rigorous research on
special education and related services on the full range of
issues facing children with disabilities, parents of children
with disabilities, and school personnel. Research findings help
inform interventions, teaching strategies, and other critical
factors in educating children with disabilities.
Statistics
The Committee provides $122,500,000 for the activities of
the National Center for Education Statistics (NCES), which is
$1,000,000 above the fiscal year 2026 budget request and the
fiscal year 2025 enacted level.
Statistics activities are authorized under Title I of the
Education Sciences Reform Act of 2002. NCES collects, analyzes,
and reports statistics on all levels of education in the U.S.
Activities are carried out directly and through grants and
contracts and include projections of enrollments, teacher
supply and demand, and educational expenditures. NCES also
provides technical assistance to State and local educational
agencies and postsecondary institutions.
Civics Assessment.--The Committee requests an update from
NCES and the National Assessment Governing Board on the plans,
budgetary requirements, and timeline for the National
Assessment of Educational Progress Civics Assessment in the
fiscal year 2027 congressional justification.
Legacy Status.--The Committee notes interest in promoting
merit in college admissions. The Committee further notes the
lack of data available regarding legacy status--the
relationship to institution alumni--and first-time, first-year,
degree-seeking admissions decisions. Starting with the 2022-
2023 Integrated Postsecondary Education Data System (IPEDS)
admission surveys, NCES began to ask if IHEs consider legacy
status. The Committee encourages NCES to consider collecting
data on applications, admission, and enrollments by applicants
with legacy status at institutions eligible to participate in
Title IV programs under the HEA and those IHEs that also
provide legacy preferences according to their IPEDS response.
School Cellphone Bans.--The Committee directs NCES to study
and issue a report on cell phone use in schools and any
policies that limit cell phone use in K-12 schools, and any
correlation between phone use and student academic achievement.
The Committee provides an increase of $1,000,000 for this
purpose.
Regional Educational Laboratories
The Committee does not provide funding for this program.
The Regional Education Laboratories support dissemination and
technical assistance activities that are duplicative of
existing investments in areas of training, technical
assistance, and professional development to build State
capacity to provide high-quality education. States can use
Title I funds to pay for these services directly. States may
reserve funds under Title I that may be used to obtain needed
technical assistance, and LEAs are not limited in the amount of
Title I funds that may be used for reasonable and necessary
technical assistance services related to the effective
implementation of Title I program requirements.
Research in Special Education
The Committee provides $64,255,000 for Research in Special
Education, which is same as the fiscal year 2025 enacted level.
This program supports competitive grants to produce and
advance the use of knowledge to improve services and results
for children with disabilities. The program focuses on
producing new knowledge, integrating research and practice, and
improving the use of knowledge.
National Center for Special Education Research.--The
Committee supports the National Center for Special Education
Research, which provides high quality and rigorous research on
special education and related services on the full range of
issues facing children with disabilities, parents of children
with disabilities, and school personnel. Research findings help
inform interventions, teaching strategies, and other critical
factors in educating children with disabilities.
Special Education Studies and Evaluations
The Committee provides $13,318,000 for Special Education
Studies and Evaluations, which is the same as the fiscal year
2025 enacted level.
This program awards competitive grants, contracts, and
cooperative agreements to assess the implementation of the IDEA
and the effectiveness of State and local efforts to provide
special education and early intervention programs and services
to infants, toddlers, and children with disabilities.
Statewide Longitudinal Data Systems
The Committee provides $28,500,000 for this program, which
is $28,500,000 below the fiscal year 2026 budget request and
the same as the fiscal year 2025 enacted level. These
competitive grants are awarded to States to design and maintain
longitudinal data systems.
Strengthening Data Privacy.--The Committee directs the
Secretary, in conjunction with the Secretary of Labor, to
provide guidance and technical assistance on integrated data
systems and student and worker privacy. This guidance should
build on and expand the guidance issued by the Privacy
Technical Assistance Center in January 2017 (PTAC-IB-4).
Assessment
The Committee provides $193,300,000 for Assessment, which
is $55,970,000 above the fiscal year 2026 budget request and
the same as the fiscal year 2025 enacted level. This amount
includes $8,300,000 for the National Assessment Governing Board
(NAGB), which is $870,000 above the fiscal year 2026 budget
request and the same as the fiscal year 2025 enacted level.
The National Assessment of Educational Progress (NAEP) is
the only nationally representative and continuing survey of
educational ability and achievement of students in the U.S. The
primary goal of the assessment is to determine and report the
status and trends of the knowledge and skills of students,
subject by subject. Subject areas assessed in the past have
included reading, writing, mathematics, science, history,
citizenship, literature, art, and music. The NAEP is operated
by contractors through competitive grants made by the NCES. The
NAGB formulates the policy guidelines for the program.
Program Administration
The Committee provides $73,500,000 for Program
Administration, which is $73,500,000 above the fiscal year 2026
budget request and the same as the fiscal year 2025 enacted
level.
Operating Plan.--The agreement directs the Director to
submit an operating plan within 90 days of enactment of this
Act to the Committees detailing how IES plans to allocate
funding available to the Institute for research, evaluation,
statistics, administration, and other activities.
DEPARTMENTAL MANAGEMENT
Appropriation, fiscal year 2025....................... $627,407,000
Budget request, fiscal year 2026...................... 447,007,000
Committee Recommendation.............................. 447,007,000
Change from enacted level......................... -180,400,000
Change from budget request........................ - - -
PROGRAM ADMINISTRATION
Appropriation, fiscal year 2025....................... $419,907,000
Budget request, fiscal year 2026...................... 293,007,000
Committee Recommendation.............................. 293,007,000
Change from enacted level......................... -126,900,000
Change from budget request........................ - - -
The Committee recommends $293,007,000 for Program
Administration, which is $126,900,000 less than the fiscal year
2025 enacted level. These funds are used for expenses related
to staff and other costs of administering programs and
activities at the Department. Such expenses include personnel
compensation, health, retirement, and other benefits, as well
as travel, rent, telephones, utilities, postage fees, data
processing, printing, equipment, supplies, technology training,
consultants, and other contractual services.
Bill Wide Requirements.--The Committee notes the inclusion
of a bill-wide requirements section of this report. This
section contains requirements which apply to all agencies
funded by this Act.
Comprehensive Literacy Programs.--The Committee supports
efforts to equip educators with comprehensive literacy
resources in a website format with a specific focus on children
in kindergarten through sixth grade. The Committee encourages
the Department to build upon existing programs that leverage
public partnerships and multidisciplinary tools and have
demonstrated outcomes of success.
Course Materials.--The Committee recognizes there are
different models through which students obtain course
materials. The Committee is aware of concerns regarding
proposed restrictions related to the use of certain models
known as tuition- and fee-based course materials fees and
access programs. The Committee supports the Department in not
restricting the use of such models as a condition of receiving
a Federal grant.
Cost Savings of Inclusive Access Programs Study.--The
Committee is aware of concerns regarding previously proposed
changes to the Cash Management regulations related to Books and
Supplies for Title IV funds, including concerns about
unintentional price increases and limits on first-day access
for students receiving Federal financial aid. The Committee
directs GAO to report on the potential cost savings and
accessibility of ``Inclusive Access'' and other ``first-day''
programs that provide students with books and materials at
below market rates by the first day of class. The report shall
consider the potential impact of ``Inclusive Access'' and other
``first-day'' programs on access and affordability for students
receiving Federal financial aid, as well as other topics GAO
determines appropriate.
Healthcare Workforce Education.--The U.S. healthcare
workforce faces challenges including primary care shortages,
high levels of burnout and mental health issues, declining job
and career satisfaction, and a workforce that is aging along
with the general population. The U.S. Bureau of Labor
Statistics projects 193,100 openings for nurses in the U.S.
each year through 2032. These openings are due to increased
demand associated with the aging population and a decrease in
supply due, as well as educational enrollment not keeping pace
with the demand for healthcare workers. Accrediting agencies
play an important role in ensuring a basic level of quality
education for these and other healthcare workers. The Committee
is aware of concerns related to the supply of healthcare
workers and encourages efforts to address existing barriers to
ensure such supply can meet demands.
Military Student Identifier.--The Committee recognizes the
unique challenges faced by children of members of the National
Guard and Reserve who are not currently identified under the
Military Student Identifier (MSI) established in the Every
Student Succeeds Act. The Committee encourages the Department
of Education to explore options for expanding the MSI to
include all military-connected students, including those whose
parents serve in the Reserve Components but are not on full-
time active duty. The Committee further urges the Department to
provide guidance to States and local educational agencies on
how to support these students through targeted programs, data
collection, and educator training, to ensure equitable
recognition and support for all military-connected children.
Nonrecurring Expenses Fund.--The Committee directs the
Department to provide quarterly reports for all ongoing
projects. The report shall include the following for each
project: agency project is funded under; a description for each
project; the date the project was notified to the Committees;
total obligations to date; obligations for the prior fiscal
year; anticipated obligations for current fiscal year; and any
expected future obligations. For any project ongoing for more
than 3 years, the report should include a narrative describing
the cause for delay and steps being taken by the agency to
ensure prompt completion. In addition, the Committee requests
biannual reports on expired balances that are eligible for
transfer to the Nonrecurring Expenses Fund (NEF). Such report
shall include the Treasury Account Fund Symbol, program name,
unobligated balance, and unexpended balance. Such report shall
be transmitted 30 days after the close of the second quarter
and within 45 days after the close of the fourth quarter of the
fiscal year.
Paperwork Reduction.--The Committee appreciates efforts, as
appropriate, by the Department to streamline the paperwork
burden associated with administering grants to school
districts.
Reports to Congress.--The Department is directed to provide
5 business days' notice to the Committees before release of any
congressionally directed report.
Responsiveness to GAO.--The Committee is aware that under
the prior Administration, there were engagements where the
Department of Education delayed in providing GAO with timely
and complete information in response to GAO requests. Such
actions diminished transparency and accountability. The public
rightly expects both. The Committee notes the opportunity for
the Department under the new Administration to provide timely
and complete information to GAO on its engagements within
timeframes as GAO may specify and urges it to do so. The
Committee notes GAO may choose to develop timeliness criteria
to measure the Department's responsiveness to GAO requests for
information, and in such case, GAO should consult with the
Department, as GAO determines appropriate, in developing such
criteria. Congressional oversight often relies on GAO
activities, and the development of such criteria will assist
GAO in the timely completion of work.
Science of Reading.--The Committee commends the success
science of reading curriculum has had on literacy scores in
States such as Louisiana, California, and Mississippi. The
Committee encourages the Department of Education to develop a
report on State implementation of science of reading
curriculum, including the use of grants, roadblocks to State
implementation, and best practices for science of reading
curriculum.
Teacher Resources.--The Committee is concerned about the
decreasing number of candidates entering the teaching
profession, which has a direct impact on classroom performance
by students at every grade level. The Committee supports
efforts by the Department to foster new approaches to human
capital management systems and performance-based compensation
systems through the development and implementation of strategic
school staffing models that include new educator roles, team-
based models, distributed expertise, and opportunities for
teacher leadership.
Transparency about Foreign Influence in American
Postsecondary Education.--The Committee remains concerned about
the ongoing risks associated with malign foreign influence in
American postsecondary education. Section 117 of the HEA
requires institutions of higher education receiving Federal
funding to disclose foreign-sourced gifts and contracts if the
value is $250,000 or more, and they must disclose ownership or
control by a foreign source. The Committee notes the White
House executive order issued on April 23, 2025, ``Transparency
Regarding Foreign Influence at American Universities,'' to
enhance reporting transparency under section 117, and the
Department's announcement that it is transferring enforcement
of these issues from the Office of Federal Student Aid back to
the Office of General Counsel. Given the missed opportunity for
strong oversight under the prior Administration, the Committee
is encouraged by the Department's renewed focus in this area
and requests a briefing within 90 days of enactment of this Act
on the Department's enforcement efforts related to section 117.
Additionally, as part of the Department's efforts to ensure
robust enforcement, the Committee encourages the Department to
consider the merits of utilizing a secure, data-driven
technology platform that could strengthen the Department's
ability to monitor and analyze section 117 compliance, provide
greater transparency to Congress and the public, and ultimately
improve the Department's ability to fulfill its obligations
under section 117.
The Department is urged to modernize its College Foreign
Gift and Contract Report website to allow disclosed information
to be individually identified and compared and searchable and
sortable by date received, type, date filed, and country of
origin. The Department is urged to implement technical
improvements to its public database, including improving upload
functionality by allowing institutions to batch upload one file
with all required information. The Department is further
encouraged to publish a database users guide, including
information on how to edit an entry and how to report errors.
OFFICE FOR CIVIL RIGHTS
Appropriation, fiscal year 2025....................... $140,000,000
Budget request, fiscal year 2026...................... 91,000,000
Committee Recommendation.............................. 91,000,000
Change from enacted level......................... -49,000,000
Change from budget request........................ - - -
The Office for Civil Rights (OCR) is responsible for
enforcing laws that prohibit discrimination on the basis of
race, color, national origin, sex, disability, and age in all
programs and institutions that receive funds from the
Department. These laws extend to SEAs, LEAs, and IHEs,
including proprietary schools. They also extend to State
rehabilitation agencies, libraries, museums, and other
institutions receiving Federal funds.
The Committee supports efforts by the Office for Civil
Rights to provide technical assistance regarding antisemitism
on campuses and to complete pending investigations of
complaints relating to antisemitism under Title VI of the Civil
Rights Act of 1964.
Antisemitism Investigations.--The Committee remains
concerned by instances of antisemitism on campuses and commends
the new Administration for taking steps to address this
increase. Following the explosion of antisemitism at IHEs
across the U.S. after the terrorist attack on Israel and the
subsequent failure of some IHEs to address antisemitic conduct
on campus, it was unclear what actions OCR took under the prior
Administration to respond to submitted complaints. The
Committee requests an update in the fiscal year 2027
congressional justification on such efforts, including the
processing of shared ancestry investigations, responses to
complaints, investigation completions, and related activities
to address antisemitism.
OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2025....................... $67,500,000
Budget request, fiscal year 2026...................... 63,000,000
Committee Recommendation.............................. 63,000,000
Change from enacted level......................... -4,500,000
Change from budget request........................ - - -
The Office of Inspector General has authority to inquire
into all program and administrative activities of the
Department, as well as related activities of grant and contract
recipients. It conducts audits and investigations to determine
compliance with applicable laws and regulations, to check
alleged fraud and abuse, efficiency of operations, and
effectiveness of results.
General Provisions
Sec. 301. The Committee continues a provision related to
the implementation of programs of voluntary prayer and
meditation in public schools.
(TRANSFER OF FUNDS)
Sec. 302. The Committee continues a provision regarding
transfer authority.
Sec. 303. The Committee modifies a provision allowing ESEA
funds consolidated for evaluation purposes to be available from
July 1, 2026 through September 30, 2027.
Sec. 304. The Committee modifies a provision allowing
certain institutions to continue to use endowment income for
student scholarships.
Sec. 305. The Committee modifies a provision extending the
authorization of the National Advisory Committee on
Institutional Quality and Integrity.
Sec. 306. The Committee modifies a provision extending the
authority to provide account maintenance fees to guaranty
agencies for Federal student loans.
Sec. 307. The Committee continues a provision allowing
administrative funds to cover outstanding Perkins loans
servicing costs.
