Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2021
Summary
House Report 116–450 is the report of the Committee on Appropriations, submitted by Ms. DeLauro and ordered to be printed July 15, 2020, with minority views, on H.R. 7614, the bill making appropriations for the Departments of Labor, Health and Human Services, and Education, and related agencies for fiscal year 2021. The report describes the bill as covering the three departments, with exceptions for parts of Health and Human Services, and a list of independent agencies including the Corporation for National and Community Service, the Corporation for Public Broadcasting, the National Labor Relations Board and the Occupational Safety and Health Review Commission. The text read ends in that list of agencies.
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“Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2021.”
Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/crpt-crpt-116hrpt450-crpt-116hrpt450/
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1
116TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
2d Session 116–450
DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS
BILL, 2021
R E P O R T
OF THE
COMMITTEE ON APPROPRIATION
HOUSE OF REPRESENTATIVES
ON
H.R. 7614
together with
MINORITY VIEWS
JULY 15, 2020.—Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
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1
116TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
2d Session 116–450
DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS
BILL, 2021
R E P O R T
OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
ON
H.R. 7614
together with
MINORITY VIEWS
JULY 15, 2020.—Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
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U.S. GOVERNMENT PUBLISHING OFFICE
40–837 WASHINGTON : 2020
E:\Seals\Congress.#13
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116TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
2d Session 116–450
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERV-
ICES, AND EDUCATION, AND RELATED AGENCIES AP-
PROPRIATIONS BILL, 2021
JULY 15, 2020.—Committed to the Committee of the Whole House on the State of
the Union and ordered to be printed
Ms. DELAURO, from the Committee on Appropriations,
submitted the following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 7614]
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 Edu-
cation, and the Committee for Purchase from People Who Are
Blind or Severely Disabled, Corporation for National and Commu-
nity Service, Corporation for Public Broadcasting, Federal Medi-
ation and Conciliation Service, Federal Mine Safety and Health Re-
view Commission, Institute of Museum and Library Services, Med-
icaid and CHIP Payment and Access Commission, Medicare Pay-
ment Advisory Commission, National Council on Disability, Na-
tional Labor Relations Board, National Mediation Board, Occupa-
tional Safety and Health Review Commission, Railroad Retirement
Board, and Social Security Administration for the fiscal year end-
ing September 30, 2021, and for other purposes.
INDEX TO BILL AND REPORT
Page number
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Bill Report
Summary of Estimates and Appropriations ............................................. ........ 3
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Page number
Bill Report
General Summary of the Bill .................................................................... ........ 3
Title I—Department of Labor:
Employment and Training Administration ....................................... 2 12
Employee Benefits Security Administration ..................................... 20 24
Pension Benefit Guaranty Corporation ............................................. 21 24
Wage and Hour Division .................................................................... 22 24
Office of Labor-Management Standards ........................................... 22 26
Office of Federal Contract Compliance Programs ............................ 23 26
Office of Workers’ Compensation Programs ..................................... 23 27
Occupational Safety and Health Administration ............................. 27 29
Mine Safety and Health Administration ........................................... 28 30
Bureau of Labor Statistics ................................................................. 30 31
Office of Disability Employment Policy ............................................. 31 33
Departmental Management ............................................................... 31 33
General Provisions .............................................................................. 36 39
Title II—Department of Health and Human Services:
Health Resources and Services Administration ............................... 46 40
Centers for Disease Control and Prevention .................................... 56 61
National Institutes of Health ............................................................. 63 92
Substance Abuse and Mental Health Services Administration ...... 72 152
Agency for Healthcare Research and Quality ................................... 77 157
Centers for Medicare & Medicaid Services ....................................... 78 159
Administration for Children and Families ........................................ 83 176
Administration for Community Living .............................................. 93 197
Office of the Secretary ........................................................................ 96 205
Public Health and Social Services Emergency Fund ....................... 100 221
General Provisions .............................................................................. 102 228
Title III—Department of Education:
Education for the Disadvantaged ...................................................... 126 232
Impact Aid ........................................................................................... 127 235
School Improvement Programs .......................................................... 128 236
Indian Education ................................................................................. 130 241
Innovation and Improvement ............................................................. 130 242
Safe Schools and Citizenship Education ........................................... 131 248
English Language Acquisition ........................................................... 131 250
Special Education ................................................................................ 132 251
Rehabilitation Services ....................................................................... 136 253
Special Institutions for Persons with Disabilities ............................ 138 255
Career, Technical and Adult Education ............................................ 138 257
Student Financial Assistance ............................................................. 139 259
Federal Direct Student Loan Program Account ............................... ........ 262
Student Aid Administration ............................................................... 139 263
Higher Education ................................................................................ 143 266
Howard University .............................................................................. 144 276
College Housing and Academic Facilities Loans .............................. 144 276
Historically Black College and University Capital Financing Pro-
gram Account ................................................................................... 144 276
Institute of Education Sciences .......................................................... 146 277
Departmental Management ............................................................... 147 279
General Provisions .............................................................................. 148 288
Title IV—Related Agencies:
Committee for the Purchase from People Who Are Blind or Se-
verely Disabled ................................................................................ 162 289
Corporation for National and Community Service ........................... 163 290
Corporation for Public Broadcasting ................................................. 168 293
Federal Mediation and Conciliation Service ..................................... 169 294
Federal Mine Safety and Health Review Commission ..................... 170 295
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Institute of Museum and Library Services ....................................... 170 295
Medicaid and CHIP Payment and Access Commission ................... 170 296
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Page number
Bill Report
Medicare Payment Advisory Commission ......................................... 171 296
National Council on Disability ........................................................... 171 296
National Labor Relations Board ........................................................ 171 297
National Mediation Board .................................................................. 173 299
Occupational Safety and Health Review Commission ..................... 173 300
Railroad Retirement Board ................................................................ 173 300
Social Security Administration .......................................................... 175 301
Title V—General Provisions:
Title VI—Emergency Funding:
House of Representatives Report Requirements ........ ...........
SUMMARY OF ESTIMATES AND APPROPRIATIONS
The following table compares on a summary basis the appropria-
tions, including trust funds for fiscal year 2021, the budget request
for fiscal year 2021, and the Committee recommendation for fiscal
year 2021 in the accompanying bill.
2021 LABOR, HHS, EDUCATION BILL
[Discretionary funding in thousands of dollars]
Fiscal Year— 2021 Committee compared to—
Budget Activity
2020 Enacted 2021 Budget 2021 Committee 2020 Enacted 2021 Budget
Department of Labor ......................... $12,413,848 $11,174,499 $12,667,501 +253,653 +1,493,002
Department of Health and Human
Services ......................................... $94,901,177 $85,267,729 $96,357,874 +1,456,797 +11,090,145
Department of Education .................. $72,751,214 $66,560,692 $73,467,154 +715,940 +6,906,462
Related Agencies ............................... $15,346,861 $14,146,294 $15,507,471 +160,610 +1,361,177
GENERAL SUMMARY OF THE BILL
For fiscal year 2021, the Committee recommends a total of
$182,914,000,000 in current year discretionary funding—the 302(b)
allocation—and $196,546,000,000 in overall programmatic funding,
including offsets and adjustments. The fiscal year 2021 rec-
ommendation is an increase of $2,399,000,000 above the fiscal year
2020 enacted level.
COVID–19 PANDEMIC
The United States and the international community continue to
respond to the deadly COVID–19 pandemic—the worst public
health crisis of the last century.
According to the Centers for Disease Control and Prevention
(CDC), between February 29 and June 30, the U.S. recorded more
than 2.6 million cases of coronavirus and 127,000 deaths due to
COVID–19. Moreover, those figures likely under count the true toll
of the pandemic, due to a shortage of diagnostic testing since the
virus began spreading across our communities in early 2020.
Unfortunately, the Administration’s response to the coronavirus
pandemic has been inconsistent and incoherent.