Sec. 308. The Committee modifies a provision allowing up to
0.5 percent of funds appropriated in this Act for programs
authorized under the HEA, except for the Pell Grant program, to
be used for evaluation of any HEA program.
(INCLUDING TRANSFER OF FUNDS)
Sec. 309. The Committee modifies a provision regarding
centralized support costs for the Institute of Education
Sciences.
(INCLUDING RESCISSION AND TRANSFER OF FUNDS)
Sec. 310. The Committee includes a new provision rescinding
amounts from the Nonrecurring Expenses Fund and transferring
funds to Student Aid Administration.
Sec. 311. The Committee includes a new provision regarding
participation in athletic programs.
Sec. 312. The Committee includes a new provision
prohibiting certain rules regarding Title IX of the Education
Amendments of 1972.
Sec. 313. The Committee includes a new provision regarding
protection for religious student groups at institutions of
higher education.
Sec. 314. The Committee includes a new provision
prohibiting certain Federal student loan cancellations, and
rules related to income-driven repayment, borrower defense to
repayment, 90/10, and gainful employment.
Sec. 315. The Committee includes a new provision
redesignating Workforce Pell Grants as ``Trump Grants.''
Sec. 316. The Committee includes a new provision related to
local education agencies.
TITLE IV--RELATED AGENCIES
Appropriation, fiscal year 2025....................... $16,918,955,000
Budget request, fiscal year 2026...................... 14,840,697,000
Committee Recommendation.............................. 16,280,246,000
Change from enacted level......................... -638,709,000
Change from budget request........................ +1,439,549,000
This bill provides just over $16 billion in discretionary
budget authority for the title IV Related Agencies, a reduction
of 4 percent over fiscal year 2025 enacted level. The agencies
within title IV comprise 8 percent of the total 302(b)
allocation for this subcommittee.
America First Corps
Appropriation, fiscal year 2025....................... $1,027,806,000
Budget request, fiscal year 2026...................... -92,319,000
Committee Recommendation.............................. 642,947,000
Change from enacted level......................... -384,859,000
Change from budget request........................ +735,266,000
The Committee renames the Corporation for National and
Community Service, operating under the name of AmeriCorps, as
the America First Corps (AFC) to more clearly reflect the
agency's core mission of funding organizations that place
Americans at the center of service initiatives. The new name
emphasizes resilience, civic responsibility, and a renewal of
national pride through community-based service. The Committee
recognizes the potential of improving recruitment, enhancing
visibility, and increasing program participation through the
program's alignment with America First principles.
OPERATING EXPENSES
Appropriation, fiscal year 2025....................... $975,525,000
Budget request, fiscal year 2026...................... 32,430,000
Committee Recommendation.............................. 524,725,000
Change from enacted level......................... -450,800,000
Change from budget request........................ +492,295,000
The Committee notes that ongoing audit findings confirm AFC
has not fully resolved long-standing issues or conducted proper
oversight of its grant programs.
Within the total for AFC, the Committee provides the
following amounts:
------------------------------------------------------------------------
FY 2026
Budget Activity FY 2025 Enacted Committee
------------------------------------------------------------------------
Operating Expenses
Volunteers in Service to $103,285,000 $51,643,000
America......................
National Senior Volunteer 236,917,000 146,012,000
Corps........................
Foster Grandparents 125,363,000 62,682,000
Program..................
Senior Companion Program.. 56,449,000 28,225,000
Retired Senior Volunteer 55,105,000 55,105,000
Program..................
State and National Grants..... 557,094,000 278,547,000
Innovation, Assistance, and 14,706,000 14,706,000
Other Activities.............
Research and Evaluation....... 6,250,000 3,125,000
National Civilian Community 37,735,000 20,923,000
Corps........................
State Service Commission 19,538,000 9,769,000
Grants.......................
------------------------------------------------------------------------
Data Collection.--The Committee directs AFC to clearly
communicate with grantees involved in any data collection,
whether the information being collected is optional for
reporting or required information as part of a grant.
National Senior Volunteer Corps
The Retired Senior Volunteer Program (RSVP) provides grants
to organizations that engage Americans aged 55 years and older
in volunteer service. RSVP volunteers participate in community
service activities that put Americans First including serving
veterans and military families, supporting workforce
development and training in job readiness skills, assisting in
disaster preparedness and mitigation efforts, and mentoring and
tutoring opportunities.
Innovation, Assistance, and Other Activities
The Committee provides $14,706,000 for innovation,
assistance and other activities, which is the same as the
fiscal year 2025 enacted program level. These activities help
increase recruitment and retention of volunteers and promote
national service and civic participation.
Volunteer Generation Fund.--Within the total, the Committee
provides $8,558,000 for the Volunteer Generation Fund as
authorized under section 198P of the SERVE America Act (P.L.
111-13). This program supports community-based organizations to
improve volunteer capacity.
National Days of Service.--Within the total, the Committee
provides $6,148,000 for National Days of Service including the
September 11 National Day of Service and Remembrance and the
Martin Luther King, Jr. National Day of Service--two important
national events. The Committee encourages AFC to prioritize
making grants, entering into cooperative agreements, or
providing other forms of support to eligible organizations with
expertise in representing families of victims of the September
11, 2001, terrorist attacks and other impacted constituencies
when planning for the September 11 National Day of Service and
Remembrance.
Payment to the National Service Trust
Appropriation, fiscal year 2025....................... $180,000,000
Budget request, fiscal year 2026...................... - - -
Committee Recommendation.............................. 40,000,000
Change from enacted level......................... -140,000,000
Change from budget request........................ +40,000,000
The National Service Trust makes payments for Segal
education awards, pays interest that accrues on qualified
student loans for participants during terms of service in
approved national service positions, and makes other payments
entitled to members who serve in AFC programs.
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $99,686,000
Budget request, fiscal year 2026...................... 69,627,000
Committee Recommendation.............................. 69,627,000
Change from enacted level......................... -30,059,000
Change from budget request........................ - - -
OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2025....................... $7,595,000
Budget request, fiscal year 2026...................... 5,624,000
Committee Recommendation.............................. 8,595,000
Change from enacted level......................... +1,000,000
Change from budget request........................ +2,971,000
The OIG provides oversight of AFC programs, operations, and
grantees with the goal of preventing and detecting fraud,
waste, and abuse. The Committee notes the OIG identified
approximately $10,290,000 in wasteful spending during fiscal
year 2024 due to improper recordkeeping, insufficient
documentation, inadequate subgrantee monitoring, and
noncompliance with Federal requirements.
The Committee directs the OIG to continue focusing on its
top three priority areas for AFC, including: (1) improving
agency compliance with applicable laws and regulations; (2)
ensuring robust financial reporting processes and internal
controls; and (3) strengthening the grant processes to ensure
grantees are prioritizing Americans seeking volunteer
opportunities.
ADMINISTRATIVE PROVISIONS
Sec. 401. The Committee continues a provision requiring the
agency to make any significant changes to program requirements,
service delivery or policy through rulemaking.
Sec. 402. The Committee continues a provision related to
National Service Trust minimum share requirements.
Sec. 403. The Committee continues a provision related to
donations.
Sec. 404. The Committee continues a provision related to
veterans.
Sec. 405. The Committee continues a provision related to
criminal history background checks.
Sec. 406. The Committee continues a provision related to
1,200 hours of service positions.
Sec. 407. The Committee continues a provision related to
Volunteers in Service to America members' education awards.
Sec. 408. The Committee adds a provision renaming the
agency as the America First Corps.
Committee For Purchase From People Who are Blind or Severely Disabled
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $13,124,000
Budget request, fiscal year 2026...................... 13,124,000
Committee Recommendation.............................. 13,124,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Committee for Purchase from People Who Are Blind or
Severely Disabled, an independent Federal agency, oversees and
manages the AbilityOne Program, which uses the purchasing power
of the Federal government to buy products and services from
participating, community-based nonprofit agencies nationwide.
These organizations are dedicated to training and employing
individuals with disabilities.
Employment Outcomes.--The Committee notes the seven percent
increase in private sector AbiltyOne jobs in the last year,
including the delivery of mission critical Made in America
products and services for our armed forces. The Committee
encourages continued growth in the number and quality of
employment opportunities that the program makes possible for
more than 39,000 Americans, including approximately 2,500
Veterans, who are blind or have significant disabilities.
OIG.--The Committee provides not less than $3,150,000 for
the Office of Inspector General, the same as the fiscal year
2025 enacted level.
Corporation for Public Broadcasting
Appropriation, fiscal year 2025....................... $595,000,000
Budget request, fiscal year 2026...................... 30,000,000
Committee Recommendation.............................. - - -
Change from enacted level (for FY 2026)........... -595,000,000
Change from budget request........................ -30,000,000
The Committee provides no funding for the Corporation for
Public Broadcasting, including both National Public Radio (NPR)
and the Public Broadcasting System. Under CPB leadership
appointed by the Biden Administration, the CPB failed to abide
by the statutory requirement that the CPB adhere to principals
of political impartiality (47 U.S.C. 396(f)(3)) resulting in
taxpayer funding being used to subsidize politicized messaging
in promotion of Democrat candidates and policy priorities.
Federal Mediation and Conciliation Service
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $53,705,000
Budget request, fiscal year 2026...................... 7,400,000
Committee Recommendation.............................. 7,400,000
Change from enacted level......................... -46,305,000
Change from budget request........................ - - -
The Federal Mediation and Conciliation Service provides
mediation and conflict resolution services to industry,
government agencies, and communities.
The Committee provides $7,400,000 for expenses necessary
for carrying out the closure of the agency, including the
discharge of financial obligations, proper disposal of
government assets, and the protection of government information
and records.
Federal Mine Safety and Health Review Commission
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $18,012,000
Budget request, fiscal year 2026...................... 16,890,000
Committee Recommendation.............................. 16,890,000
Change from enacted level......................... -1,122,000
Change from budget request........................ - - -
The FMSHRC is an independent adjudicative agency that
provides administrative trial and appellate review of legal
disputes arising under the Federal Mine Safety and Health Act
of 1977.
Institute of Museum and Library Services
OFFICE OF MUSEUM AND LIBRARY SERVICES: GRANTS AND ADMINISTRATION
Appropriation, fiscal year 2025....................... $294,800,000
Budget request, fiscal year 2026...................... 6,000,000
Committee Recommendation.............................. 291,800,000
Change from enacted level......................... -3,000,000
Change from budget request........................ +285,800,000
Within the total for IMLS, the Committee provides the
following amounts:
------------------------------------------------------------------------
Budget Activity FY 2025 Enacted FY 2026 Committee
------------------------------------------------------------------------
Library Services Technology Act:
Grants to States.............. $180,000,000 $180,400,000
Native American Library 5,763,000 5,763,000
Services.....................
National Leadership: Libraries 15,287,000 15,287,000
Laura Bush 21st Century 10,000,000 10,000,000
Librarian....................
Museum Services Act:
Museums for America........... 30,330,000 28,730,000
Native American/Hawaiian 3,772,000 3,772,000
Museum Service...............
National Leadership: Museums.. 9,348,000 9,348,000
African American History and
Culture Act:
Museum Grants for African 6,000,000 6,000,000
American History and Culture.
National Museum of the American
Latino Act:
Museum Grants for American 6,000,000 6,000,000
Latino History and Culture...
Museum and Library Services Act
General Provisions:
Research, Analysis and Data 5,650,000 5,500,000
Collection...................
Program Administration............ 22,650,000 21,000,000
------------------------------------------------------------------------
America250.--The Committee recognizes IMLS's commitment to
the 250th Anniversary of the United States in coordination with
the U.S. Semiquincentennial Commission and the White House Task
Force on Celebrating America's 250th Birthday. IMLS has a key
role in supporting existing activities and new projects at the
State and local levels that enhance civic engagement,
innovation, and community collaboration in preparation for the
250th Anniversary. The Committee fully funds IMLS library
formula grants to States and museums for America formula grants
to States to support local libraries and museums interested in
hosting historical programming ahead of the celebration.
Grant Decision Making.--The Committee encourages IMLS in
its grant review process to consider the full scope of an
organization's work or activities before awarding grants,
regardless of whether the IMLS grant will directly fund such
work or activities.
Medicaid and Chip Payment and Access Commission
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $9,405,000
Budget request, fiscal year 2026...................... 10,698,000
Committee Recommendation.............................. 9,405,000
Change from enacted level......................... - - -
Change from budget request........................ -1,293,000
The Medicaid and CHIP Payment and Access Commission
(MACPAC) is an independent Agency tasked with advising Congress
on issues affecting Medicaid and CHIP. MACPAC conducts policy
and data analysis on Medicaid and CHIP to support policymakers
and promote program accountability.
The Committee supports the role played by MACPAC in
providing nonpartisan policy recommendations and data analysis
on a wide array of issues affecting Medicaid and CHIP. The
Committee encourages MACPAC to include with their policy
recommendations additional specific recommended policy changes
to the programs that can result in savings designed to help
improve access to care for beneficiaries and offset proposed
increases in spending. Additionally, the Committee encourages
MACPAC to provide more detailed cost estimates and actuarial
analyses for costs that would be incurred by the Federal
government and the States to better understand the implications
of the Commission's recommendations.
Medicare Payment Advisory Commission
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $13,824,000
Budget request, fiscal year 2026...................... 14,673,000
Committee Recommendation.............................. 14,673,000
Change from enacted level......................... +849,000
Change from budget request........................ - - -
The Medicare Payment Advisory Commission (MedPAC) is an
independent agency tasked with advising Congress on issues
affecting the Medicare program. In addition to advising on
payments to private health plans participating in Medicare and
providers in Medicare's traditional fee-for-service (FFS)
program, MedPAC is responsible for providing analysis on access
to care, quality of care, and other issues affecting Medicare.
National Council on Disability
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $3,850,000
Budget request, fiscal year 2026...................... 3,850,000
Committee Recommendation.............................. 3,850,000
Change from enacted level......................... - - -
Change from budget request........................ - --
The National Council on Disability (NCD) is an independent
Federal agency charged with advising the President, Congress,
and other Federal agencies regarding policies, programs,
practices, and procedures that affect people with disabilities.
NCD is comprised of a team of Presidential and Congressional
appointees, an Executive Director appointed by the Chair, and a
full-time professional staff.
National Labor Relations Board
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $299,224,000
Budget request, fiscal year 2026...................... 285,224,000
Committee Recommendation.............................. 200,000,000
Change from enacted level......................... -99,224,000
Change from budget request........................ -85,224,000
The National Labor Relations Board (NLRB) is responsible
for enforcing U.S. labor law related to collective bargaining
and unfair labor practices, including the National Labor
Relations Act of 1935.
ADMINISTRATIVE PROVISIONS
Sec. 409. The Committee continues language restricting the
use of electronic voting.
National Mediation Board
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $15,113,000
Budget request, fiscal year 2026...................... 14,300,000
Committee Recommendation.............................. 14,300,000
Change from enacted level......................... -813,000
Change from budget request........................ - - -
The National Mediation Board coordinates labor-management
relations within the U.S. railroads and airlines industries.
Occupational Safety and Health Review Commission
SALARIES AND EXPENSES
Appropriation, fiscal year 2025....................... $15,449,000
Budget request, fiscal year 2026...................... 14,214,000
Committee Recommendation.............................. 14,214,000
Change from enacted level......................... -1,235,000
Change from budget request........................ - - -
The Occupational Safety and Health Review Commission
provides administrative trial and appellate review related to
contests of citations or penalties resulting from OSHA
inspections of American workplaces.
Railroad Retirement Board
DUAL BENEFITS PAYMENTS ACCOUNT
Appropriation, fiscal year 2025....................... $7,000,000
Budget request, fiscal year 2026...................... 5,000,000
Committee Recommendation.............................. 5,000,000
Change from enacted level......................... -2,000,000
Change from budget request........................ - - -
This appropriation is authorized by the Railroad Retirement
Act of 1974 to fund vested dual benefits received by railroad
retirees who, under prior law, would have become covered by
both the railroad retirement system and the Social Security
system because railroad retirement was not fully coordinated
with Social Security from 1937 to 1974.
The Committee is concerned that the Railroad Retirement
Board (RRB) has yet to implement and integrate an enterprise
risk management (ERM) system including a lack of measurable
goals and implementation timeline. The Committee notes that the
RRB's pervasive challenges in risk management extend to program
integrity, as evidenced by persistent findings of material
weaknesses in financial reporting that the RRB's Office of
Inspector General (OIG) has identified. The Committee also
notes that the RRB has not had its current internal assessment
substantiated by the OIG or an independent auditor or
contractor. The Committee, therefore, notes that the RRB's ERM
process merits further evaluation.
The Committee also notes that in prior years, the OIG
issued a disclaimer of opinion for the RRB's overall financial
statements. RMA Associates, an independent public accounting
firm, audited the RRB's fiscal year 2022 financial statements.
RMA identified 9 material weaknesses and 1 non-compliance with
laws and regulations, and it made 15 recommendations to address
the material weaknesses identified. RMA did not make
recommendations for two findings, because they were repeated
from prior OIG reports and remain open. The Committee is
concerned that the RRB non-concurred with the RMA findings.
Additionally, the Committee notes that RMA did not express
an opinion on the fiscal year 2022 financial statements. RMA
did not express an opinion on the effectiveness of the RRB's
internal control over financial reporting, and RRB could not
provide sufficient appropriate evidential matter to support its
internal control over financial reporting due to inadequate
process, controls, and records.
The RRB is directed to provide the Committee with a
corrective action plan explaining how the RRB will address
these areas of concern, within 120 days of enactment of this
Act. Additionally, the RRB's Audit Compliance Section (ACS)
does not provide adequate audit coverage of railroad employees.
Such a deficiency is troubling, and therefore the RRB is
directed to brief the Committee within 120 days of enactment of
this Act on the ACS and how it plans to provide adequate
coverage in this area.
FEDERAL PAYMENT TO THE RAILROAD RETIREMENT ACCOUNTS
Appropriation, fiscal year 2025....................... $150,000
Budget request, fiscal year 2026...................... 150,000
Committee Recommendation.............................. 150,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
LIMITATION ON ADMINISTRATION
Appropriation, fiscal year 2025....................... $126,000,000
Budget request, fiscal year 2026...................... 126,000,000
Committee Recommendation.............................. 126,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
LIMITATION ON THE OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2025....................... $14,000,000
Budget request, fiscal year 2026...................... 14,000,000
Committee Recommendation.............................. 14,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
Social Security Administration
In fiscal year 2026, the Social Security Administration
(SSA) anticipates exceeding $1.72 trillion in total spending on
social security retirement, disability insurance, and
supplemental security income (SSI) payments. SSA's total
outlays have grown 194 percent since 2006 as mandatory
entitlement programs continue to grow. The SSA Old-Age and
Survivors Insurance Trust Fund, which funds retirement and
survivor benefit payments, is projected to be depleted in 2033,
at which time, Americans will see a 23 percent cut to their
benefits. By comparison, SSA's discretionary budget request for
fiscal year 2026, which funds the agency's administrative
expenses, totals $14.8 billion, an increase of 62 percent since
2006. The escalating pace of mandatory entitlement-driven
spending remains the primary cost driver within SSA.
PAYMENTS TO SOCIAL SECURITY TRUST FUNDS
Appropriation, fiscal year 2025....................... $15,000,000
Budget request, fiscal year 2026...................... 15,000,000
Committee Recommendation.............................. 15,000,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Committee provides this mandatory funding to reimburse
the Old Age and Survivors Insurance (OASI) and Disability
Insurance (DI) trust funds for non-trust fund activities. This
appropriation restores the trust funds to the same financial
position they would have been in had they not borne these
costs.
SUPPLEMENTAL SECURITY INCOME PROGRAM
Appropriation, fiscal year 2025....................... $46,252,042,000
Budget request, fiscal year 2026...................... 49,447,966,000
Committee Recommendation.............................. 49,447,966,000
Change from enacted level......................... +3,195,924,000
Change from budget request........................ - - -
The Committee provides $49,447,966,000 in fiscal year 2026
mandatory funds for the SSI program. This is in addition to the
$22,100,000,000 provided in the fiscal year 2025 appropriations
act for the first quarter of fiscal year 2026. In addition, the
Committee provides $23,500,000,000 in advance funding for the
first quarter of fiscal year 2027, as requested.
Federal Benefit Payments
The Committee provides a fiscal year 2026 program level of
$66,762,000,000 for Federal benefit payments.
Beneficiary Services
The Committee provides $75,000,000 in new mandatory budget
authority for beneficiary services. These funds reimburse
vocational rehabilitation (VR) agencies for successfully
rehabilitating disabled SSI recipients by helping them achieve
and sustain productive, self-supporting work activity. Funds
also support the Ticket to Work program that provides SSI
recipients with a ticket to offer employment networks (ENs),
including VR agencies, in exchange for employment and support
services. The Ticket to Work program pays ENs based on
recipients achieving certain milestones and outcomes.
Research and Demonstration
Sections 1110, 1115, and 1144 of the Social Security Act
provide authority to the Social Security Administration to
conduct research and demonstration projects related to SSA's
programs. Within the appropriation for Supplemental Security
Income, the Committee provides $91,000,000 in mandatory funds
for research and demonstration activities, as requested. These
funds support a variety of research and demonstration projects
designed to improve the disability process, promote self-
sufficiency and assist individuals in returning to work,
encourage savings and retirement planning through financial
literacy, and generally provide analytical and data resources
for use in preparing and reviewing policy proposals.
Administration
Within the appropriation for SSI, the Committee provides
$4,619,966,000 for payment to the Social Security trust funds
for SSI's share of the administrative expenses of SSA.
LIMITATION ON ADMINISTRATIVE EXPENSES
Appropriation, fiscal year 2025....................... $14,297,978,000
Budget request, fiscal year 2026...................... 14,791,978,000
Committee Recommendation.............................. 14,791,978,000
Change from enacted level......................... +494,000,000
Change from budget request........................ - - -
The Limitation on Administrative Expenses (LAE) account
funds the administrative and operational costs for
administering the OASI, DI, and SSI programs, and associated
costs to support CMS in administering the Medicare program. The
LAE account is funded by the Social Security and Medicare trust
funds for their share of administrative expenses, the general
fund for the SSI program's share of administrative expenses,
and applicable user fees. These funds support core
administrative activities including processing retirement and
disability claims, conducting hearings to review disability
determination appeals, issuing Social Security numbers and
cards, processing individuals' annual earnings information, and
ensuring the integrity of Social Security programs through
continuing disability reviews (CDR) and SSI redeterminations of
non-medical eligibility.
Bill Wide Requirements.--The Committee notes the inclusion
of a bill wide requirements section of this report. This
section contains requirements which apply to all agencies
funded by this Act.
Hiring and Retention.--The Committee continues to direct
SSA to provide a quarterly staffing report to the Committee
detailing full-time permanent staff and new hires by component
and retention rates of new hires by component.
Occupational Information System (OIS).--The Committee
continues to direct SSA to include information in its
congressional justifications detailing efforts to fully
implement the OIS project, including the status of
implementation and timeline for transitioning entirely to OIS,
an action plan to accomplish such timeline, and the costs
associated with the project.
Payment Integrity.--The Committee understands the
importance of maintaining accurate records and delivering
timely and reliable benefits to those who qualify. The
Committee directs SSA to submit a report to the Committees on
Appropriations of the House of Representatives and the Senate
within 180 days of the enactment of this Act detailing the
steps the agency is taking to improve the timeliness and
efficiency of its error correction processes. The report should
include any ongoing or planned improvements to internal review
systems, how the agency informs the applicant of an error,
staffing and training initiatives, and what improvements the
agency has taken to avoid prolonged delays resulting from such
errors.
Report on LAE Expenditures.--The Committee continues to
request that the data referenced under this heading in House
Report 114-699 be included in future congressional
justifications. In addition, the Committee requests the fiscal
year 2027 congressional justification include a historical
table of costs and fiscal year 2027 requests for personnel and
benefits, by major SSA component to include Operations (field
offices, teleservice centers, processing centers, and regional
offices); Office of Hearings Operations; Systems; Office of
Analytics, Review, and Oversight; and Headquarters.
Social Security Administration Technology Development.--The
Committee urges SSA to consider the delays faced by individuals
who apply for Social Security Disability Insurance (SSDI) and
are waiting for their initial determination. The Committee
urges SSA to explore and expand process changes that lead to
faster determinations for applicants. The Committee also urges
SSA to allocate adequate resources to the development of new
technology that will relieve burdens on disability adjudicators
and other personnel who play a role in preparing, evaluating,
or finalizing initial determinations for SSDI applications. The
Committee directs SSA to provide an update in the fiscal year
2027 congressional justification detailing specific procedures,
staffing strategies, technology investments, and planned
process improvements to reduce the backlog of disability
claims.
Social Security Program Integrity.--The Committee supports
continued efforts to strengthen SSA's program integrity efforts
in the SSDI and SSI benefit programs. Section 824 of the
Bipartisan Budget Act of 2015 authorized SSA to enter into an
information exchange with payroll data providers. There has
been considerable success in reducing improper payments and
leveraging technology to assist with beneficiary reporting
requirements for other Federal and State benefit programs, and
the Committee urges SSA to prioritize opportunities to do so
for the SSDI and SSI benefit programs. Within the funds
provided to SSA for enhancing beneficiary service delivery, the
Committee urges SSA to use all the available tools provided by
commercial entities that collect and maintain data regarding
employment and wages to ensure that SSDI and SSI benefits are
properly paid and to strengthen program integrity. In addition,
the Committee encourages SSA to proceed expeditiously to
implement system requirements and integrate the program for all
beneficiaries throughout the agency. Further, the Committee
requests SSA provide an update in its fiscal year 2027
congressional justification regarding the status and progress
of the payroll information exchange.
Work Incentives Planning and Assistance (WIPA) and
Protection and Advocacy for Beneficiaries of Social Security
(PABSS).--The recommendation includes $23,000,000 for WIPA and
$10,000,000 for PABSS. These programs provide services to help
Social Security disability beneficiaries return to work.
Continuing Disability Reviews, Redeterminations, and Program
Integrity Activities
As requested in the fiscal year 2026 budget request, the
Committee provides $2,397,000,000 for program integrity
activities, an increase of $494,000,000 over the fiscal year
2025 enacted level. This includes $273,000,000 in base funding
and $2,124,000,000 in budget adjustment funding.
The bill also includes language transferring up to
$24,600,000 to the OIG for the cost of jointly operating co-
operative disability investigation units.
Social Security Advisory Board
The Committee provides $2,700,000 for the Social Security
Advisory Board, which is the same as the fiscal year 2025
enacted level.
User Fees
In addition to the other amounts provided, the Committee
provides $171,000,000 for administrative activities funded from
user fees. Of this amount, $170,000,000 is derived from fees
collected from States that request SSA administer State SSI
supplementary payments. The remaining $1,000,000 is derived
from fees charged to non-attorneys who apply for certification
to represent claimants under titles II and XVI of the Social
Security Act.
Sec. 410. The Committee includes a new provision related to
phone services and field offices.
OFFICE OF THE INSPECTOR GENERAL
Appropriation, fiscal year 2025....................... $114,665,000
Budget request, fiscal year 2026...................... 114,665,000
Committee Recommendation.............................. 114,665,000
Change from enacted level......................... - - -
Change from budget request........................ - - -
The Office of the Inspector General is responsible for
meeting the statutory mission of promoting economy, efficiency,
and effectiveness in the administration of SSA programs and
operations and to prevent and detect fraud, waste, abuse, and
mismanagement in such programs and operations. To accomplish
this mission, the OIG directs, conducts, and supervises audits,
evaluations, and investigations. In addition, the OIG searches
for and reports on systemic weaknesses in SSA programs and
operations and makes recommendations for needed improvements
and corrective actions.
Social Security Administration Office of Investigations.--
The Committee supports SSA's anti-fraud operations that ensure
only individuals who qualify for Social Security benefits
receive them. The Committee encourages SSA to support
appropriate staffing levels of OIG special agents and to
encourage strong partnerships with SSA field offices, State
Disability Determination Services offices, State and local law
enforcement, and others as appropriate in order to improve
investigations and prosecutions of fraudulent claims.
TITLE V--GENERAL PROVISIONS
(TRANSFER OF FUNDS)
Sec. 501. The Committee continues a provision allowing the
Secretaries of Labor, Health and Human Services, and Education
to transfer unexpended balances of prior appropriations to
accounts corresponding to current appropriations to be used for
the same purposes and for the same periods of time for which
they were originally appropriated.
Sec. 502. The Committee continues a provision prohibiting
the obligation of funds beyond the current fiscal year unless
expressly so provided.
Sec. 503. The Committee continues a provision prohibiting
funds from being used to support or defeat legislation.
Sec. 504. The Committee continues a provision limiting the
amount available for official reception and representation
expenses for the Secretaries of Labor and Education, the
Director of the Federal Mediation and Conciliation Service, and
the Chairman of the National Mediation Board.
Sec. 505. The Committee continues a provision requiring
grantees receiving Federal funds to clearly state the
percentage of the total cost of the program or project that
will be financed with Federal money.
Sec. 506. The Committee continues a provision prohibiting
the use of funds for any abortion.
Sec. 507. The Committee continues a provision providing
exceptions to section 506 and a provision prohibiting funds
from being made available to a Federal agency or program, or to
a State or local government, if such agency, program, or
government discriminates against institutional or individual
health care entities because they do not provide, pay for,
provide coverage of, or refer for abortions.
Sec. 508. The Committee continues a provision prohibiting
use of funds for certain research involving human embryos.
Sec. 509. The Committee continues a provision prohibiting
use of funds for any activity that promotes the legalization of
any drug or substance included in schedule I of the schedules
of controlled substances.
Sec. 510. The Committee continues a provision prohibiting
use of funds to promulgate or adopt any final standard
providing for a unique health identifier until legislation is
enacted specifically approving the standard.
Sec. 511. The Committee continues a provision related to
annual reports to the Secretary of Labor.
Sec. 512. The Committee continues a provision prohibiting
transfer of funds made available in this Act except by
authority provided in this Act or another appropriations Act.
Sec. 513. The Committee continues a provision to limit
funds in the bill for public libraries to those that comply
with the requirements of the Children's Internet Protection
Act.
Sec. 514. The Committee modifies a provision regarding
procedures for reprogramming of funds.
Sec. 515. The Committee continues a provision pertaining to
appointments to scientific advisory committees.