In a public health emergency, historically, the Federal response
should be led by the CDC, the nation’s foremost public health agen-
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cy, based on science and public health expertise. The Trump Ad-
ministration, however, has sidelined the CDC and downplayed the
recommendations of the world’s foremost public health experts.
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In their place, the Administration has elevated non-expert views
of political appointees in the White House. As a result, the Admin-
istration did not develop a coordinated Federal strategy to contain
the coronavirus, which has resulted in the worst response to the
pandemic of any of the world’s economically-advanced industri-
alized nations.
Other nations, from Germany to South Korea, applied rigorous
public health guidelines to successfully contain the coronavirus.
The U.S., on the other hand, deferred to political operatives and
business leaders to focus on reopening economic activity without re-
gard to public health. As a result, while nations such as New Zea-
land and Japan have contained the coronavirus, the U.S. has suf-
fered approximately one-quarter of COVID–19 deaths across the
globe, despite having less than five percent of the global popu-
lation.
Congress demanded a national strategy for diagnostic testing
and contact tracing to contain the virus and enable Americans to
return to economic and social activities—but the Administration
deferred to States to take action. Despite the urgent need for fed-
eral leadership, the Administration announced that States should
develop their own testing plans and the federal government should
be considered ‘‘the supplier of last resort.’’
In response to the COVID–19 pandemic, the President abdicated
all federal responsibility. As a result, the Administration’s failed
response cannot be defended from a public health perspective.
But it did not have to be this way.
Timeline
In January, China confirmed its first known death caused by the
novel coronavirus. Shortly thereafter, cases were identified in
Japan, South Korea, Thailand, and the United States. By January
23, China closed down Wuhan, a city of 11 million people and the
epicenter of the outbreak.
On January 25, HHS Secretary Alex Azar notified the Committee
that the CDC would begin to access funds in the Infectious Dis-
eases Rapid Response Reserve Fund, which was first established in
the fiscal year 2019 Labor-HHS Education Appropriations Act, to
support public health preparedness and response activities.
On January 30, the World Health Organization declared a ‘‘pub-
lic health emergency of international concern.’’ The following day,
the Administration imposed travel restrictions to prevent foreign
nationals who had recently traveled to China from entering the
United States.
The evidence was becoming clear—the U.S. needed to prepare for
a serious public health crisis.
On February 4, House Appropriations Committee Chairwoman
Nita Lowey and LHHS Subcommittee Chair Rosa DeLauro sent a
letter to HHS Secretary Alex Azar, urging him to submit a request
for emergency supplemental appropriations to prepare for this pub-
lic health threat. Chairwoman Lowey and Chair DeLauro noted: ‘‘It
is clear, however, that further resources will be necessary to sup-
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port an aggressive and comprehensive government-wide response
to the 2019 novel Coronavirus, both domestically and internation-
ally.’’
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The Chairwomen urged the Secretary to submit an emergency
supplemental request no later than February 10, including suffi-
cient resources to support ‘‘surveillance, epidemiology, and labora-
tory capacity; enhanced screening at ports of entry; repatriation of
U.S. nationals; mandatory quarantine of travelers; research, ad-
vanced development, and procurement of medical countermeasures,
including vaccines, therapeutics, and diagnostics; communications
and public awareness; direct assistance to state and local public
health departments, including through the Public Health Emer-
gency Preparedness Cooperative Agreement and the Hospital Pre-
paredness Program; and other activities to prevent, prepare for, or
respond to the 2019 novel Coronavirus.’’
In response, the Administration noted ‘‘[it] is still early on in the
response effort for the 2019-nCOV and we cannot predict with ac-
curacy when [the Infectious Diseases Rapid Response Reserve
Fund] will run out of funding, nor how the outbreak and our re-
sponse needs will evolve.’’ The Administration did not submit a re-
quest for emergency supplemental appropriations until February
24—at which point, the request was limited to $1,250,000,000 in
new emergency funding, repurposing of $535,000,000 in emergency
funding for Ebola, and transfers from other existing health pro-
grams.
On February 25, Dr. Nancy Messonnier, Director of the CDC’s
National Center for Immunization and Respiratory Diseases, held
a media briefing and presciently warned the country of the severity
of the coronavirus outbreak. According to Dr. Messonnier, ‘‘Ulti-
mately, we expect we will see community spread in the United
States. It’s not a question of if this will happen, but when this will
happen and how many people in this country will have severe ill-
nesses.’’ She further noted, ‘‘disruptions to everyday life may be se-
vere’’ and advised that Americans should begin to plan accordingly.
According to credible media accounts, President Trump did not
heed the warning of the CDC’s foremost expert on respiratory dis-
eases. Instead, the President was angry at Dr. Messonnier for up-
setting the stock market.
On February 25, in response to the CDC’s warnings, Larry
Kudlow, Director of the National Economic Council, told reporters,
‘‘We have contained this. I won’t say airtight, but pretty close to
airtight.’’ The following day, the President said, ‘‘It’s going to dis-
appear. One day, it’s like a miracle, it’s going to disappear.’’
Two weeks later, on March 11, the World Health Organization
declared the coronavirus outbreak a pandemic. On March 13, the
President declared a state of national emergency under the Staf-
ford Act and four days later, on March 17, the President encour-
aged Americans to work from home, postpone unnecessary travel,
and avoid gatherings of more than 10 people.
At the time, in mid-March, there were fewer than 100 confirmed
or presumed cases of COVID–19 in the United States. The country
heeded the advice of public health experts to mitigate the spread
of COVID–19 and to flatten the curve of the outbreak—thereby re-
ducing the peak number of hospitalizations, easing the strain on
the health care system, and saving hundreds of thousands of Amer-
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ican lives.
But the Trump Administration quickly reverted to its incon-
sistent and incoherent response.
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By April and May, the Administration had essentially given up
any attempt to mitigate or contain the COVID–19 pandemic. As
more than 1,300 Americans died every day of COVID–19, and more
than 23,000 Americans tested positive every day, the Administra-
tion inexplicably shifted its attention to re-starting economic and
social activities. The White House urged States to reopen busi-
nesses and the President urged Governors to dismantle public
health measures.
Public health leaders continued to express deep concerns about
re-starting economic and social activities without sufficient testing,
contact tracing, or quarantine capabilities.
The CDC published guidance for schools, child care, employers
with workers at high risk, restaurants and bars, and mass transit.
The CDC advised against crowded indoor gatherings.
Not a single State met the CDC’s recommended thresholds for
widespread reopening of activities. But the Administration urged
States to reopen anyway.
In the span of only two months—April and May—100,000 Ameri-
cans died of COVID–19.
In June, as States relaxed stay-at-home orders and reopened
businesses, coronavirus cases in the U.S. surged by nearly 50 per-
cent. The surge of new cases was led by States that reopened their
economies most rapidly and aggressively. By the end of June, the
U.S. reported a total of more than 125,000 deaths due to COVID–
19.
On July 1, States reported more than 52,000 new cases, the high-
est single-day total since the beginning of the pandemic. The new
single-day peak lasted for 24 hours. On July 2, States reported
more than 55,000 new cases. On July 3, States reported more than
57,000 new cases.
Emergency Supplemental Appropriations
Despite the Administration’s inconsistent and incoherent re-
sponse to the coronavirus pandemic, the Appropriations Committee
has worked on a bipartisan basis since the beginning of the out-
break. Since March 6, Congress has passed four emergency supple-
mental appropriations packages, including more than
$2,000,000,000,000 in emergency relief through the CARES Act. In
addition, the House of Representatives passed the Heroes Act on
May 15 to provide further emergency relief—however, the Senate
has thus far failed to vote on the bill.