Sec. 516. The Committee modifies a provision requiring each
department and related agency funded through this Act to submit
an operating plan within 45 days of enactment, detailing any
funding allocations that are different than those specified in
this Act, the accompanying detailed table, or budget request.
Sec. 517. The Committee modifies a provision requiring the
Secretaries of Labor, Health and Human Services, and Education
to submit a quarterly report to the Committees on
Appropriations containing certain information on noncompetitive
contracts, grants, and cooperative agreements exceeding
$500,000 in value.
Sec. 518. The Committee continues a provision prohibiting
the use of funds to process claims for credit for quarters of
coverage based on work performed under a Social Security number
that was not the claimant's number, where the performance of
such work under such number has formed the basis for a
conviction of the claimant of a violation of section 208(a)(6)
or (7) of the Social Security Act.
Sec. 519. The Committee continues a provision prohibiting
the use of funds to implement a Social Security totalization
agreement with Mexico.
Sec. 520. The Committee continues a provision prohibiting
the use of funds for the downloading or exchanging of
pornography.
Sec. 521. The Committee continues a provision related to
reporting requirements for conference expenditures.
Sec. 522. The Committee continues a provision related to
disclosure of U.S. taxpayer funding for programs used in
advertising.
Sec. 523. The Committee modifies a provision requesting
quarterly reports on the status of balances of appropriations
from the departments of Labor, Health and Human Services and
Education.
Sec. 524. The Committee continues a provision related to
grant notifications.
Sec. 525. The Committee modifies a provision related to
needle exchange.
Sec. 526. The Committee continues a provision related to
questions for the record.
Sec. 527. The Committee modifies a provision related to
research and evaluation funding flexibility.
(RESCISSION)
Sec. 528. The Committee modifies a provision to permanently
rescind funds from the Child Enrollment Contingency Fund.
(RESCISSION)
Sec. 529. The Committee includes a new provision rescinding
unobligated balances from the American Rescue Plan Act.
Sec. 530. The Committee includes a new provision
prohibiting certain actions related to a sincerely held
religious belief.
Sec. 531. The Committee includes a new provision related to
the display of flags over Federal facilities.
Sec. 532. The Committee includes a new provision related to
executive orders related to climate change.
Sec. 533. The Committee includes a new provision related to
certain executive orders related to diversity, equity, and
inclusion.
Sec. 534. The Committee includes a new provision related to
diversity, equity, and inclusion.
Sec. 535. The Committee includes a new provision related to
Critical Race Theory.
Sec. 536. The Committee includes a new provision related to
antisemitism.
Sec. 537. The Committee includes a new provision related to
gain of function research in certain countries.
Sec. 538. The Committee includes a new provision related to
COVID mask and vaccine mandates.
Sec. 539. The Committee includes a new provision related to
certain actions with specific entities or subsidiaries.
Sec. 540. The Committee includes a new provision related to
the provision related to partnerships with entities operated or
controlled by the Chinese Communist Party or the Government of
the People's Republic of China.
Sec. 541. The Committee includes a new provision related to
entities in which the People's Republic of China has any
ownership stake.
SPENDING REDUCTION ACCOUNT
Sec. 542. The Committee includes a Spending Reduction
Account.
House of Representatives Report Requirements
The following materials are submitted in accordance with
various requirements of the Rules of the House of
Representatives:
Minority Views
Pursuant to the provisions of clause 3(a)(1) of House Rule
XIII and sec. 6(i) of the Committee Rules, the dissenting views
of the minority party of the House of Representatives, are
printed below:
This bill is a continuation of the Republican Party's
multi-year effort to dismantle the nation's health care and
public education systems. It would cut funding for health care,
education, and labor programs by $24 billion--more than 10
percent below the 2025 level.
This bill would hurt the middle class, the working class,
and the vulnerable across every single one of our congressional
districts.
Americans are struggling with rising costs of everyday
necessities. They are living paycheck to paycheck. But the
President, and House Republicans, are not laser-focused on the
cost-of-living crisis. They are making it worse.
In their first six months in office, Republicans passed a
budget bill to cut nearly a trillion dollars from Medicaid and
the Affordable Care Act, which will take away health care
coverage from more than 15 million people. Their budget bill
also slashed nutrition benefits for poor families, which will
lead to an additional 1 million kids going hungry. And the
Republican bill will trigger a cut of more than $500 billion to
Medicare over the next 10 years, harming America's seniors.
All to pass trillions of dollars in tax cuts for big
corporations and billionaires--adding $4 trillion to the
national debt over the next 10 years.
At the same time, President and House Republicans are
marching toward their goal of shutting down the Department of
Education and turning public education into a for-profit
enterprise.
In March, President Trump signed an executive order seeking
to eliminate the Department of Education. Elon Musk and DOGE
fired or pushed out half of the Department of Education's
workforce. And OMB Director Russ Vought illegally froze
billions of dollars in funding for education programs.
And now, Republicans are eviscerating our public health
system and promoting Secretary Robert F. Kennedy Jr.'s anti-
vaccine ideology.
Secretary Kennedy has no scientific or medical expertise.
He pushes deadly conspiracies and spreads lies about vaccines.
He has surrounded himself with political appointees, or
inserted appointees at the Centers for Disease Control and
Prevention (CDC), who have no expertise on vaccines or
immunization.
In June, Secretary Kennedy fired all 17 independent
scientific advisers on the Advisory Committee on Immunization
Policy (ACIP) and replaced them with anti-vaccine acolytes. He
hired an unqualified and discredited vaccine skeptic as a top
adviser on vaccine policy.
In August, President Trump fired the CDC Director, Dr.
Susan Monarez, at Secretary Kennedy's request because the CDC
Director refused to rubber-stamp Secretary Kennedy's anti-
vaccine agenda that would hurt millions of our children. Dr.
Monarez insisted that CDC's vaccine recommendations be based on
credible data--not ideology or preordained outcomes. For
standing on scientific principle, Dr. Monarez was fired.
ACIP's next meeting is scheduled for September 18th and
19th. They are going to consider recommendations for an array
of vaccines, including Hepatitis B, Covid, RSV, chickenpox, and
the combination vaccine for measles, mumps, and rubella. I have
serious concerns that a number of these recommendations are in
grave danger.
The ACIP meeting must be postponed. All original ACIP
members must be reinstated and Secretary Kennedy's unqualified
appointees must be removed.
And now, the Republican majority has introduced a fiscal
year 2026 appropriations bill that continues the Republican
assault on education, health care, and workers.
The bill decimates support for public schools, students,
and K-12 school teachers, and it abandons college students.
The bill cuts the Department of Education by $12 billion,
or 15 percent, including a $4.7 billion cut to Title I Grants
to Local Educational Agencies which will take at least 72,000
teachers out of low-income classrooms.
The bill eliminates $2.2 billion for Supporting Effective
Instruction State grants, which provide professional
development opportunities for teachers and educators;
eliminates $890 million for English language acquisition, which
helps more than five million English learners nationwide; and
eliminates $729 million for Adult Education grants, which help
more than one million adults with basic education services.
The bill slashes $1.4 billion for need-based financial aid
for students who need assistance to finance their post-
secondary education--including a cut of $451 million to Federal
Work Study, affecting 220,000 students, and elimination of $910
million for Supplemental Educational Opportunity Grants, which
provide financial assistance for more than 1.6 million low-
income students.
Moreover, the bill eviscerates job training programs by
more than 50 percent, including the elimination of funding for
WIOA Adult Job Training, WIOA Youth Job Training, and the Job
Corps program, destroying job training and career development
opportunities for more than 300,000 adults and more than
150,000 young adults.
And, once again, the majority's bill would harm women's
health, children's health, and public health, surrendering the
safety and wellbeing of the American people to multiple health
crises.
The bill completely eliminates funding for HIV/AIDS
prevention at CDC, a cut of more than $1 billion, and cuts HIV/
AIDS treatment under the Ryan White program by more than $500
million.
The bill would eliminate funding for Title X Family
Planning, which would be the end of support for preventive
health care services, including contraception and cancer
screenings, for 2.6 million low-income women and men. And it
would eliminate funding for the Teen Pregnancy Prevention
Program.
In addition, the bill eliminates funding for CDC's tobacco
prevention programs, as well as firearm injury and mortality
prevention research.
The bill cuts funding for research at the National
Institutes of Health by nearly $500 million. This comes as OMB
Director Russell Vought has cancelled billions of dollars in
previously-awarded research grants, throwing away potential
discoveries of life-saving cures or treatments.
And in keeping with the majority's other partisan bills,
this bill includes the usual poison pill riders, including
multiple provisions that target abortion rights and
reproductive health care services. Policy riders in the bill
create an open season for discrimination against LGBTQI+
individuals, and they prohibit policies and programs intended
to promote diversity in the federal government.
Similar to previous years, these new policy riders will
need to be removed from the bill before it can be enacted.
Full Committee Markup
During full committee markup, House Democrats proposed
amendments to restore funding for Title I Grants to Local
Educational Agencies, Preschool Development Grants, Promise
Neighborhoods, Full Service Community Schools, English Language
Acquisition, Federal Work Study, and Supplemental Educational
Opportunity Grants, but each of the amendments were rejected by
the Republican majority.
House Democrats proposed amendments to restore funding for
HIV/AIDS prevention and treatment, community health centers,
nursing workforce development, tobacco prevention, firearm
injury and mortality prevention research, substance use
prevention and treatment, criminal and juvenile justice
programs, and senior nutrition, but each of the amendments were
rejected by the Republican majority.
House Democrats proposed amendments to restore funding for
WIOA Adult and Youth Job Training, Job Corps, the Bureau of
International Labor Affairs (ILAB), the Women's Bureau, and the
Federal Mediation and Conciliation Service, but each of the
amendments were rejected by the Republican majority.
House Democrats proposed amendments to restore funding for
the Corporation for Public Broadcasting, but it was rejected by
the Republican majority.
In addition, House Democrats proposed an amendment to
prohibit CDC from removing vaccines from the Child and
Adolescent Immunization Schedule, as well as an amendment to
prohibit CDC from making any changes that would reduce no-cost
coverage of vaccines by federal or private health insurance
plans, but both amendments were rejected by the Republican
majority.
Finally, House Democrats proposed amendments to strike
harmful policy riders that do not belong in the Labor-HHS-
Education appropriations bill, including the Hyde and Weldon
amendments, the prohibition on funding for Planned Parenthood
clinics, and multiple poison pill riders that target abortion
rights and reproductive health care services, but each of the
amendments were rejected by the Republican majority.
Impoundment
This bill has been considered during a time of remarkable
upheaval for the Committee. Since taking office in January 2025
the executive branch has been engaged in a rampant, unlawful,
and unconstitutional disregard for spending laws. In
particular, the Office of Management and Budget has been at the
center of a government-wide effort to thwart the intent of this
Committee's laws in its actions, while also unlawfully refusing
to publish the agency's legally-binding budget decisions (known
as apportionments) in contravention of an unambiguous and
constitutionally sound assertion of the Congress's authority to
impose transparency requirements upon the executive branch.
The current executive branch has contended--at times--an
inherent Presidential power to impound. However, while this
bill was approved over the objection of all Democrats on the
Committee, the debate and proceedings made unmistakably clear,
just as former Chief Justice of the Supreme Court of the United
States William Rehnquist concluded (at the time an Assistant
Attorney General with the Department of Justice Office):
``With respect to the suggestion that the President
has a constitutional power to decline to spend
appropriated funds, we must conclude that existence of
such a broad power is supported by neither reason nor
precedent.''
The current Administration's unfounded views of their
purported authorities peaked one week before this bill was
considered when the President transmitted a second special
message of proposed rescission under the Impoundment control
Act of 1974 to the Congress. The Office of Management and
Budget followed that message--sent 34 days before the end of
the fiscal year--by issuing an apportionment to freeze all of
the funding proposed for rescission and has publicly stated
that it intends to keep those funds frozen through their
expiration, describing their request to Congress as a ``pocket
rescission.'' This action is unlawful, and the Government
Accountability Office's 2018 legal opinion remains the correct
view on the matter:
``We conclude that the [Impoundment Control Act of
1974] ICA does not permit the impoundment of funds
through their date of expiration. The plain language of
the ICA permits only the temporary withholding of
budget authority and provides that unless Congress
rescinds the amounts at issue, they must be made
available for obligation. Amounts proposed for
rescission must be made available for prudent
obligation before the amounts expire, even where the
45-day period provided in the ICA approaches or spans
the date on which funds would expire.''
GAO B-33030, December 10, 2018
The laws considered and enacted by this Committee reflect
the legally binding expression of Congress's constitutional
power of the purse, effectuated through the conditions and
permissions the Committee places on spending authority through
the Congress's Article I powers. Just as the Committee chooses
to allow or restrict the purpose for any funds in the bill, so
too does the Committee decide the amount for which an activity
shall be funded. When the Committee allows the flexibility of
merely mandating a ceiling (or upper limit) or a floor (lowest
required level) for an activity, it does so in contrast to
every other instance where it has included a specific amount,
which unless otherwise stated is Congress's clear intent to be
both a floor and a ceiling.
These perspectives are both uncontroversial and
longstanding principles on which all of the Committee's work
rests.
Conclusion
Instead of addressing the cost-of-living crisis, this bill
continues the Republican Party's multi-year effort to dismantle
the nation's health care and public education systems--so I
cannot support it.
This bill, like the 11 other appropriations bills, will
need support from Republicans and Democrats in the House and
Senate in order to become law.
Despite my opposition to the current bill, I look forward
to working with Chairman Cole and Chairman Aderholt through
this year's appropriations process to produce a responsible
bill that both parties can support.
Rosa L. DeLauro.
Full Committee Votes
Pursuant to the provisions of clause 3(b) of rule XIII of
the House of Representatives, the results of each roll call
vote on an amendment or on the motion to report, together with
the names of those voting for and those against, are printed
below:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Comparative Statement of Budget Authority
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and section 308(a)(1)(A) of the
Congressional Budget Act of 1974, the following table compares
the levels of new budget authority provided in the bill with
the appropriate allocation under section 302(b) of the Budget
Act.
Funding amounts displayed under the FY 2025 Estimate column
reflect FY 2025 Operating Plans and other available
information. Some funding amounts displayed under the FY 2026
Request column are displayed in accordance with the programs
and accounts under current law and may not be directly
comparable to the display in the FY 2026 budget request
submitted by the Office and Management and Budget.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
BUDGETARY IMPACT OF THE DEPARTMENTS OF LABOR, HEALTH AND HUMAN
SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL,
2026, PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE
PURSUANT TO SECTION 308(A) OF THE CONGRESSIONAL BUDGET ACT OF 1974
[IN MILLIONS OF DOLLARS]
COMPARISON WITH BUDGET RESOLUTION
Pursuant to clause 3(c)(2) of rule XIII of the Rules of the
House of Representatives and section 308(a)(1)(A) of the
Congressional Budget Act of 1974, the following table compares
the levels of new budget authority provided in the bill with
the appropriate allocation under section 302(b) of the Budget
Act:
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
302(b) Allocation This Bill
---------------------------------------------------------------
Budget Budget
Authority Outlays Authority Outlays
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee
allocations to its subcommittees: Subcommittee
on Labor, Health and Human Services, and
Education, and Related Agencies:
Discretionary............................... $187,245 .............. $187,245 \1\$233,405
Mandatory................................... .............. .............. 1,362,476 \1\1,353,213
----------------------------------------------------------------------------------------------------------------
\1\Includes outlays from prior-year budget authority.
FIVE-YEAR OUTLAY PROJECTIONS
Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(A) of the Congressional Budget Act of 1974, the
following table contains five-year projections associated with
the budget authority provided in the accompanying bill as
provided to the Committee by the Congressional Budget Office:
[In millions of dollars]
------------------------------------------------------------------------
Outlays
------------------------------------------------------------------------
Projection of outlays associated with the
recommendation:
2026............................................. \1\$1,416,168
2027............................................. 103,940
2028............................................. 24,844
2029............................................. 5,830
2030 and future years............................ 1,209
------------------------------------------------------------------------
\1\ Excludes outlays from prior-year budget authority.
FINANCIAL ASSISTANCE TO STATE AND LOCAL GOVERNMENTS
Pursuant to clause 3(c)(2) of rule XIII and section
308(a)(1)(A) of the Congressional Budget Act of 1974, the
Congressional Budget Office has provided the following
estimates of new budget authority and outlays provided by the
accompanying bill for financial assistance to State and local
governments:
[In millions of dollars]
------------------------------------------------------------------------
Budget Authority Outlays
------------------------------------------------------------------------
Financial Assistance to State and $582,734 \1\$732,016
local governments for 2026.......
------------------------------------------------------------------------
\1\ Excludes outlays from prior-year budget authority.
Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII of the Rules of the
House of Representatives, the following is a statement of
general performance goals and objectives for which this measure
authorizes funding:
The Committee on Appropriations considers program
performance, including a program's success in
developing and attaining outcome-related goals and
objectives, in developing funding recommendations.
Program Duplication
No provision of this bill establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Committee Hearings
Pursuant to clause 3(c)(6) of rule XIII of the Rules of the
House of Representatives, the following hearings were used to
develop or consider the Labor, Health and Human Services, and
Education, and Related Agencies Appropriations Bill, 2024:
The Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies held a hearing on February 12,
2025, entitled ``Career Ready Students: Innovations from
Community Colleges and the Private Sector.'' The Subcommittee
received testimony from:
Preston Cooper, Senior Fellow, American Enterprise
Institute,
Dr. Vicki Karolewics, President, Wallace State
Community College,
Dennis Parker, Consultant for Regional Talent
Development, Toyota Motor North America, and
Dr. Mary Alice McCarthy, Senior Director, Center on
Education & Labor, New America.
The Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies held a hearing on February 26,
2025, entitled ``Federal Investments in Elementary Education.''
The Subcommittee received testimony from:
Virginia Gentles, Director, Defense of Freedom
Institute for Policy Studies,
Dr. Lindsey Burke, Director of Education Policy, The
Heritage Foundation,
Robert Kim, Executive Director, Education Law Center,
and
Ms. Starlee Coleman, President and CEO, National
Alliance for Public Charter Schools.
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a hearing on March 5,
2025, entitled ``Member Day.'' The Subcommittee received
testimony from:
The Honorable Glenn Thompson, and
The Honorable Seth Magaziner.
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a hearing on April 9,
2025, entitled ``Public Witness Day.'' The Subcommittee
received testimony from:
Jessica Pescatore, Clinical Director Alabama Poison
Information Center, America's Poison Centers,
Jennifer Carroll, Assistant Director, Community
Action Partnership of North Alabama,
Michelle Sie Whitten, Executive Director, The Global
Down Syndrome Foundation,
Christopher French, Co-Chair and Senior Vice
President, Alliance for BioSecurity,
Christopher M. Kramer, President, American College of
Cardiology,
Rey Saldana, President and CEO, Communities in
Schools,
Theresa Sokol, Louisiana State Epidemiologist, Board
Member, Council of State and Territorial
Epidemiologists,
Sara Schapiro, Executive Director, Alliance for
Learning Innovation,
Dr. Scott Harris, State Health Officer of the Alabama
Department of Health, President, Association of State
and Territorial Health Officials,
Dr. Colleen Kelley, Chair, HIV Medicine Association.
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a budget hearing on May
14, 2025, entitled ``Fiscal Year 2026 Request for the
Department of Health and Human Services.'' The Subcommittee
received testimony from:
The Honorable Robert F. Kennedy Jr., Secretary,
Department of Health and Human Services.
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a budget hearing on May
21, 2025, entitled ``Fiscal Year 2026 Request for the United
States Department of Labor.'' The Subcommittee received
testimony from:
The Honorable Lori Chavez-DeRemer, Secretary,
Department of Labor.
The Subcommittee on Labor, Health and Human Services, and
Education, and Related Agencies held a budget hearing on May
21, 2025, entitled ``Fiscal Year 2026 Request for the United
States Department of Education.'' The Subcommittee received
testimony from:
The Honorable Linda McMahon, Secretary, Department of
Education.
Compliance With Rule XIII, Cl. 3(d) (Ramseyer Rule)
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
Compliance With Rule XIII, Cl. 3(e) (Ramseyer Rule)
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
ACT OF MARCH 4, 1913
(Public Law 62-141)
AN ACT To create a Department of Labor.
* * * * * * *
Sec. 11. That this Act (except for section 12) shall take
effect March fourth, nineteen hundred and thirteen, and all
Acts or parts of Acts inconsistent with this Act are hereby
repealed.
SEC. 12. SECURITY DETAIL.
(a) In General.--The Secretary of Labor is authorized to
employ law enforcement officers or special agents to provide--
(1) protection for the Secretary and Deputy Secretary
during the performance of official duties by each such
officer and during any activity that is preliminary or
postliminary to the performance of official duties by
each such officer;
(2) protection, incidental to the protection provided
pursuant to paragraph (1), to an individual
accompanying each such officer who is participating in
an activity or event relating to the official duties of
each such officer when there is an articulable threat
to such individual;
(3) continuous protection to the Secretary and Deputy
Secretary (including during periods not described in
paragraph (1)) if there is an articulable threat of
physical harm, in accordance with guidelines
established by the Secretary; and
(4) protection of another senior officer (including a
person nominated to be the Secretary during the
pendency of such nomination) if there is an articulable
threat of physical harm, in accordance with guidelines
established by the Secretary.
(b) Authorities of the Protective Operation.--
(1) In general.--The Secretary may authorize officers
or special agents employed pursuant to subsection (a)--
(A) to carry firearms;
(B) to conduct criminal investigations into
potential threats to the security of persons
protected under this section;
(C) to make arrests without a warrant for any
offense against the United States committed in
the presence of such officer or special agent;
(D) to perform protective intelligence work,
including identifying and mitigating potential
threats and conducting advance work to review
security matters relating to sites and events;
and
(E) coordinate with local law enforcement
agencies.
(2) Guidelines.--The authority provided by this
section shall be exercised in accordance with any--
(A) guidelines issued by the Attorney
General; and
(B) such additional guidelines as may be
issued by the Secretary.
(c) Exception.--The authorities granted under this section
may be exercised notwithstanding section 1343(b)(1) of Title
31.
----------
COMMUNITY SERVICES BLOCK GRANT ACT
Subtitle B--Community Services Block Grant Program
* * * * * * *
SEC. 675C. USES OF FUNDS.
(a) Grants to Eligible Entities and Other Organizations.--
(1) In general.--Not less than 90 percent of the
funds made available to a State under section 675A or
675B shall be used by the State to make grants for the
purposes described in section 672 to eligible entities.
(2) Obligational authority.--Funds distributed to
eligible entities through grants made in accordance
with paragraph (1) for a fiscal year shall be available
for obligation during that fiscal year and the
succeeding fiscal year[, subject to paragraph (3)].
[(3) Recapture and redistribution of unobligated
funds.--
[(A) Amount.--Beginning on October 1, 2000, a
State may recapture and redistribute funds
distributed to an eligible entity through a
grant made under paragraph (1) that are
unobligated at the end of a fiscal year if such
unobligated funds exceed 20 percent of the
amount so distributed to such eligible entity
for such fiscal year.
[(B) Redistribution.--In redistributing funds
recaptured in accordance with this paragraph,
States shall redistribute such funds to an
eligible entity, or require the original
recipient of the funds to redistribute the
funds to a private, nonprofit organization,
located within the community served by the
original recipient of the funds, for activities
consistent with the purposes of this subtitle.]
(b) Statewide Activities.--
(1) Use of remainder.--If a State uses less than 100
percent of the grant or allotment received under
section 675A or 675B to make grants under subsection
(a), the State shall use the remainder of the grant or
allotment under section 675A or 675B (subject to
paragraph (2)) for activities that may include--
(A) providing training and technical
assistance to those entities in need of such
training and assistance;
(B) coordinating State-operated programs and
services, and at the option of the State,
locally-operated programs and services,
targeted to low-income children and families
with services provided by eligible entities and
other organizations funded under this subtitle,
including detailing appropriate employees of
State or local agencies to entities funded
under this subtitle, to ensure increased access
to services provided by such State or local
agencies;
(C) supporting statewide coordination and
communication among eligible entities;
(D) analyzing the distribution of funds made
available under this subtitle within the State
to determine if such funds have been targeted
to the areas of greatest need;
(E) supporting asset-building programs for
low-income individuals, such as programs
supporting individual development accounts;
(F) supporting innovative programs and
activities conducted by community action
agencies or other neighborhood-based
organizations to eliminate poverty, promote
self-sufficiency, and promote community
revitalization;
(G) supporting State charity tax credits as
described in subsection (c); and
(H) supporting other activities, consistent
with the purposes of this subtitle.
(2) Administrative cap.--No State may spend more than
the greater of $55,000, or 5 percent, of the grant
received under section 675A or State allotment received
under section 675B for administrative expenses,
including monitoring activities. Funds to be spent for
such expenses shall be taken from the portion of the
grant under section 675A or State allotment that
remains after the State makes grants to eligible
entities under subsection (a). The cost of activities
conducted under paragraph (1)(A) shall not be
considered to be administrative expenses. The startup
cost and cost of administrative activities conducted
under subsection (c) shall be considered to be
administrative expenses.
(c) Charity Tax Credit.--
(1) In general.--Subject to paragraph (2), if there
is in effect under State law a charity tax credit, the
State may use for any purpose the amount of the
allotment that is available for expenditure under
subsection (b).
(2) Limit.--The aggregate amount a State may use
under paragraph (1) during a fiscal year shall not
exceed 100 percent of the revenue loss of the State
during the fiscal year that is attributable to the
charity tax credit, as determined by the Secretary of
the Treasury without regard to any such revenue loss
occurring before January 1, 1999.
(3) Definitions and rules.--In this subsection:
(A) Charity tax credit.--The term ``charity
tax credit'' means a nonrefundable credit
against State income tax (or, in the case of a
State that does not impose an income tax, a
comparable benefit) that is allowable for
contributions, in cash or in kind, to qualified
charities.
(B) Qualified charity.--
(i) In general.--The term ``qualified
charity'' means any organization--
(I) that is--
(aa) described in
section 501(c)(3) of
the Internal Revenue
Code of 1986 and exempt
from tax under section
501(a) of such Code;
(bb) an eligible
entity; or
(cc) a public housing
agency as defined in
section 3(b)(6) of the
United States Housing
Act of 1937 (42 U.S.C.
1437a(b)(6));
(II) that is certified by the
appropriate State authority as
meeting the requirements of
clauses (iii) and (iv); and
(III) if such organization is
otherwise required to file a
return under section 6033 of
such Code, that elects to treat
the information required to be
furnished by clause (v) as
being specified in section
6033(b) of such Code.
(ii) Certain contributions to
collection organizations treated as
contributions to qualified charity.--
(I) In general.--A
contribution to a collection
organization shall be treated
as a contribution to a
qualified charity if the donor
designates in writing that the
contribution is for the
qualified charity.
(II) Collection
organization.--The term
``collection organization''
means an organization described
in section 501(c)(3) of such
Code and exempt from tax under
section 501(a) of such Code--
(aa) that solicits
and collects gifts and
grants that, by
agreement, are
distributed to
qualified charities;
(bb) that distributes
to qualified charities
at least 90 percent of
the gifts and grants
the organization
receives that are
designated for such
qualified charities;
and
(cc) that meets the
requirements of clause
(vi).
(iii) Charity must primarily assist
poor individuals.--
(I) In general.--An
organization meets the
requirements of this clause
only if the appropriate State
authority reasonably expects
that the predominant activity
of such organization will be
the provision of direct
services within the United
States to individuals and
families whose annual incomes
generally do not exceed 185
percent of the poverty line in
order to prevent or alleviate
poverty among such individuals
and families.
(II) No recordkeeping in
certain cases.--An organization
shall not be required to
establish or maintain records
with respect to the incomes of
individuals and families for
purposes of subclause (I) if
such individuals or families
are members of groups that are
generally recognized as
including substantially only
individuals and families
described in subclause (I).
(III) Food aid and homeless
shelters.--Except as otherwise
provided by the appropriate
State authority, for purposes
of subclause (I), services to
individuals in the form of--
(aa) donations of
food or meals; or
(bb) temporary
shelter to homeless
individuals;
shall be treated as provided to
individuals described in
subclause (I) if the location
and provision of such services
are such that the service
provider may reasonably
conclude that the beneficiaries
of such services are
predominantly individuals
described in subclause (I).
(iv) Minimum expense requirement.--
(I) In general.--An
organization meets the
requirements of this clause
only if the appropriate State
authority reasonably expects
that the annual poverty program
expenses of such organization
will not be less than 75
percent of the annual aggregate
expenses of such organization.
(II) Poverty program
expense.--For purposes of
subclause (I)--
(aa) In general.--The
term ``poverty program
expense'' means any
expense in providing
direct services
referred to in clause
(iii).
(bb) Exceptions.--
Such term shall not
include any management
or general expense, any
expense for the purpose
of influencing
legislation (as defined
in section 4911(d) of
the Internal Revenue
Code of 1986), any
expense for the purpose
of fundraising, any
expense for a legal
service provided on
behalf of any
individual referred to
in clause (iii), any
expense for providing
tuition assistance
relating to compulsory
school attendance, and
any expense that
consists of a payment
to an affiliate of the
organization.
(v) Reporting requirement.--The
information required to be furnished
under this clause about an organization
is--
(I) the percentages
determined by dividing the
following categories of the
organization's expenses for the
year by the total expenses of
the organization for the year:
expenses for direct services,
management expenses, general
expenses, fundraising expenses,
and payments to affiliates; and
(II) the category or
categories (including food,
shelter, education, substance
abuse prevention or treatment,
job training, or other) of
services that constitute
predominant activities of the
organization.
(vi) Additional requirements for
collection organizations.--The
requirements of this clause are met if
the organization--
(I) maintains separate
accounting for revenues and
expenses; and
(II) makes available to the
public information on the
administrative and fundraising
costs of the organization, and
information as to the
organizations receiving funds
from the organization and the
amount of such funds.
(vii) Special rule for states
requiring tax uniformity.--In the case
of a State--
(I) that has a constitutional
requirement of tax uniformity;
and
(II) that, as of December 31,
1997, imposed a tax on personal
income with--
(aa) a single flat
rate applicable to all
earned and unearned
income (except insofar
as any amount is not
taxed pursuant to tax
forgiveness
provisions); and
(bb) no generally
available exemptions or
deductions to
individuals;
the requirement of paragraph (2) shall
be treated as met if the amount of the
credit described in paragraph (2) is
limited to a uniform percentage (but
not greater than 25 percent) of State
personal income tax liability
(determined without regard to credits).