On March 4, the House of Representatives passed the first emer-
gency supplemental appropriations bill, the Coronavirus Prepared-
ness and Response Supplemental Appropriations Act (P.L. 116–
123). The bill included a total of $8,300,000,000, including
$6,100,000,000 through the Labor-HHS Education subcommittee—
• $2,200,000,000 for the CDC to support State and local pub-
lic health departments, including for surveillance, laboratory
testing, contact tracing, infection control; and mitigation; as
well as global disease detection and emergency response;
• More than $3,000,000,000 for NIH and BARDA to support
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research and development of vaccines, therapeutics, and
diagnostics; and
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• Nearly $1,000,000 for procurement of masks, personal pro-
tective equipment, pharmaceuticals, and other medical sup-
plies, as well as funding for Community Health Centers.
On March 14, the House of Representatives passed the second
emergency supplemental appropriations bill, the Families First
Coronavirus Response Act (P.L. 116–127). The bill included a total
of $192,000,000,000, including $21,000,000,000 for Supplemental
Nutrition Assistance Program benefits and $50,000,000,000 to in-
crease the Federal share of expenditures in the Medicaid and CHIP
programs, as well as $1.25 billion through the Labor-HHS Edu-
cation subcommittee—
• $250,000,000 for home-delivered and prepackaged meals
for low-income seniors; and
• $1,000,000,000 to cover diagnostic testing for the unin-
sured.
On March 27, the House of Representatives passed the third
emergency supplemental appropriations bill, the Coronavirus Aid,
Relief, and Emergency Security Act (CARES Act) (P.L. 116–136).
The bill included more than $2,000,000,000,000 in emergency re-
lief, including direct payments to households, enhanced unemploy-
ment compensation, and emergency assistance for state and local
governments, small businesses, and corporation. The CARES Act
included $172,000,000,000 in emergency supplemental appropria-
tions through the Labor-HHS Education subcommittee—
• $100,000,000,000 for health care providers to cover health
care expenses or lost revenues attributable to the coronavirus;
• $27,000,000,000 for the Assistant Secretary for Prepared-
ness and Response, including $16,000,000,000 for the Strategic
National Stockpile and at least $3,500,000,000 for additional
advanced research and development of vaccines and thera-
peutics;
• $4,300,000,000 for the CDC to support State and local pub-
lic health departments, including for surveillance, laboratory
testing, contact tracing, infection control; and mitigation; as
well as global disease detection and emergency response;
• $945,000,000 for NIH to expand research on COVID–19;
• $425,000,000 for mental health and substance abuse pre-
vention and treatment activities at the Substance Abuse and
Mental Health Services Administration (SAMHSA);
• $200,000,000 for CMS to assist nursing homes with infec-
tion control and support States’ efforts to prevent the spread
of coronavirus in nursing homes;
• $6,300,000,000 for the Administration for Children and
Families (ACF), supporting child care for essential workers in-
cluding healthcare workers and first responders, Head Start,
and grants to States for community and social services, home
energy assistance, child welfare services, runaway and home-
less youth, and family violence prevention services;
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• $955,000,000 for the Administration for Community Living
(ACL) to support nutrition programs, home- and community-
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based services, support for family caregivers, and expand over-
sight and protections for seniors and individuals with disabil-
ities;
• $275,000,000 for the Health Resources and Services Ad-
ministration, including funding for rural hospitals, expansion
of telehealth services, and Ryan White HIV/AIDS programs;
• $30,900,000,000 for the Department of Education to assist
students, school districts, institutions of higher education and
States with immediate needs related to the coronavirus;
• $360,000,000 for the Department of Labor, including
$345,000,000 for States and communities to respond to work-
force impacts and layoffs resulting from the coronavirus
through the Dislocated Worker National Reserve;
• $338,000,000 for the Social Security Administration to
support essential telework, communication needs, and salaries
and benefits of Federal employees impacted by office closures,
and for the purposes of issuing emergency assistance Economic
Impact Payments;
• $75,000,000 for stabilization grants through the Corpora-
tion for Public Broadcasting to maintain programming services
and to preserve small and rural public telecommunication sta-
tions;
• $50,000,000 for digital access and technical support serv-
ices through the Institute for Museum and Library Services;
and
• $5,000,000 for the Railroad Retirement Board to support
telework and administer the Railroad Unemployment Insur-
ance Act.
On April 23, the House of Representatives passed the fourth
emergency supplemental appropriations bill, the Paycheck Protec-
tion Program and Health Care Enhancement Act (P.L. 116–139).
The bill included nearly $500,000,000,000 in emergency relief, in-
cluding $100,000,000,000 through the Labor-HHS Education sub-
committee—
• $75,000,000,000 for the Health Care Provider Relief Fund;
and
• $25,000,000,000 to support increased diagnostic testing
and contact tracing across the United States.
On May 15, the House of Representatives passed the Heroes Act
(H.R. 6800). The bill includes more than $3,000,000,000,000 in
emergency relief for American families, workers, and businesses, as
well as ongoing emergency response activities, including nearly
$200,000,000,000 through the Labor-HHS Education sub-
committee—
• $100,000,000,000 for the Health Care Provider Relief
Fund;
• $75,000,000,000 to support increased diagnostic testing
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and contact tracing;
• $7,600,000,000 for Community Health Centers;
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• $2,100,000,000 for the CDC to support State and local pub-
lic health agencies;
• $4,700,000,000 for NIH to expand research on COVID–19,
as well as support research projects interrupted by the pan-
demic;
• $4,500,000,000 for BARDA for additional advanced re-
search and development of vaccines and therapeutics;
• $10,100,000,000 for the Administration for Children and
Families (ACF), including $7,000,000,000 in Child Care and
Development Block Grant (CCDBG) funding to States,
$3,000,000,000 in home energy and water bill assistance to low
income households, and additional funding for family violence
and child abuse prevention services;
• $100,000,000,000 to provide direct services such as home-
delivered and pre-packaged meals, and supportive services for
seniors and disabled individuals and their caregivers through
the Administration for Community Living (ACL);
• $100,200,000,000 to support the educational needs of stu-
dents, school districts, institutions of higher education and
States in response to the coronavirus, including
$90,000,000,000 through a State Fiscal Stabilization Fund to
support statewide and local funding for elementary and sec-
ondary schools and public postsecondary institutions and
$10,200,000,000 for private colleges and Minority Serving In-
stitutions;
• $2,000,000,000 through the Department of Labor to sup-
port workforce training, including through remote access, and
providing emergency supportive services for migrant and sea-
sonal workers;
• $940,000,000,000 to support the Unemployment Insurance
system, including funds to speed the payment of benefits and
assist States in processing claims;
• $107,000,000 for worker protection activities, including ad-
ditional enforcement of standards and directives at slaughter-
houses, poultry processing plants, and agricultural workplaces,
and outreach to workers to make them aware of their rights
to paid family and medical leave and paid sick leave;
• $5,000,000 to support libraries and museums with costs
and expenses associated with the coronavirus; and
• $5,000,000 for the Railroad Retirement Board to support
the processing of unemployment benefits under the Railroad
Unemployment Insurance Act.
In March and April, the Labor-HHS Education subcommittee
provided a total of $279,500,000,000 in emergency appropriations
to protect the health and safety of Americans and to help Ameri-
cans families and businesses to recover.
Oversight of the Administration’s Response to COVID–19
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Since the beginning of February, the Labor-HHS Education sub-
committee has held nine subcommittee hearings or bipartisan
briefings on the topic of COVID–19, including hearings and brief-
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10
ings with senior HHS officials as well as hearings and briefings
with non-governmental public health experts. The Subcommittee
intends to hold additional oversight hearings through the rest of
this Congress.
On February 12, the Subcommittee held a bipartisan briefing to
examine HHS’s response to the coronavirus. The briefing was led
by Dr. Nancy Messonnier, Director of CDC’s National Center for
Immunization and Respiratory Diseases; Dr. Anthony Fauci, Direc-
tor of NIH’s National Institute of Allergy and Infectious Diseases;
and Dr. Robert Kadlec, Assistant Secretary for Preparedness and
Response. These HHS officials outlined the Department’s prepared-
ness and response activities, including efforts to assist in repa-
triating U.S. nationals from China, as well as screening and quar-
antine operations at ports of entry. Dr. Fauci and Dr. Kadlec also
provided an overview of early efforts to develop medical counter-
measures for the coronavirus, including vaccines and therapeutics.