(4) Limitation on use of funds for startup and
administrative activities.--Except to the extent
provided in subsection (b)(2), no part of the aggregate
amount a State uses under paragraph (1) may be used to
pay for the cost of the startup and administrative
activities conducted under this subsection.
(5) Prohibition on use of funds for legal services or
tuition assistance.--No part of the aggregate amount a
State uses under paragraph (1) may be used to provide
legal services or to provide tuition assistance related
to compulsory education requirements (not including
tuition assistance for tutoring, camps, skills
development, or other supplemental services or
training).
(6) Prohibition on supplanting funds.--No part of the
aggregate amount a State uses under paragraph (1) may
be used to supplant non-Federal funds that would be
available, in the absence of Federal funds, to offset a
revenue loss of the State attributable to a charity tax
credit.
* * * * * * *
SEC. 680. DISCRETIONARY AUTHORITY OF THE SECRETARY.
(a) Grants, Contracts, Arrangements, Loans, and Guarantees.--
(1) In general.--The Secretary shall, from funds
reserved under section 674(b)(3), make grants, loans,
or guarantees to States and public agencies and
private, nonprofit organizations, or enter into
contracts or jointly financed cooperative arrangements
with States and public agencies and private, nonprofit
organizations (and for-profit organizations, to the
extent specified in paragraph (2)(E)) for each of the
objectives described in paragraphs (2) through (4).
(2) Community economic development.--
(A) Economic development activities.--The
Secretary shall make grants described in
paragraph (1) on a competitive basis to
private, nonprofit organizations that are
community development corporations to provide
technical and financial assistance for economic
development activities designed to address the
economic needs of low-income individuals and
families by creating employment and business
development opportunities.
(B) Consultation.--The Secretary shall
exercise the authority provided under
subparagraph (A) after consultation with other
relevant Federal officials.
(C) Governing boards.--For a community
development corporation to receive funds to
carry out this paragraph, the corporation shall
be governed by a board that shall consist of
residents of the community and business and
civic leaders and shall have as a principal
purpose planning, developing, or managing low-
income housing or community development
projects.
(D) Geographic distribution.--In making
grants to carry out this paragraph, the
Secretary shall take into consideration the
geographic distribution of funding among States
and the relative proportion of funding among
rural and urban areas.
(E) Reservation.--Of the amounts made
available to carry out this paragraph, the
Secretary may reserve not more than 1 percent
for each fiscal year to make grants to private,
nonprofit organizations or to enter into
contracts with private, nonprofit or for-profit
organizations to provide technical assistance
to aid community development corporations in
developing or implementing activities funded to
carry out this paragraph and to evaluate
activities funded to carry out this paragraph.
(F) Uses of funds.--Funds made available to
carry out this paragraph may be used for
financing construction and rehabilitation, and
for loans or investments, in private business
enterprises, including those owned by community
development corporations.
(G) Ownership of intangible property and
earnings.--The Secretary shall establish
procedures regarding the disposition of
intangible assets and program income that
permit such assets acquired with, and program
income derived from, grants made under this
paragraph, to become the sole property of the
grantees after a period of not more than 12
years after the end of the grant period for any
activity consistent with subsection (a)(2)(A).
(H) Use of intangible assets.--Intangible
assets in the form of loans, equity investments
and other debt instruments, and program income
may be used by grantees for any eligible
purpose consistent with subsection (a)(2)(A).
(3) Rural community development activities.--The
Secretary shall provide the assistance described in
paragraph (1) for rural community development
activities, which shall include providing--
(A) grants to private, nonprofit corporations
to enable the corporations to provide
assistance concerning home repair to rural low-
income families and concerning planning and
developing low-income rural rental housing
units; and
(B) grants to multistate, regional, private,
nonprofit organizations to enable the
organizations to provide training and technical
assistance to small, rural communities
concerning meeting their community facility
needs.
(4) Neighborhood innovation projects.--The Secretary
shall provide the assistance described in paragraph (1)
for neighborhood innovation projects, which shall
include providing grants to neighborhood-based private,
nonprofit organizations to test or assist in the
development of new approaches or methods that will aid
in overcoming special problems identified by
communities or neighborhoods or otherwise assist in
furthering the purposes of this subtitle, and which may
include providing assistance for projects that are
designed to serve low-income individuals and families
who are not being effectively served by other programs.
(b) Evaluation.--The Secretary shall require all activities
receiving assistance under this section to be evaluated for
their effectiveness. Funding for such evaluations shall be
provided as a stated percentage of the assistance or through a
separate grant awarded by the Secretary specifically for the
purpose of evaluation of a particular activity or group of
activities.
(c) Annual Report.--The Secretary shall compile an annual
report containing a summary of the evaluations required in
subsection (b) and a listing of all activities assisted under
this section. The Secretary shall annually submit the report to
the Chairperson of the Committee on Education and the Workforce
of the House of Representatives and the Chairperson of the
Committee on Labor and Human Resources of the Senate.
* * * * * * *
----------
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS
* * * * * * *
Part B--Miscellaneous Provisions
* * * * * * *
SEC. 245A. CIVIL ACTION FOR CERTAIN VIOLATIONS.
(a) In General.--A qualified party may, in a civil action,
obtain appropriate relief with regard to a designated
violation.
(b) Definitions.--For purposes of this section:
(1) Designated violation.--The term ``designated
violation'' means an actual or threatened violation
of--
(A) section 507(d) of division D of the
Further Consolidated Appropriations Act, 2024
(or any subsequent substantially similar
provision); or
(B) any funding condition imposed by the
Federal Government pursuant to such section
507(d) (or such substantially similar
provision).
(2) Qualified party.--The term ``qualified party''
means--
(A) the Attorney General of the United
States;
(B) any attorney general of a State; or
(C) any person or entity adversely affected
by the designated violation without regard to
whether such person or entity is a health care
provider.
(3) State governmental entity.--The term ``State
governmental entity'' means a State, a local government
within a State, and any agency or other governmental
unit or subdivision of a State, or of such a local
government.
(c) Administrative Remedies Not Required.--An action under
this section may be commenced, and relief may be granted,
without regard to whether the party commencing the action has
sought or exhausted any available administrative remedies.
(d) Defendants.--An action under this section may be
maintained against a Federal agency committing a designated
violation described in subsection (b)(1)(A) or any recipient or
subrecipient of Federal assistance committing a designated
violation described in subsection (b)(1)(B), including a State
governmental entity.
(e) Nature of Relief.--In an action under this section, the
court shall grant--
(1) all appropriate relief, including injunctive
relief, declaratory relief, and compensatory damages,
to prevent the occurrence, continuance, or repetition
of the designated violation and to compensate for
losses resulting from the designated violation; and
(2) to a prevailing plaintiff, reasonable attorneys'
fees and litigation costs.
Relief in an action under this section may include money
damages even if the defendant is a governmental entity.
(f) Abrogation of State Immunity.--No State or governmental
official that commits a designated violation shall be immune
under the Tenth Amendment to the Constitution of the United
States, the Eleventh Amendment to the Constitution of the
United States, or any other source of law, from an action under
subsection (a).
* * * * * * *
TITLE VII--HEALTH PROFESSIONS EDUCATION
* * * * * * *
PART D--INTERDISCIPLINARY, COMMUNITY-BASED LINKAGES
* * * * * * *
SEC. 752. CONTINUING EDUCATIONAL SUPPORT FOR HEALTH PROFESSIONALS
SERVING IN RURAL AND UNDERSERVED COMMUNITIES.
(a) In General.--The Secretary, as appropriate, shall make
grants to, and enter into contracts with, eligible entities to
support access to accredited continuing medical education for
primary care physicians and health care providers at community
health centers or rural health clinics to improve and increase
access to care for patients in rural and medically underserved
areas. Such grants or contracts may be used to improve health
care, increase retention, increase representation of minority
health care providers, enhance the practice environment,
increase primary care physician and health care provider
knowledge, and provide information dissemination and
educational support to reduce professional isolation through
the timely dissemination of research findings using relevant
resources.
(b) Eligible Entities.--For purposes of this section, the
term ``eligible entity'' means an entity described in section
799(b), such as a community health center or rural health
clinic.
(c) Application.--An eligible entity desiring to receive an
award under this section shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
(d) Use of Funds.--
(1) In general.--An eligible entity shall use amounts
awarded under a grant or contract under this section to
provide innovative supportive activities to enhance
education for primary care physicians and health care
providers described in subsection (a) through distance
learning, continuing educational activities,
collaborative conferences, and electronic and
telelearning activities, with priority for primary care
providers who are seeking additional education in
specialty fields such as infectious disease,
endocrinology, pediatrics, mental health and substance
use disorders, pain management, geriatrics, and other
areas, as appropriate, in order to--
(A) improve retention of primary care
physicians and health care providers and
increase access to specialty health care
services for patients; and
(B) support access to the integration of
specialty care through existing service
delivery locations and care across settings.
(2) Clarification.--Entities may use amounts awarded
under a grant or contract under this section for
continuing educational activities that include a
clinical training component, including in-person
patient care, in the respective community health center
or rural health clinic, with the primary care physician
or health care provider at such site and the clinical
specialist from whom such additional training is being
provided.
(e) Administrative Expenses.--An entity that revives a grant
or contract under this section shall use not more than 5
percent of the amounts received under the grant or contract
under this section for administrative expenses.
(f) Non-duplication of Effort.--The Secretary shall ensure
that activities under this section do not unnecessarily
duplicate efforts of other programs overseen by the Health
Resources and Services Administration, including activities
described in section 330N.
(g) Authorization.--There is authorized to be appropriated to
carry out this section $5,000,000 for each of [fiscal years
2023 through 2025] fiscal years 2026 through 2028.
* * * * * * *
Changes in the Application of Existing Law
Pursuant to clause 3(f)(1)(A) of rule XIII of the Rules of
the House of Representatives, the following statements are
submitted describing the effect of provisions in the
accompanying bill that directly or indirectly change the
application of existing law.
The bill includes a number of provisions which place
limitations on the use of funds in the bill or change existing
limitations and that might, under some circumstances, be
construed as changing the application of existing law:
TITLE I--DEPARTMENT OF LABOR
Language is included under ``Employment and Training
Administration'' providing that allotments to outlying areas
are not required to be made through the Pacific Region
Educational Laboratory as provided by section 127 of the
Workforce Innovation and Opportunity Act (WIOA).
Language is included under ``Employment and Training
Administration'' providing that outlying areas may submit a
single application for consolidated grant awards and may use
the funds for any of the programs and activities authorized
under subtitle B of title I of WIOA.
Language is included under ``Employment and Training
Administration'' providing amounts made available for
dislocated workers may be used for State activities or across
multiple local areas where workers remain dislocated.
Language is included under ``Employment and Training
Administration'' providing that technical assistance and
demonstration projects may provide assistance to new entrants
in the workforce and incumbent workers.
Language is included under ``Employment and Training
Administration'' providing that the Secretary may reserve a
higher percentage of funds for technical assistance than what
is provided in section 168(b) of the WIOA.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing funds to States
to improve operations and modernize State Unemployment
Insurance systems.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing authority for
States to use funds to assist other States to carry out
authorized activities in cases of a major disaster declared by
the President under the Robert T. Stafford Disaster Relief and
Emergency Assistance Act.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing that the
Department of Labor may make payments on behalf of States for
the use of the National Directory of New Hires.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing that the
Department of Labor may make payments from funds appropriated
for States' grants on behalf of States to the entity operating
the State Information Data Exchange System.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing that
appropriations for establishing a national one-stop career
system may be obligated in contracts, grants or agreements with
States or non-State entities.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing that funds
available for integrated Unemployment Insurance and Employment
Service automation may be used by States notwithstanding cost
allocation principles prescribed under the Office of Management
and Budget ``Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards.''
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' providing that the
Department of Labor may reallot funds among States
participating in a consortium.
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' allowing the Secretary to
collect fees for the costs associated with additional data
collection, analyses, and reporting services related to the
National Agricultural Workers Survey.
Language is included under ``Veterans' Employment and
Training'' providing that funds may be used for support
specialists providing intensive services to wounded service
members, spouses or other family caregivers of the service
member, and to Gold Star Spouses.
Language is included under ``Veterans' Employment and
Training'' providing that the Department may award grants under
section 2023 of Title 38, United States Code.
Language is included under ``Veterans' Employment and
Training'' providing that services may be provided to certain
homeless or recently incarcerated veterans under section 2021,
2021A, and 2023 of Title 38, United States Code.
Language is included under ``Veterans' Employment and
Training'' providing that the fees assessed pursuant to the
HIRE Vets Medallion Award Fund shall be available to the
Secretary for expenses of the HIRE Vets Medallion Award Program
and that the start date prescribed in the Act shall not apply.
Language is included under ``Special Benefits'' providing
that the Department of Labor may use authority to reimburse an
employer who is not the employer at the time of injury for
portions of the salary of a reemployed, disabled beneficiary.
Language is included under ``Special Benefits'' providing
that funds shall be transferred to the appropriation from
entities required under 5 U.S.C. 8147(c) as determined by the
Department of Labor.
Language is included under ``Special Benefits'' providing
that of funds transferred from entities under 5 U.S.C. 8147(c),
specified amounts may be used by the Department of Labor for
maintenance and data and communications systems, workload
processing, roll disability management and medical review, and
program integrity with remaining amounts paid into the
Treasury.
Language is included under ``Special Benefits'' providing
that the Secretary may prescribe regulations requiring
identification for the filing of benefit claims.
Language is included under ``Administrative Expenses,
Energy Employees Occupational Illness Compensation Fund''
providing that the Secretary may prescribe regulations for
requiring identification for the filing of benefit claims.
Language is included under ``Occupational Safety and Health
Administration'' providing that up to a certain amount of fees
collected from the training institute may be retained and used
for related training and education.
Language is included under ``Occupational Safety and Health
Administration'' providing that fees collected from Nationally
Recognized Testing Laboratories may be used to administer
laboratory recognition programs that ensure safety of equipment
used in the workplace.
Language is included under ``Mine Safety and Health
Administration'' providing that a specific amount may be
collected by the National Mine Health and Safety Academy and
made available for mine safety and health education and
training.
Language is included under ``Mine Safety and Health
Administration'' providing that a specific amount may be
collected from the approval and certification of equipment and
materials and made available for other such activities.
Language is included under ``Mine Safety and Health
Administration'' providing that the Department of Labor may
accept lands, buildings, equipment, and other contributions
from public and private sources for cooperative projects.
Language is included under ``Mine Safety and Health
Administration'' providing that the Department of Labor may
promote health and safety education and training through
cooperative agreements with States, industry, and safety
associations.
Language is included under ``Mine Safety and Health
Administration'' providing that the Department of Labor may
recognize the Joseph A. Holmes Safety Association as the
principal safety association and may provide funds or personnel
as officers in local chapters or the national organization.
Language is included under ``General Provisions''
prohibiting the use of any funds appropriated for grants under
section 414(c) of the American Competitiveness and Workforce
Improvement Act of 1998, for purposes other than competitive
grants for training individuals over the age of 16 who are not
currently enrolled in school in the occupations and industries
for which employers are using H-1B visa to hire foreign
workers.