On March 10, the Subcommittee held a hearing with the CDC to
examine the agency’s 2021 budget request. Witnesses included Dr.
Robert Redfield, Director of the CDC; Dr. Ileana Arias, Associate
Deputy Director for Public Health Science and Surveillance; Dr.
Debra Houry, Director of the National Center for Injury Prevention
and Control; and Ms. Sherri Berger, Chief Strategy Officer and
Chief Operating Officer. The Subcommittee held the hearing one
week after Congress passed the first emergency supplemental ap-
propriations package, including $2.2 billion for the CDC, and fo-
cused on CDC’s COVID–19 response activities, including the delay
in producing diagnostic test kits, as well as the recent transition
from a strategy of containment of the coronavirus to a strategy of
mitigation (including social distancing).
On April 15, the Subcommittee held a bipartisan briefing for full
committee members with HHS Secretary Alex Azar to examine the
Department of Health and Human Services’ plans to allocate
$100,000,000,000 in emergency relief—enacted in the CARES Act
on March 27—to hospitals, health care providers, and other entities
for their health-related expenses and lost revenues due to the
coronavirus. The briefing focused on how the Department would
disseminate emergency funding quickly to health care providers,
including to hospitals and other providers in areas most directly af-
fected by the COVID–19 pandemic.
On April 16, the Subcommittee held a bipartisan briefing for full
committee members to examine the Department of Education’s im-
plementation of CARES Act funding. The briefing was led by
James Blew, Assistant Secretary for Planning, Evaluation and Pol-
icy Development; Robert King, Assistant Secretary for Postsec-
ondary Education; Frank Brogan, Assistant Secretary for Elemen-
tary and Secondary Education; and, Diane Jones, Principal Deputy
Under Secretary, Delegated the Duties of the Under Secretary. In
the winter and spring of 2020, school buildings, campuses and li-
braries physically closed, and social and economic services that stu-
dents and their families rely upon were disrupted or ceased en-
tirely. In response, Congress passed the CARES Act to provide
vital resources to assist students whose educations have been dis-
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rupted. During the briefing, members had an opportunity to ask
questions of Department officials about the Secretary’s timeline for
distributing aid. Unfortunately, details regarding the Secretary’s
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11
implementation of key provisions of the law that are in contraven-
tion of both the plain reading of the statute and the intent of Con-
gress were omitted during the briefing. And to date, the Depart-
ment has issued conflicting and confusing guidance, which has re-
sulted in the delay of assistance to students, families and institu-
tions in need. As such, the Heroes Act takes steps to provide fur-
ther relief and reassert Congressional intent.
On May 1, the Subcommittee held a bipartisan briefing for full
committee members with Dr. Scott Gottlieb, former FDA Commis-
sioner, to discuss recommendations for the conditions that would be
necessary to re-start economic and social activities during the pan-
demic. Dr. Gottlieb outlined recommendations in a recent report by
the American Enterprise Institute, A Road Map to Reopening, that
he co-authored with Dr. Caitlin Rivers, Dr. Mark McClellan,
Lauren Silvis, and Dr. Crystal Watson. The briefing focused on im-
provements in state and local capacity that would be necessary to
slow community transition of COVID–19 before local communities
could safely reopen.
On May 6, the Subcommittee held a hearing with two public
health experts, Dr. Tom Frieden and Dr. Caitlin Rivers, to examine
the necessary public health measures to respond to COVID–19, in-
cluding surveillance, diagnostic testing, contact tracing, quarantine,
social distancing, production and distribution of personal protective
equipment, medical surge and health care resiliency, development
of vaccines and therapeutics, and long-term investments in public
health preparedness and response activities—including state and
local health departments, public health laboratories, public health
data modernization, public health workforce, and global disease de-
tection and response.
On June 4, the Subcommittee held a hearing with Dr. Robert
Redfield, Director of the CDC, to examine the Administration’s in-
consistent and incoherent response to the COVID–19 pandemic.
While the CDC had issued guidance for re-starting economic and
social activities, many States were already moving forward with ac-
tivities despite failing to meet the CDC’s recommended criteria.
The hearing focused on the Administration’s efforts to sideline the
CDC, the nation’s foremost public health agency, in favor of non-
expert guidance from political appointees in the White House.
On June 11, the Subcommittee held a bipartisan briefing for full
committee members with Dr. Ashish Jha, Professor of Global
Health at the Harvard T.H. Chan School of Public Health and Di-
rector of the Harvard Global Health Institute, to examine the ongo-
ing Federal response to the COVID–19 pandemic, particularly as
the number of cases were increasing in many States and the U.S.
continued to record as many as 800–1,000 deaths on a daily basis.
The briefing focused on the projected course of the pandemic over
subsequent months, including a likely worsening of the outbreak in
the Fall and Winter months until a successful therapeutic or vac-
cine is widely available, as well as the need for the Administration
to take a leadership role in responding to the pandemic.
On June 22, the Subcommittee held a bipartisan briefing with
Randi Weingarten, President of the American Federation of Teach-
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ers to discuss reopening schools safely, preventing State and local
layoffs, and addressing learning loss among our most at-risk stu-
dents. In particular, Members discussed the effects of ongoing trau-
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12
ma and mental health issues, how adverse childhood experiences
impede and even prevent learning and the importance of trauma-
informed care and services. The briefing also included a discussion
on the importance of appropriate personal protective equipment for
students and employees, including the availability of and training
on how to effectively use it.
TITLE I—DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING ADMINISTRATION
Appropriation, fiscal year 2020 ......................................................... $9,973,160,000
Budget request, fiscal year 2021 ....................................................... 8,676,681,000
Committee Recommendation ............................................................. 10,160,630,000
Change from enacted level ......................................................... +187,470,000
Change from budget request ...................................................... +1,483,949,000
The Employment and Training Administration (ETA) admin-
isters Federal job training grant programs and Trade Adjustment
Assistance and provides funding for the administration and over-
sight of the State Unemployment Insurance and Employment Serv-
ice system.
TRAINING AND EMPLOYMENT SERVICES
Appropriation, fiscal year 2020 ......................................................... $3,611,200,000
Budget request, fiscal year 2021 ....................................................... 3,358,304,000
Committee Recommendation ............................................................. 3,696,700,000
Change from enacted level ......................................................... +85,500,000
Change from budget request ...................................................... +338,396,000
Training and Employment Services provides funding for Federal
job training programs authorized primarily by the Workforce Inno-
vation and Opportunity Act of 2014 (WIOA).
The Committee recommendation includes new bill language al-
lowing the Secretary to waive certain requirements to permit the
outlying areas to submit a single application for a consolidated
grant.
Adult Employment and Training Activities.—For Adult Employ-
ment and Training Activities, the Committee recommends
$864,649,000, which is $10,000,000 more than the fiscal year 2020
enacted level and the fiscal year 2021 budget request.
Youth Employment and Training Activities.—For Youth Employ-
ment and Training Activities, the Committee recommends
$925,130,000, which is $12,000,000 more than the fiscal year 2020
enacted level and the fiscal year 2021 budget request.
The Committee is concerned that many 16–24 year-olds seeking
employment are unable to find jobs due to limited access to re-
sources and networks. This inability is worsened by racial dispari-
ties, especially in urban areas. The Committee directs the Sec-
retary to include an update in the fiscal year 2022 Congressional
Budget Justification on youth unemployment, including the num-
ber of unemployed youth ages 16–24, disaggregated by race, socio-
economic status, and age, as well as the disparities such youth face
in seeking and obtaining employment. This update must also in-
clude information on youth unemployment by industry and sector,
including Science, Technology, Engineering, and Math (STEM), as
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well as entrepreneurship. In addition, the Committee directs the
Secretary to include recommendations on actions Congress can
take to ensure that youth unemployment decreases.
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In addition to the challenges posed by youth unemployment, the
Committee recognizes that participation in work-based learning
during high school can have a positive impact on students that may
lead to sustained employment and higher-quality jobs. Therefore,
the Committee urges the Department to encourage local secondary
educational authorities with expertise in work-based learning to be
included as part of the required education and training organiza-
tion representatives on local workforce development boards to pro-
vide guidance on work experience, including summer employment
opportunities for youth.
Dislocated Worker Employment and Training Activities.—For
Dislocated Worker Employment and Training Activities, the Com-
mittee recommends $1,080,053,000, which is $28,000,000 more
than the fiscal year 2020 enacted level and the fiscal year 2021
budget request.
Dislocated Worker Assistance National Reserve.—The Committee
recommends $280,859,000 for the Dislocated Workers National Re-
serve, an increase of $10,000,000 over the fiscal year 2020 enacted
level and $120,000,000 over the fiscal year 2021 budget request.
In addition, the Coronavirus Aid, Relief, and Economic Security
Act (CARES Act) (P.L. 116–136) included $345,000,000 for the Dis-
located Worker National Reserve for States and communities to
help address workforce-related impacts of COVID–19.
The Committee recommendation includes $50,000,000, an in-
crease of $10,000,000 over the fiscal year 2020 enacted level, for
Strengthening Community College Training Grants to support a
new grant competition. This funding will continue to help better
align workforce development efforts with postsecondary education
and build off lessons learned from the Trade Adjustment Assist-
ance Community College and Career Training Grant program. The
fiscal year 2021 budget request did not include funding for this pro-
gram.
The Committee is deeply troubled by the Department’s failure to
follow the requirements for this program as laid out in the Depart-
ment of Labor Appropriations Act, 2020. This legislation included
language requiring the Department to ‘‘follow the requirements for
the program in House Report 116–62,’’ which included a require-
ment that the solicitation for grant applications (SGA) be issued
within 120 days of enactment of that Act. As such, this require-
ment was incorporated by reference into the appropriations meas-
ure and had the same legal effect as the legislation itself. The De-
partment issued an SGA more than 200 days after enactment,
thereby failing to follow the requirements for this program. Cou-
pled with the ETA’s misuse of registered apprenticeship funds, the
Committee notices a concerning trend within ETA regarding proper
execution of the law and is disappointed ETA continues to dis-
regard Congressional intent. The Committee recommendation con-
tinues to direct the Department to follow the program require-
ments as laid out in House Report 116–62 and includes new bill
language requiring ETA to issue an SGA within 120 days of enact-
ment of this Act. The Committee recommendation includes new bill
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language reducing the Department’s Executive Direction budget by
$100,000 for each day the SGA is not issued beyond the 120 day
requirement.
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The Committee includes $10,000,000, the same as the fiscal year
2020 enacted level, for grants to support national out-of-school time
organizations that serve youth and teens and place an emphasis on
age-appropriate workforce readiness programming to expand job
training and workforce pathways for youth and disconnected youth,
including soft skill development, career exploration, job readiness
and certification, summer jobs, year-round job opportunities, and
registered apprenticeships. Funding will also support partnerships
between workforce investment boards and youth serving organiza-
tions. The fiscal year 2021 budget request did not include funding
for this initiative.
Native Americans.—For the Indian and Native American pro-
grams, the Committee recommends $55,500,000, which is $500,000
more than the fiscal year 2020 enacted level. The fiscal year 2021
budget request proposes to eliminate this program.
Migrant and Seasonal Farmworkers.—For the National Farm-
worker Jobs program, the Committee recommends $95,896,000,
which is $4,000,000 more than the fiscal year 2020 enacted level.
The fiscal year 2021 budget request proposes to eliminate this pro-
gram.
The Committee recognizes that grantee performance may suffer
as a result of the coronavirus, leading to lower performance meas-
ures in the future. Accordingly, the Committee encourages the Sec-
retary to take into account the effects of the coronavirus outbreak
on performance. Moreover, the recommendation includes new bill
language adjusting the definition of ‘‘low-income’’ for purposes of
this program.
YouthBuild.—For the YouthBuild program, the Committee rec-
ommends $100,534,000, which is $6,000,000 more than the fiscal
year 2020 enacted level and $16,000,000 more than the fiscal year
2021 budget request.
Reintegration of Ex-Offenders.—The Committee recommends
$103,079,000 for training and reintegration activities for individ-
uals with criminal records or who have been justice system-in-
volved, which is $5,000,000 more than the fiscal year 2020 enacted
level and $10,000,000 more than the fiscal year 2021 budget re-
quest. The Committee directs the Department to ensure grantees
establish formal partnerships with employers and that program
participants receive industry recognized credentials and training in
fields that prepare them for successful reintegration, including en-
suring participants receive training and credentials in fields where
their record is not a barrier to entry or continued employment. The
Committee also directs the Department to consider the needs of
communities that have recently experienced significant unrest.
The Committee also continues the set-aside of $25,000,000 for
competitive grants to national and regional intermediaries for ac-
tivities that prepare for employment young adults with criminal
records or who have been justice system-involved or who have
dropped out of school or other educational programs, with a pri-
ority for projects serving high-crime, high-poverty areas. The Com-
mittee directs the Department to consult data from the Department
of Education and prioritize grants in communities where students
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of color have disproportionate rates of expulsions and suspensions.
The Committee is aware that recent re-entry programs are an
excellent way to help address workforce challenges, including those
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15
in the advanced manufacturing sector. The Committee directs the
Department to provide an update in the fiscal year 2022 Congres-
sional Budget Justification on information from the last three fiscal
years on pathways and relationships built with employers, includ-
ing data on formerly incarcerated individuals who have utilized the
program, rates of increased credentials, and placement in higher
paying positions. The Committee also directs the Department to
provide a briefing to the Committees on Appropriations within 180
days of enactment of this Act on such information.
Workforce Data Quality Initiative.—The Committee recommends
$6,000,000 for the Workforce Data Quality Initiative, which is the
same as the fiscal year 2020 enacted level. The fiscal year 2021
budget request proposes to eliminate this program. The Committee
supports the work of States in using these funds to create and uti-
lize data to align preschool through workforce systems.
Apprenticeship Grants.—The Committee recommends
$185,000,000 for the apprenticeship grants program, which is
$10,000,000 more than the fiscal year 2020 enacted level and
$15,000,000 below the fiscal year 2021 budget request. The Com-
mittee established this program in 2016 to expand work-based
learning programs in in-demand industries through registered ap-
prenticeships. Registered apprenticeships are a proven strategy for
meeting the needs of our nation’s workforce and industry simulta-
neously.
The Committee continues to invest in expanding opportunities
relating to Registered Apprenticeship programs registered only
under the National Apprenticeship Act, to be available to the Sec-
retary to carry out activities through grants, cooperative agree-
ments, contracts and other arrangements with States and other ap-
propriate entities. As part of these opportunities, the Committee di-
rects the Secretary to continue funding for national and local ap-
prenticeship intermediaries, business and labor industry partner
intermediaries, and equity intermediaries. The Committee also di-
rects the Department to ensure that these intermediaries are given
opportunities to apply for competitive grants, cooperative agree-
ments, contracts, and other funding opportunities. The Committee
urges the Secretary to ensure that States engage both business and
labor as part of any State funding opportunities associated with
this program. In addition, the Committee continues to support the
funding and development of industry or sector partnerships as a
means to expand work-based learning programs and registered ap-
prenticeships in in-demand industries.
The Committee directs the Secretary to submit a report to the
Committees on Appropriations providing details on entities award-
ed funding, selection criteria used, and the funding amount for
each grant or contract awarded at the time such awards are made.
Not later than 90 days after enactment of this Act, the Department
shall provide the Committees on Appropriations a detailed spend
plan of anticipated uses of funds made available, including admin-
istrative costs.