Language is included under ``General Provisions'' allowing
the Secretary to furnish a certain amount of excess personal
property to apprenticeship programs through grants, contracts,
and other arrangements.
Language is included under ``General Provisions'' modifying
certain authorities related to the Secretary's security detail.
Language is included under ``General Provisions'' providing
that the Secretary may dispose or divest of certain Job Corps
center property and use the proceeds to carry out the program
in the same geographic location.
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
Language is included under ``Health Resources and Services
Administration--Health Workforce'' overriding the proportional
funding requirements in the Public Health Service Act for
sections 751 and 756.
Language is included under ``Health Resources and Services
Administration--Health Workforce'' providing permissive
authority to the Secretary to waive requirements for entities
awarded funds from sections 751(d)(2)(A) and 751(d)(2)(B).
Language is included under ``Health Resources and Services
Administration--Health Workforce'' providing that fees
collected for the disclosure of information under the
information reporting requirement program authorized by section
1921 of the Social Security Act shall be sufficient to recover
the full costs of the operation program and shall remain
available until expended to carry out that Act.
Language is included under ``Health Resources and Services
Administration--Health Workforce'' allowing funds for the Nurse
Corps and National Health Service Corps Scholarship and Loan
programs to be used to make prior year adjustments.
Language is included under ``Health Resources and Services
Administration--Health Workforce'' providing funding under the
National Health Service Corps Loan Repayment Program for
substance use disorder counselors and placement in Indian
Health Service facilities.
Language is included under ``Health Resources and Services
Administration--Health Workforce'' to provide funds for the
purpose of establishing or expanding optional community-based
nurse practitioner fellowship programs.
Language is included under ``Health Resources and Services
Administration--Health Workforce'' to provide funds for grants
to public institutions of higher education meeting certain
requirements for graduate education for physicians.
Language is included under ``Health Resources and Services
Administration--Rural Health'' to provide funding for State
Offices of Rural Health notwithstanding section 338J(k), which
terminates the program after an aggregate funding amount.
Language is included under ``Centers for Disease Control
and Prevention--CDC-Wide'' related to the implementation of the
Epidemiology-Laboratory Capacity Grant program.
Language is included under ``Centers for Disease Control
and Prevention--Buildings and Facilities'' providing the use of
funds to support acquisition, renovation, or replacement, of
the National Institute Occupational Safety and Health's
underground and surface coal mining research capacity.
Language is included under ``Substance Use And Mental
Health Services Administration--Mental Health'' related to data
infrastructure development.
Language is included under ``Substance Use And Mental
Health Services Administration--Mental Health'' requiring that
5 percent of the Mental Health Block Grant funding be available
to support evidence-based crisis systems.
Language is included under ``Substance Use And Mental
Health Services Administration--Mental Health'' allowing up to
10 percent of the amounts made available to carry out the
Children's Mental Health Services program may be used to carry
out demonstration grants or contracts for early interventions
for people 25 years and younger at high risk of developing a
first episode of psychosis.
Language is included under ``Substance Use And Mental
Health Services Administration--Mental Health'' exempting the
Mental Health Block Grant from the evaluation set-aside in
section 241 of the Public Health Service Act.
Language is included under ``Substance Use And Mental
Health Services Administration--Substance Use Services''
requiring that 4 percent of State Opioid Response grant funding
be made available for Indian Tribes or tribal organizations.
Language is included under ``Administration for Children
and Families--Low Income Home Energy Assistance'' modifying the
formula distribution of funds.
Language is included under ``Administration for Children
and Families--Refugee and Entrant Assistance'' to exempt the
matching requirements of certain funds as required in section
235(c)(6)(C)(iii) of the William Wilberforce Trafficking
Victims Protection Reauthorization Act of 2008.
Language is included under ``Administration for Children
and Families--Payments to States for the Child Care and
Development Block Grant'' increasing the tribal set-aside.
Language is included under ``Administration for Children
and Families--Payments to States for the Child Care and
Development Block Grant'' to make amounts available for Federal
administrative expenses.
Language is included under ``Administration for Children
and Families--Children and Families Services Programs'' related
to the calculation of base grants, the Tribal Colleges and
Universities Head Start Partnership program, and selection
criteria for Head Start programs operated by Indian tribes.
Language is included under ``Administration for Children
and Families--Children and Families Services Programs'' related
to the allocation of funding in the Family Violence Prevention
and Services Act.
Language is included under ``Administration for Community
Living'' to allow funding provided for adult protective
services grants under section 2042 of title XX of the Social
Security Act to be set-aside for Tribes and Tribal
organizations.
Language is included limiting the amount of appropriations
available for the Public Health Service Act Evaluation transfer
to 2.5 percent.
Language is included modifying the timeframe when a
contract may be terminated.
Language is included requiring that providers of Title X
services adhere to State laws requiring notification or the
reporting of child abuse, child molestation, sexual abuse,
rape, or incest.
Language is included prohibiting the Secretary from denying
participation in the Medicare Advantage program to entities who
do not provide coverage or referrals for abortion services.
Language is included limiting assignments of Public Health
Service staff to assist in child survival activities to not
more than 60 employees.
Language is included permitting funding for HHS
international HIV/AIDS and other infectious disease, chronic
and environmental disease, and other health activities abroad
to be spent under the State Department Basic Authorities Act of
1956.
Language is included granting authority to the Office of
the Director of the NIH to enter directly into transactions in
order to implement the NIH Common Fund for medical research and
permitting the Director to utilize peer review procedures as
the Director deems appropriate.
Language is included providing the Biomedical Advanced
Research and Development Authority ten-year contract authority.
Language is included directing the Secretary to consider
current recommendations of the United State Preventive Services
Task Force with respect to breast cancer screening,
mammography, and prevention as if such recommendations were a
reference to such recommendations issued before 2009.
Language is included allowing HHS to cover travel expenses
when necessary for employees to obtain medical care when they
are assigned to duty in a location in response to a public
health emergency.
Language is included limiting the circumstances when the
Secretary may accept donations related to the care of
unaccompanied alien children.
Language is included related to allowed uses of funds in
the Community Services Block Grant program.
Language is included prohibiting funding from being made
available to Planned Parenthood Federation of America or its
affiliates.
Language is included prohibiting funding from being made
available for drugs or surgery that alter bodily sex traits as
interventions for gender dysphoria.
Language is included allowing for civil actions for certain
violations.
TITLE III--DEPARTMENT OF EDUCATION
Language is included under ``Impact Aid'' allowing
continued eligibility for students affected by the deployment
or death of their military parent so long as the children
attend school in the same local education agency they attended
prior to the parent's death or deployment.
Language is included under ``School Improvement Programs''
related to the funding limitation for administrative purposes.
Language is included under ``School Improvement Programs''
related to the funding limitation for administrative purposes.
Language is included under ``Innovation and Improvement''
related to the provision of awards under the Charter School
Program.
Language is included under ``Innovation and Improvement''
related to the provision of awards under the Per-Pupil
Facilities Aid Program.
Language is included under ``Innovation and Improvement''
related to the period of availability of funding awarded under
such section.
Language is included under ``Special Education'' regarding
the factors to be considered by the Secretary when making
formula awards to States.
Language is included under ``Special Education'' outlining
procedures for reducing a State award because of a failure to
meet the maintenance of State financial support requirements of
the Individuals with Disabilities Education Act.
Language is included under ``Special Education'' permitting
States to subgrant funds that they reserve for ``Other State-
Level Activities'' under the Grants to States, Preschool Grants
to States, and Grants for Infants and Families programs.
Language is included under ``Special Education'' to promote
continuity of services for eligible infants and their families.
Language is included under ``Rehabilitation Services''
expanding State allowed uses of funding for funding received
under the Rehabilitation Act.
Language is included under ``Higher Education'' allowing
funds to carry out Title VI of the Higher Education Act to be
used to support visits and study in foreign countries for
participants in advanced foreign countries by individuals who
are participating in advanced foreign language training and
international studies in areas that are vital to United States
national security and who plan to apply their language skills
and knowledge of these countries in the fields of government,
the professions, or international development.
Language is included under ``Higher Education'' stating the
section 313(d) of the Higher Education Act does not apply to an
institution of higher education that is eligible to receive
funding under section 318 of such Act.
Language is included under ``Higher Education'' related to
the provision of awards to institutions of higher education to
assist the institutions in providing campus-based child care
services.
Language is included under ``Higher Education'' allowing
activities authorized under sections 317(c)(2)(B),
319(c)(2)(B), and 320(c)(2)(B) of the Higher Education Act to
include construction and maintenance in classrooms, libraries,
laboratories, and other instructional facilities.
Language is included under ``General Provisions'' allowing
certain institutions to continue to use endowment income for
student scholarships.
Language is included under ``General Provisions'' regarding
the National Advisory Committee on Institutional Quality and
Integrity.
Language is included under ``General Provisions'' regarding
account maintenance fees.
TITLE IV--RELATED AGENCIES
Language is included under ``The Committee for Purchase
from People Who are Blind or Severely Disabled'' requiring that
written agreements, with certain oversight provisions, be in
place in order for authorized fees to be charged by certified
nonprofit agencies.
Language is included under ``Corporation for National and
Community Service'' related to the provision of awards.
Language is included under ``Corporation for National and
Community Service'' allowing the requirements of section
112(c)(1)(D) to be met through a determination of need by the
local community.
Language is included under ``Corporation for National and
Community Service'' related to the grantee minimum share
requirement.
Language is included under ``Corporation for National and
Community Service'' limiting the use of an educational award
under section 148(a)(4) to individuals who are veterans.
Language is included under ``Corporation for National and
Community Service'' related to criminal background checks.
Language is included under ``Corporation for National and
Community Service'' related to education awards.
Language is included under ``National Labor Relations
Board'' related to electronic voting.
Language is included under ``Railroad Retirement Board--
Limitation on Administration'' related to the hiring of
attorneys.
TITLE V--GENERAL PROVISIONS
Language is included related to the use of funds
transferred pursuant to Section 4002 of Public Law 111-148.
Language is included related to public posting requirements
for programs, projects, or activities funded with Federal
funds.
Language is included limiting ability for trust funds
receiving funding appropriated by this act to fund health
benefits coverage that includes abortion.
Language is included related to sincerely held religious
beliefs and moral convictions.
Appropriations Not Authorized by Law
Pursuant to clause 3(f)(1)(B) of rule XIII of the Rules of
the House of Representatives, the following table lists the
appropriations in the accompanying bill which are not
authorized by law for the period concerned:
----------------------------------------------------------------------------------------------------------------
Appropriations in
Agency Program Last Year of Authorization Last Year of Appropriations in
Authorization Level Authorization this Bill
----------------------------------------------------------------------------------------------------------------
DEPARTMENT OF LABOR ETA
Adult Training.............. FY 2020........... $899,987,000...... $854,649,000...... $885,649,000
Dislocated Worker Employment FY 2020........... 1,436,137,000..... 1,052,053,000..... 1,095,553,000
and Training Activities.
Native Americans............ FY 2020........... 54,137,000........ 55,000,000........ 65,000,000
YouthBuild.................. FY 2020........... 91,087,000........ 94,534,000........ 105,000,000
Job Corps................... FY 2020........... 1,983,236,000..... 1,743,655,000..... 880,078,000
One-Stop Career Centers/ FY 2020........... 70,667,000........ 62,653,000........ 52,893,000
Labor Market Information.
DEPARTMENT OF HEALTH AND HUMAN
SERVICES HRSA
School-Based Health Centers. FY 2013........... 50,000,000........ 47,450,000........ 55,000,000
Nurse Practitioner Optional N/A............... N/A............... N/A............... 7,000,000
Fellowship Program.
Medical Student Education... N/A............... N/A............... N/A............... 75,000,000
Early Hearing Detection and FY 2022........... 19,522,758........ 17,818,000........ 18,818,000
Intervention.
Heritable Disorders......... FY 2019........... 19,900,000........ 18,883,000........ 20,883,000
Pediatric Mental Health FY 2022........... 9,000,000......... 10,000,000........ 13,000,000
Access.
Screening and Treatment for FY 2022........... 5,000,000......... 5,000,000......... 13,500,000
Maternal Depression.
Emergency Relief--Part A.... FY 2013........... 789,471,000....... 649,373,000....... 680,752,000
Comprehensive Care--Part B.. FY 2013........... 1,562,169,000..... 1,314,446,000..... 1,364,878,000
Organ Transplantation....... FY 1993........... Such Sums......... 2,767,000......... 54,049,000
Rural Hospital Flexibility FY 2012........... Such Sums......... 41,040,000........ 74,277,000
Grants.
State Offices of Rural FY 2002........... Such Sums......... 4,000,000......... 12,500,000
Health.
CDC
Sexually Transmitted FY 1998........... Such Sums......... 112,117,000....... 30,000,000
Infections.
National Center for Health FY 2003........... Such Sums......... 125,899,000....... 187,397,000
Statistics.
WISEWOMAN................... FY 2003........... Such Sums......... 12,419,000........ 34,620,000
National Cancer Registries.. FY 2003........... Such Sums......... N/A............... 53,440,000
Asthma Surveillance & Grants FY 2005........... Such Sums......... 32,422,000........ 33,500,000
Injury Prevention and FY 2005........... Such Sums......... 138,237,000....... 665,329,000
Control.
Oral Health Promotion....... FY 2005........... Such Sums......... 11,204,000........ 22,250,000
Screening, Referrals, and FY 2005........... 40,000,000........ 36,474,000........ 51,000,000
Education Regarding Lead
Poisoning.
Birth Defects, Developmental FY 2007........... Such Sums......... 122,242,000....... 208,560,000
Disability, Disability and
Health.
Breast and Cervical Cancer.. FY 2012........... 275,000,000....... 204,779,000....... 206,380,000
Public Health Workforce..... FY 2013........... 39,500,000........ 64,000,000........ 71,000,000
National Diabetes Prevention FY 2014........... Such Sums......... 10,000,000........ 40,300,000
Program.
Johanna's Law............... FY 2014........... 18,000,000........ 4,972,000......... 12,000,000
Section 317 Immunization.... FY 2014........... Such Sums......... 610,847,000....... 699,993,000
Young Women's Breast Health FY 2019........... 4,900,000......... 4,960,000......... 6,960,000
Awareness and Support of
Young Women Diagnosed with
Breast Cancer (PHSA 399NN).
Preventive Health Measures FY 2004........... Such Sums......... 14,091,000........ 16,205,000
with regard to Prostate
Cancer.
Combating Antimicrobial FY 2006........... Such Sums......... 17,443,000........ 197,000,000
Resistance.
Newborn Screening Quality FY 2019........... 8,000,000......... 17,250,000........ 21,000,000
Assurance.
Early Hearing Detection and FY 2022........... 11,852,000........ 10,760,000........ 10,760,000
Intervention.
Firefighter Cancer Registry. FY 2022........... 2,500,000......... 2,500,000......... 5,500,000
NIH
National Institutes of FY 2020........... 36,472,442,775.... 40,954,400,000.... 47,845,000,000
Health.
SAMHSA
Protection and Advocacy for FY 2003........... 19,500,000........ 36,146,000........ 40,000,000
Individuals with Mental
Illness.
ACF
Low Income Home Energy FY 2007........... 5,100,000,000..... 2,161,170,000..... 4,035,000,000
Assistance Program.