The Committee is deeply concerned by the Industry Recognized
Apprenticeship Program (IRAP) final rule as published in the Fed-
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eral Register on March 11, 2020 (85 Fed. Reg. 14,294), entitled
‘‘Apprenticeship Programs, Labor Standards for Registration,
Amendment of Regulations.’’ The Committee maintains that IRAPs
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16
are a duplicative apprenticeship model that wastes not only tax-
payer dollars, but Federal resources and staff capacity at the De-
partment. Therefore, the Committee includes a new bill-wide provi-
sion defining ‘‘apprenticeship’’ and ‘‘apprenticeship program’’ as an
apprenticeship program registered under the National Apprentice-
ship Act, including any requirement, standard, or rule promulgated
under such Act as was in effect on December 30, 2019. The Com-
mittee directs the Secretary to submit a report, not later than 90
days after the enactment of this Act, to the Committees on Appro-
priations on the implementation of the rule and any impact on Reg-
istered Apprenticeship programs. Such a report shall include, but
not be limited to: a list of all entities awarded funding through
grants or contracts related to the development or execution of
IRAPs during fiscal years 2018, 2019, and 2020, including the
funding amounts from Program Administration, H–1B fees, and all
other sources derived; a list of all entities recognized or under con-
sideration for recognition as Standards and Recognition Entities
(SREs); a list of all IRAPs approved or seeking approval and the
SREs for those programs recognized under the rule; an analysis of
the starting wages and expected pay increases for apprentices in
IRAPs and the portability of the credentials offered by the pro-
grams; the number of Departmental full-time equivalent employees
dedicated solely to the Registered Apprenticeship program, and a
list of any applications submitted under the rule. The report shall
also include an accounting of all funds used for implementing or
supporting IRAPs or awarded through grants or contracts under
this rule since the date of the Executive Order issued on June 15,
2017, entitled Expanding Apprenticeships in America, through the
end of fiscal year 2020, including any funds used from Program Ad-
ministration, any grant programs under ETA, or H1–B fees.
The Committee also directs the Department to provide a detailed
report within 90 days of enactment of this Act, outlining specific
steps the Department will take towards effective oversight of the
IRAP system, including monitoring conflicts of interests between
SREs and program operators, the finances of SREs and any fees
charged to program operators for recognition by the SRE, and any
violations of civil rights laws or non-compliance with Equal Em-
ployment Opportunity regulations and guidelines.
The Committee strongly supports efforts to expand Registered
Apprenticeships to traditionally underrepresented communities and
encourages the Department to explore the feasibility and expansion
of Registered Apprenticeship programs within the arts, theater,
film, and television industries. Specifically, the Committee requests
that the Department explore expanding the Registered Apprentice-
ship model to create career training strategies for all roles in the
entertainment industry such as creative, production, technical,
marketing and public relations roles.
In addition, the Committee notes that apprenticeships are an im-
portant path to the middle-class, with those completing a program
earning an average annual income of $70,000. However, women are
largely underrepresented in apprenticeship programs, and women
who do participate make far less than men. Therefore, the Com-
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mittee directs the Department to accelerate efforts to recruit and
retain women as part of these programs and to ensure equal com-
pensation.
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The Committee is concerned about shortages nationwide of quali-
fied drinking water and wastewater operation professionals, espe-
cially in rural areas, and encourages the Secretary to make funding
available to address these challenges.
The Committee also supports the use of apprenticeship grants
that provide worker education based on public-private partnerships
in in-demand fields, including first responder, utility (water), as
well as in goods movement sectors such as global logistics, rail and
other freight-related employment.
The Committee encourages the Department to support appren-
ticeship programs that increase the number of trained workers in
cybersecurity.
JOB CORPS
Appropriation, fiscal year 2020 ......................................................... $1,743,655,000
Budget request, fiscal year 2021 ....................................................... 1,015,897,000
Committee Recommendation ............................................................. 1,755,655,000
Change from enacted level ......................................................... +12,000,000
Change from budget request ...................................................... +739,758,000
Job Corps is the nation’s largest residential employment and
workforce development program for youth, helping prepare thou-
sands of young people ages 16 through 24 for jobs in in-demand oc-
cupations with good wages each year.
Operations.—For Job Corps Operations, the Committee rec-
ommends $1,603,325,000, which is the same as the fiscal year 2020
enacted level and $719,991,000 more than the fiscal year 2021
budget request.
Construction, Rehabilitation, and Acquisition.—The Committee
recommends $120,000,000 for construction, rehabilitation, and ac-
quisition activities of Job Corps centers, which is $12,000,000 more
than the fiscal year 2020 enacted level and $19,984,000 more than
the fiscal year 2021 budget request.
Administration.—The Committee recommends $32,330,000 for
the administrative expenses of the Job Corps program, which is the
same as the fiscal year 2020 enacted level and $217,000 less than
the fiscal year 2021 budget request.
For over 50 years, Job Corps has successfully educated and
trained millions of young adults for jobs in high demand industries
and trades. Job Corps has campuses across all 50 States and Puer-
to Rico and provides a safe living, learning and disciplined residen-
tial setting that allows disconnected and opportunity youth to gain
the employment and skills that U.S. employers seek. The Com-
mittee recommendation includes funding for Job Corps to meet ca-
pacity and ensure a safe learning environment for all students and
staff, including to train youth for employment in industry sectors
facing critical shortages of skilled workers, such as construction,
healthcare, manufacturing, transportation, and cyber technologies.
Job Corps centers are capable of serving approximately 50,000 out-
of-work and out-of-school youth each year, and the Committee en-
courages the Department to use such funding accordingly.
In addition, the Committee is concerned with the administration
of the Job Corps program, including the underutilization of centers
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relative to on-board strength, industry-standard training, and per-
formance incentives. The Committee directs the Department to
submit a report, within 90 days of enactment of this Act, on obliga-
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18
tions, outlays, and unobligated funds for the current fiscal year and
the most recent fiscal year to the Committees on Appropriations.
To better utilize Job Corps centers, the Committee directs the De-
partment to include an update in the fiscal year 2022 Congres-
sional Budget Justification on specific outreach and admissions ef-
forts, the most recent geographic assignment plan required by Sec.
145(c) of the WIOA, and an analysis of Job Corps application and
enrollment data to evaluate the relative efficacy of different invest-
ments in producing Job Corps-eligible applicants, arrivals, and
their families, including social media, national television or radio
buys, and local outreach efforts targeted at eligible youth, guard-
ians, and influencers. The Committee encourages the Department
to hire additional Outreach and Admissions staff to increase re-
cruitment efforts targeted at disconnected youth in large cities and
rural areas. The Committee directs the Department to provide a
briefing to the Committee on Appropriations within 120 days of en-
actment of this Act on efforts to responsibly increase onboard
strength and training slot capacity. Moreover, the Committee urges
the Department to suspend plans to eliminate programs based
upon the 85–90 percent On-Board Strength/Career Technical
Training range.
The Committee supports the Department’s intention to make in-
vestments in Job Corps facilities to ‘‘support high-quality training
that meets existing industry standards.’’ Therefore, the Committee
requests additional information in the fiscal year 2022 Congres-
sional Budget Justification on the cost of modernizing Job Corps
centers’ trade offerings, curricula, and equipment to meet existing
industry standards. This information is of particular interest given
the realignment of Job Corps center recruitment and placement
with local workforce development areas through the National En-
rollee Assignment Plan.
The Department states that Job Corps’ existing model
incentivizes continuous performance improvement while the transi-
tion to fixed price contracts is expected to yield cost savings. The
Committee is concerned that the current implementation of this
transition may shift Job Corps’ focus from student outcomes to cost
savings. Within 90 days of enactment of this Act, the Committee
requests detailed information regarding how the Department will
assess which Job Corps proposals will provide the best value, spe-
cifically with respect to student outcomes. In addition, the Com-
mittee requests information on options for incorporating perform-
ance-based incentives into Job Corps’ fixed price contracts in order
to ensure student outcomes are the highest priority, including a
timeline for implementation, in its fiscal year 2022 Congressional
Budget Justification.