Child Care and Development FY 2020........... 2,748,591,018..... 5,826,000,000..... 8,746,387,000
Block Grant.
Children and Families
Services Programs.
Adoption and Legal FY 2016........... 43,000,000........ 37,943,000........ 75,000,000
Guardianship Incentive
Payments.
Native American Programs.... FY 2002........... Such Sums......... 45,826,000........ 65,500,000
Community Services Block FY 2003........... Such Sums......... 645,762,000....... 793,000,000
Grant.
Economic Development........ FY 2003........... Such Sums......... 27,082,000........ 22,383,000
Rural Community Development. FY 2003........... Such Sums......... 7,203,000......... 13,000,000
Head Start.................. FY 2012........... Such Sums......... 7,968,544,000..... 12,271,820,000
Runaway and Homeless Youth FY 2013........... Such Sums......... 107,852,000....... 125,283,000
Programs.
CAPTA programs.............. FY 2015........... Such Sums......... 143,981,000....... 105,091,000
Family Violence Programs.... FY 2015........... 178,500,000....... 139,500,000....... 240,000,000
National Domestic Violence FY 2015........... Such Sums......... 4,500,000......... 20,500,000
Hotline.
Child Welfare Services...... FY 2016........... 325,000,000....... 268,735,000....... 268,735,000
Refugee and Entrant
Assistance Programs.
Survivors of Torture........ FY 2007........... 25,000,000........ 9,817,000......... 19,000,000
Anti-Trafficking in Persons FY2021............ 28,755,000........ 28,755,000........ 30,755,000
Programs.
ACL
Lifespan Respite Care....... FY 2011........... 94,810,000........ 2,495,000......... 10,000,000
State Health Insurance FY 1996........... 10,000,000........ N/A............... 55,242,000
Assistance Program.
Developmental Disabilities.. FY 2007........... Such Sums......... 155,115,000....... 190,369,000
Voting Access for People FY 2005........... 17,410,000........ 13,879,000........ 10,000,000
with Disabilities.
Traumatic Brain Injury...... FY 2019........... 8,600,000......... 11,321,000........ 13,118,000
Paralysis Resource Center... FY 2011........... 25,000,000........ 6,352,000......... 10,700,000
Limb Loss................... N/A............... N/A............... N/A............... 4,200,000
Independent Living and the FY 2020........... 214,135,000....... 228,153,000....... 268,183,000
National Institute on
Disability, Independent
Living and Rehabilitation
Research.
ASPR
BARDA....................... FY 2024........... 611,700,000....... 1,015,000......... 1,100,000,000
Strategic National Stockpile FY 2024........... 610,000,000....... 980,000,000....... 1,000,000,000
Pandemic Influenza.......... FY 2024........... 250,000,000....... 315,000,000....... 315,000,000
National Disaster Medical FY 2024........... 57,404,000........ 78,904,000........ 78,904,000
System.
Hospital Preparedness FY 2024........... 385,000,000....... 305,055,000....... 65,055,000
Program.
Medical Reserve Corps....... FY 2024........... 11,200,000........ 6,240,000......... 6,240,000
DEPARTMENT OF EDUCATION
Title I Grants to LEAs...... FY 2020........... 16,182,345,000.... 16,309,802,000.... 14,626,490,000
Innovative Approaches to FY 2020........... 180,014,000....... 27,000,000........ 30,000,000
Literacy.
Comprehensive Literacy FY 2020........... (include in 192,000,000....... 194,000,000
Development. program above).
Impact Aid.................. FY 2020........... 1,388,603,000..... 1,486,112,000..... 1,628,151,000
Supporting Effective FY 2020........... 2,295,830,000..... 2,131,830,000..... 1,681,441,000
Instruction State Grants.
Nita M. Lowey 21st Century FY 2020........... 1,100,000,000..... 1,249,673,000..... 1,329,673,000
Community Learning Centers.
Education for Homeless FY 2020........... 85,000,000........ 101,500,000....... 129,000,000
Children and Youth.
Education for Native FY 2020........... 32,397,000........ 36,897,000........ 45,897,000
Hawaiians.
Alaska Native Education..... FY 2020........... 31,453,000........ 35,953,000........ 44,953,000
Rural Education............. FY 2020........... 169,840,000....... 185,840,000....... 225,000,000
Student Support and Academic FY 2020........... 1,600,000,000..... 1,210,000,000..... 1,385,000,000
Enrichment Grants.
Indian Education Grants to FY 2020........... 106,525,000....... 105,381,000....... 110,381,000
Local Educational Agencies.
Special Programs for Indian FY 2020........... 17,993,000........ 67,993,000........ 72,000,000
Children.
Indian Education National FY 2020........... 5,565,000......... 7,365,000......... 17,365,000
Activities.
Education Innovation and FY 2020........... 90,611,000........ 190,000,000....... 229,000,000
Research.
American History and Civics. FY 2020........... 19,567,000........ 4,815,000......... 23,000,000
Charter Schools Grants...... FY 2020........... 300,000,000....... 440,000,000....... 500,000,000
Magnet Schools.............. FY 2020........... 108,530,000....... 107,000,000....... 139,000,000
School Safety National FY 2020........... 5,000,000......... 105,000,000....... 190,000,000
Activities.
Vocational Rehabilitation FY 2021........... 3,675,021,000..... 3,675,021,000..... 4,504,096,000
State Grants.
Client Assistance State FY 2021........... 14,098,000........ 13,000,000........ 13,000,000
Grants.
Supported Employment State FY 2021........... 32,363,000........ 22,548,000........ 22,548,000
Grants.
Training.................... FY 2021........... 39,540,000........ 29,388,000........ 29,388,000
Demonstration and Training FY 2021........... 6,809,000......... 5,796,000......... 5,796,000
Programs.
Services for Older Blind FY 2021........... 39,141,000........ 33,317,000........ 33,317,000
Individuals.
Protection and Advocacy of FY 2021........... 20,735,000........ 18,150,000........ 20,150,000
Individual Rights.
Helen Keller National Center FY 2004........... Such Sums......... 8,666,000......... 20,000,000
for Deaf-Blind Youths and
Adults.
National Technical Institute FY 2015........... Such Sums......... 67,016,000........ 94,500,000
for the Deaf.
Gallaudet University........ FY 2015........... Such Sums......... 120,275,000....... 168,361,000
Aid for Institutional FY 2015........... Such Sums......... 429,762,000....... 1,031,618,000
Development.
Aid for Hispanic-Serving FY 2015........... Such Sums......... 109,223,000....... 228,890,000
Institutions.
Federal TRIO Programs....... FY 2015........... Such Sums......... 839,752,000....... 1,195,000,000
IDEA National Activities.... FY 2010........... Such Sums......... 260,203,000....... 258,560,000
IDEA Grants for Infants and FY 2010........... Such Sums......... 439,427,000....... 540,000,000
Families.
RELATED AGENCIES
Corporation for National and FY 2014........... Such Sums......... 1,049,954,000..... 183,466,000
Community Service.
----------------------------------------------------------------------------------------------------------------
Transfers of Funds
Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following list includes the
transfers included in the accompanying bill:
TITLE I--DEPARTMENT OF LABOR
JOB CORPS
Language is included under ``Job Corps'' allowing the
transfer of funds from the construction, rehabilitation, and
acquisition account to the operations account.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS
Language is included under ``State Unemployment Insurance
and Employment Service Operations'' which provides for the
transfer of funds to the ``Office of Disability Employment
Policy.''
VETERANS' EMPLOYMENT AND TRAINING
Language is included under ``Veterans' Employment and
Training'' which provides for the reallocation of funds within
``Veterans' Employment and Training'' accounts.
SPECIAL BENEFITS
Language is included under ``Special Benefits'' which
provides for the transfer of funds from the ``Postal Service''
account.
BLACK LUNG DISABILITY TRUST FUND
Language is included under ``Black Lung Disability Trust
Fund'' which provides for the transfer of funds to the ``Office
of Works Compensation Programs,'' ``Departmental Management,''
and ``Inspector General'' salaries and expenses accounts and to
the ``Department of the Treasury, Miscellaneous Expenses''
account.
DEPARTMENTAL MANAGEMENT
Language is included under ``Departmental Management''
which provides for the transfer of funds for program evaluation
to any appropriate account within the Department.
OFFICE OF DISABILITY EMPLOYMENT POLICY
Language is included under ``Office of Disability
Employment Policy'' which provides for the transfer of funds to
``State Unemployment Insurance and Employment Service
Operations.''
GENERAL PROVISIONS
A general provision is included permitting up to one
percent of any discretionary appropriation to be transferred
between an existing program, project, or activity of the
Department of Labor, provided that no program, project, or
activity is increased by more than three percent by any such
transfer.
A general provision is included permitting the transfer of
``Employment and Training Administration'' funds for technical
assistance to ``Program Administration'' when such activities
would be more effectively performed by Federal employees. The
provision also authorizes the transfer of 0.5 percent of
``Employment and Training Administration'' discretionary grants
to ``Program Administration'' for purposes of program integrity
activities.
A general provision is included that allows for the
transfer of up to 0.75 of funds under the ``Training and
Employment Services,'' ``Job Corps,'' ``Community Service
Employment for Older Americans,'' State Unemployment Insurance
and Employment Service Operations,'' Employee Benefits Security
Administration,'' ``Office of Workers Compensation Services,''
Wage and Hour Division,'' Office of Federal Contract Compliance
Programs,'' ``Office of Labor Management Standards,''
Occupational Safety and Health Administration,'' ``Mine Safety
and Health Administration,'' Office of Disability Employment
Policy,'' funds made available for the ``Bureau of
International Labor Affairs'' and ``Women's Bureau'' within the
``Departmental Management, Salaries, and Expenses'' account and
``Veterans' Employment and Training'' accounts to
``Departmental Management'' for purposes of evaluating programs
or activities funded under such accounts.
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR DISEASE CONTROL AND PREVENTION
Language is included under ``Centers for Disease Control
and Prevention, CDC Wide Activities and Program Support'' for
funds to be transferred to and merged with the Infectious
Diseases Rapid Response Reserve Fund.
Language is included under ``Centers for Disease Control
and Prevention, Buildings and Facilitates'' that directs that
prior-year unobligated balances from individual learning
accounts for former employees be credited and merged with the
amounts made available for the replacement of the mine safety
and research facility.
NATIONAL INSTITUTES OF HEALTH
Language is included under the ``National Institutes of
Health, Innovation Account'' to allow the transfer of funds to
other Institutes and Canters to support activities authorized
in the 21st Century Cures Act (PL 114-255).
ADMINISTRATION FOR COMMUNITY LIVING
Language is included under the ``Administration for
Community Living, Aging and Disability Services Programs'' for
the transfer to the Secretary of Agriculture to carry out
section 311 of the Older Americans Act of 1965.
GENERAL PROVISIONS
A general provision that allows up to one percent of any
discretionary funds to be transferred between existing
appropriations accounts of the ``Department of Health and Human
Services,'' provided that no appropriation account is increased
by more than three percent by such transfer.
A general provision is included that allows the transfer of
up to three precent among the institutes and centers of the
``National Institutes of Health'' from amounts identified as
funding research pertaining to the human immunodeficiency
virus.
A general provision is included that allows for the
transfer of funding determined to be related to the human
immunodeficiency virus to the ``Office of AIDS Research.''
A general provision is included that transfers 1 percent of
the amounts made available for the ``National Research Service
Awards'' and the ``National Institutes of Health'' to the
``Health Resources and Services Administration.''
A general provision is included to direct the transfer of
the ``Prevention and Publish Health Fund'' as specified in the
committee report accompanying the Act.
A general provision is included that allows the transfer of
funds related to research on opioid addiction, opioid
alternatives, stimulant misuse and addiction, pain management,
and addiction treatment between the institutes and centers of
the ``National Institute of Health.''
A general provision is included allowing the transfer of
funds from the ``Federal Hospital Insurance Trust Fund'' and
the ``Federal Supplementary Medical Insurance Trust Fund'' to
the ``Centers for Medicare & Medicaid Services--Program
Management'' account for purposes of program management related
to the Medicare program.
A general provision is included allowing the transfer of
funds from the ``Non-recurring Expenses Fund'' to ``General
Departmental Management'' for cybersecurity and allowing for
the transfer of funds into the ``Nonrecurring Expenses Fund.''
TITLE III--DEPARTMENT OF EDUCATION
GENERAL PROVISIONS
A general provision is included that allows not to exceed
one percent of any discretionary funds to be transferred
between existing appropriations accounts of the Department of
Educations, provided that not appropriation accounts is
increased by more than three percent by such transfer.
A general provision is included that allows up to
$13,000,000 of funding made available for ``Institute of
Education Sciences'' to be available for the Secretary of
Education to provide support services to the Institute of
Education Sciences.
A general provision is included that allows the transfer of
funds from the ``Department of Education Nonrecurring Expenses
Fund'' to Student Aid Administration for purposes of
information technology and allowing for the transfer of funds
into the ``Nonrecurring Expenses Fund.''
TITLE IV--RELATED AGENCIES
SOCIAL SECURITY ADMINISTRATION
A provision is included under ``Social Security
Administration, Limitation on Administrative Expenses''
allowing for the transfer of unobligated balances to be
available until expended for information technology and
telecommunications hardware and software infrastructure.
A provision is included under ``Social Security
Administration'' allowing for the transfer of up to $24,600,000
to the ``Social Security Administration, Office of Inspector
General,'' for the costs of jointly operated-co-operative
disability investigation units.
Language is included under ``Office of the Inspector
General'' allowing the transfer of funds from the ``Federal
Old-Age and Survivors Insurance Trust Fund'' and the ``Federal
Disability Trust Fund'' for carrying out provisions of the
Inspector General Act of 1978 as well as allowing the transfer
of funds from ``Social Security Administration--Limitation on
Administrative Expenses'' to ``Social Security Administration--
Office of the Inspector General.''
TITLE V--BILL WIDE GENERAL PROVISIONS
A general provision is included that allows the Secretaries
of Labor, Health and Human Services, and Education to transfer
balances of prior appropriations to accounts corresponding to
current appropriations.
RESCISSIONS OF FUNDS
Pursuant to clause 3(f)(2) of rule XIII of the Rules of the
House of Representatives, the following table lists the
rescissions included in the accompanying bill:
------------------------------------------------------------------------
Program or Activity Amount
------------------------------------------------------------------------
Department of Labor
Employment and Training Administration Adult $712,000,000
Training FY 2025 Advance.........................
Department of Health and Human Services
Nonrecurring Expenses Fund (sec. 234)............. 1,613,000,000
Department of Education
Education for the Disadvantaged FY 2025 Advance... 938,266,000
School Improvement Programs Supporting Effective 1,681,441,000
Instruction State Grants FY 2025 Advance.........
Nonrecurring Expenses Fund (sec. 310)............. 197,000,000
Title V--General Provisions
Child Enrollment Contingency Fund (sec. 528)...... 12,835,000,000
American Rescue Plan Act (sec. 529)............... 183,000,000
------------------------------------------------------------------------
Disclosure of Earmarks and Congressionally Directed Spending Items
Pursuant to clause 9 of rule XXI of the Rules of the House
of Representatives, neither the bill nor this report contains
any congressional earmarks, limited tax benefits, or limited
tariff benefits as defined in clause 9 of rule XXI of the Rules
of the House of Representatives.
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