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS
Appropriation, fiscal year 2020 ......................................................... $405,000,000
Budget request, fiscal year 2021 ....................................................... –––
Committee Recommendation ............................................................. 410,000,000
Change from enacted level ......................................................... +5,000,000
Change from budget request ...................................................... +410,000,000
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The Community Service Employment for Older Americans pro-
gram provides grants to public and private non-profit organizations
that subsidize part-time work in community service activities for
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19
unemployed persons aged 55 and older whose family income is
below 125 percent of the poverty level.
The Committee recommends $410,000,000 for the Community
Service Employment for Older Americans program, which is
$5,000,000 more than the fiscal year 2020 enacted level. The fiscal
year 2021 budget request proposes to eliminate this program.
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
Appropriation, fiscal year 2020 ......................................................... $680,000,000
Budget request, fiscal year 2021 ....................................................... 633,600,000
Committee Recommendation ............................................................. 633,600,000
Change from enacted level ......................................................... ¥46,400,000
Change from budget request ...................................................... –––
The Trade Adjustment Assistance program (TAA) provides as-
sistance to workers adversely affected by international trade. TAA
provides training, income support, wage subsidies for older work-
ers, job search and relocation allowances to groups of workers who
file a petition and are certified as eligible to apply for such benefits
due to job losses resulting from increases in imports or foreign
trade.
The mandatory funding provided for this program is dependent
upon the Administration’s economic assumptions, and the Commit-
tee’s recommendation for fiscal year 2021 is lower than the fiscal
year 2020 enacted level for this reason.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE
OPERATIONS
Appropriation, fiscal year 2020 ......................................................... $3,374,649,000
Budget request, fiscal year 2021 ....................................................... 3,497,280,000
Committee Recommendation ............................................................. 3,506,019,000
Change from enacted level ......................................................... +131,370,000
Change from budget request ...................................................... +8,739,000
The total includes $3,421,953,000 from the Employment Security
Administration Account from the Unemployment Trust Fund and
$84,066,000 from the General Fund of the Treasury. These funds
are used to support the administration of Federal and State unem-
ployment compensation laws.
Unemployment Insurance Compensation.—For Unemployment In-
surance (UI) Compensation, the Committee recommends
$2,649,686,000, which is $108,870,000 more than the fiscal year
2020 enacted level and $3,000,000 more than the fiscal year 2021
budget request. The recommendation provides additional resources
for States to increase staffing capacity and to accommodate sus-
tained increases in workload.
In addition, the recommendation provides contingency funding
for increased workloads that States may face in the administration
of UI. The Committee recommendation includes bill language so
that, during fiscal year 2021, for every 100,000 increase in the total
average weekly insured unemployment (AWIU) above 1,728,000, an
additional $28,600,000 shall be made available to States from the
Unemployment Trust Fund. Under current economic conditions,
the Congressional Budget Office estimates that this will result in
an additional $925,000,000 to flow to States.
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In the event that additional funds are provided to States under
the AWIU contingency authority, the Department is directed to
provide notification to the Committees on Appropriations of the
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20
current projected AWIU level for the fiscal year, when funds were
provided to States, and how much additional funding was provided
in total and to each State within 15 days of funding being provided.
In the event that additional funds are provided on a quarterly
basis, the Department shall provide this information on a quarterly
basis.
The Committee includes $117,000,000 for the Reemployment
Services and Eligibility Assessments program, and an additional
$83,000,000 is made available pursuant to the Bipartisan Budget
Act of 2018 (P.L. 115–123), which is $25,000,000 more than the fis-
cal year 2020 enacted level and equal to the fiscal year 2021 budget
request.
Unemployment Compensation National Activities.—The Com-
mittee recommends $18,000,000 for National Activities, which is
$6,000,000 more than the fiscal year 2020 enacted level and the
same as the fiscal year 2021 budget request. This increase in fund-
ing is intended to help modernize the UI Interstate Connection
Network (ICON) hub and support States in administering the UI
program.
Employment Service.—The Committee recommends $673,052,000
for the Employment Service allotment to States, which is
$5,000,000 more than the fiscal year 2020 enacted level and the fis-
cal year 2021 budget request.
The Committee also recommends $24,818,000 for Employment
Service National Activities, which is $2,500,000 more than the fis-
cal year 2020 enacted level and $5,000,000 more than the fiscal
year 2021 budget request. The increase in funds is intended to re-
duce the processing backlog for the work opportunity tax credit
program and for assisting States in adopting or modernizing infor-
mation technology for processing of certification requests, which
may include training and technical assistance to States.
The Employment Service offers vital services such as referrals
for job openings, career counseling, and job searches for individuals
seeking employment, including veterans and people with disabil-
ities. Since 1933, this Federal-State partnership has facilitated the
connection between employers in need of workers and individuals
seeking employment. Given the nature of this exchange, the De-
partment has historically required that the Employment Service
system rely on State merit-staff employees to ensure that these
services are rendered in the public interest and not solely to meet
private interests. However, the Department’s recent final rule
marks a dangerous departure from this operation. This final rule
could upend vital public services provided to vulnerable popu-
lations by privatizing job search functions and other forms of as-
sistance. Although the Department received comments from the
public outlining these concerns, the Department has chosen to ig-
nore this counsel. As such, in an effort to preserve the Employment
Service system, the recommendation includes new bill language
preventing the implementation of the final rule, entitled ‘‘Wagner-
Peyser Act Staffing Flexibility’’ (85 Fed. Reg. 592).
Foreign Labor Certification.—The Committee recommends
$77,810,000 for the Foreign Labor Certification (FLC) program,
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which is $9,000,000 more than the fiscal year 2020 enacted level
and $2,088,000 below the fiscal year 2021 budget request. The rec-
ommendation includes $57,528,000 for Federal administration, an
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21
increase of $3,000,000 over the fiscal year 2020 enacted level and
$5,088,000 below the fiscal year 2021 budget request, that is in-
tended to be used to ensure effective oversight and enforcement of
employer regulations, and $20,282,000 for grants to States, an in-
crease of $6,000,000 over the fiscal year 2020 enacted level and
$3,000,000 more than the fiscal year 2021 budget request.
H–2A Program.—The Committee notes there are increases in the
number of H–2A applications requested and that States have re-
quested additional support for the proper reviewing and oversight
of processing of H–2A applications, recruitment of potential domes-
tic agricultural workers, and oversight of contract terms.
Within 120 days of enactment of this Act, the Committee directs
the Secretary to submit a report to the Committees on Appropria-
tions on the number of H–2A visa applications, trends in H–2A re-
quests, and the distribution of funding according to the needs of
States. The report shall detail how the agency considers costs asso-
ciated with administrative and oversight requirements for both the
H–2A and H–2B visa programs when determining the allocation.
The Committee encourages the Department to continue to monitor
the number and scope of requests from the previous year along
with projected use in the coming year when determining State
funding allocations.
H–2B violations.—The Committee directs the Department to sub-
mit a report to the Committees on Appropriations within 120 days
of enactment of this Act on the recent history of sanctions and rem-
edies that the Department has issued in each of the last three fis-
cal years against employers who violate H–2B provisions, including
violations listed in 29 CFR § 503.19(a). The update should contain,
but should not be limited to: a list of the employers that were cited
and for what violation; how many workers in total have been im-
pacted by violations; what impact the violations had on the domes-
tic workforce; what industries the violations occurred in; how many
employers have been debarred from the H–2B program; the meth-
odology used in the decision to debar; and a justification for why
repeat offenders continue to receive visas. The Department is also
directed to include in such a report the distribution of visas grant-
ed by industry and sector through the H–2B program and contain
a tabulation of the percentage of overall visas provided to the top
15 employers.
Schedule A Occupational Classification.—The Committee is
aware that the Schedule A occupational classification list currently
includes only two broad occupational classifications and a narrow
subset of other applicants. The Committee encourages the Sec-
retary to consider rulemaking to improve the experience of employ-
ers and to effectively allocate Department resources with the goal
of protecting U.S. workers from undue foreign competition through
the labor certification process.
One-Stop Career Centers/Labor Market Information.—The Com-
mittee recommends $62,653,000 for One-Stop Career Centers and
Labor Market Information, which is the same as the fiscal year
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2020 enacted level and $2,173,000 less than the fiscal year 2021
budget request.
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ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS
The Committee recommends such sums as necessary for Ad-
vances 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 2020 ......................................................... $158,656,000
Budget request, fiscal year 2021 ....................................................... 171,600,000
Committee Recommendation ............................................................. 158,656,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... –––
The recommendation includes $108,674,000 from the General
Fund of the Treasury and $49,982,000 from the Employment Secu-
rity Administration Account in the Unemployment Trust Fund.
The Committee includes new bill language ensuring Office of Ap-
prenticeship resources support Registered Apprenticeships and ade-
quate staffing in the Office of Apprenticeship and State offices.
Outreach.—The Committee encourages the Department to sup-
port student support services, academic advisement and profes-
sional development for faculty and staff at educational institutions
that offer accredited registered apprenticeship programs. Addition-
ally, the Committee encourages the Department to support such in-
stitutions and in their outreach to local elementary and secondary
education schools, businesses, workforce boards, and other local
leaders in order to most effectively serve current students and in-
crease program awareness for future students and their commu-
nities.
Prize Competition.—The Committee encourages the Department,
in coordination with the Office of Science and Technology Policy, to
establish a prize competition consistent with the requirements of
section 24 of the Stevenson-Wydler Technology Innovation Act of
1980, to support eligible programs designed to prepare high school
students to enter and succeed in an in-demand industry sector or
occupation.
GAO Study on Automation.—The Committee directs the Govern-
ment Accountability Office (GAO) to conduct a study that should
explore: (1) the barriers to, and opportunities for, retraining work-
ers in industries that have a high likelihood of being impacted by
automation; (2) availability of data and strategies to improve collec-
tion, with respect to the workforce in in-demand industry sectors
and occupations in the United States, such as advanced manufac-
turing, information technology, and health care, including how this
data may be used to identify skills and jobs available for retrained
workers or those displaced by automation; (3) the impact of the
geographical location of workers and their access to transportation
on the ability of the workers to access job training and related
high-skilled positions; (4) what are the lessons learned from exist-
ing training programs and what more could be done to respond to
changes in the labor market, including evolving technologies. Not
later than one year after enactment of this Act, GAO should pro-
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vide to the Committee a briefing on preliminary findings.
Advanced Manufacturing.—The Committee encourages the De-
partment to support programs that facilitate partnerships between
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local educational entities (e.g., technical colleges, community col-
leges, or entities that assist educationally underserved commu-
nities) and manufacturers that employ individuals who have ad-
vanced manufacturing skills. These programs should (1) develop
skills and competencies in communities with expected growth in
advanced manufacturing; (2) provide education and training for
available and anticipated jobs in advanced manufacturing; (3) edu-
cate individuals about career advancement opportunities within ad-
vanced manufacturing; and (4) give priority to low-income incum-
bent workers, dislocated workers, and unemployed individuals.
Artificial Intelligence.—The Committee notes that it is not yet
fully understood the extent of the disruption Artificial Intelligence
will cause and how it will impact the workforce. Therefore, the
Committee emphasizes the importance of anticipating changes in
the workforce, investing in worker retraining programs, and pro-
viding adequate funding for registered apprenticeship programs.
Long-term Unemployed.—The Committee notes the economic
challenges millions of individuals now face due to the coronavirus
pandemic and high-unemployment. Within a matter of months, a
nine-year period of sustained economic recovery and growth was
swept away by a wave of pathogen, shuttering businesses and cre-
ating economic uncertainty. The Committee also notes that the eco-
nomic prospects for many individuals unemployed prior to the start
of the national emergency were worsened as a result of COVID–19.
Prior to the pandemic, these individuals faced significant barriers
to employment, having been unemployed for 27 weeks or more.
While it is essential that the Department supports policies and
practices that put Americans back to work in a safe and sustain-
able way, the Department must also ensure that the long-term un-
employed do not fall through the cracks of our economic recovery.
To advance this effort, the Committee encourages the Department
to support reemployment programs targeting long-term unem-
ployed workers.
Open Data Reporting.—The Committee notes that Congress has
made a significant investment in our workforce development, post-
secondary, and career and technical education systems. As a result
of this investment, the number of credentials in the U.S. continues
to rise. However, the Committee is aware that many workers and
students may face challenges in navigating an intricate network of
diplomas, licenses, certifications, and badges. Therefore, the rec-
ommendation includes new bill language requiring the Department
to publicly disclose information on credentials and competencies
earned through Registered Apprenticeships and information related
to occupational and professional licenses and certifications in an
open-source format. The Committee believes that this requirement
will lead to the development of useful comparison tools and other
resources that will improve the delivery of workforce development
and postsecondary education programs, as well as enable workers
and students to make more informed choices in their educational
and job-training journeys. The Committee directs the Department
to ensure that such information is also provided in a consumer-
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tested and user-friendly manner to ensure that workers and stu-
dents are able to utilize this information about potential creden-
tials effectively.
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24
Remote Learning.—The Committee encourages the Secretary to
consider the various ways the delivery of training may need to be
altered in response to COVID–19, including through remote access.
National Guard Job ChalleNGe.—Committee appreciates the
value and success of the National Guard’s Youth ChalleNGe Pro-
gram, and the benefits the Department of Labor’s collaboration
through Job ChalleNGe provides to the youth served through the
experience. The occupational skills training, individualized career
and academic counseling, work-based learning opportunities, and
leadership development activities provided through the Job Chal-
leNGe are even more vital services during the economic fallout of
the current COVID pandemic.
EMPLOYEE BENEFITS SECURITY ADMINISTRATION
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $181,000,000
Budget request, fiscal year 2021 ....................................................... 192,738,000
Committee Recommendation ............................................................. 181,000,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... ¥11,738,000
The Employee Benefits Security Administration (EBSA) assures
the security of retirement, health and other workplace-related ben-
efits of working Americans.
The Committee recommends $181,000,000 for EBSA, which is
the same as the fiscal year 2020 enacted level and $11,738,000 less
than the fiscal year 2021 budget request.
The Committee continues to encourage EBSA to prioritize audit
resources to review the Thrift Savings Plan’s (TSP) Information
Technology operating environment, including the adequacy of con-
trols at contractor sites and TSP’s progress in remediating pre-
viously identified issues from past EBSA audits.
PENSION BENEFIT GUARANTY CORPORATION
Appropriation, fiscal year 2020 ......................................................... $452,858,000
Budget request, fiscal year 2021 ....................................................... 465,289,000
Committee Recommendation ............................................................. 465,289,000
Change from enacted level ......................................................... +12,431,000
Change from budget request ...................................................... –––
Congress established the Pension Benefit Guaranty Corporation
to insure the defined-benefit pension plans of working Americans.
WAGE AND HOUR DIVISION
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $242,000,000
Budget request, fiscal year 2021 ....................................................... 244,283,000
Committee Recommendation ............................................................. 246,283,000
Change from enacted level ......................................................... +4,283,000
Change from budget request ...................................................... +2,000,000
The Wage and Hour Division (WHD) enforces Federal minimum
wage, overtime pay, recordkeeping, and child labor requirements of
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the Fair Labor Standards Act (FLSA). WHD also has enforcement
and other administrative responsibilities related to the Migrant
and Seasonal Agricultural Worker Protection Act, the Employee
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25
Polygraph Protection Act, the Family and Medical Leave Act, the
Davis Bacon Act, and the Service Contract Act.
The Committee recommends $246,283,000 for WHD, which is
$4,283,000 above the fiscal year 2020 enacted level and $2,000,000
above the fiscal year 2021 budget request. This increase will sup-
port WHD’s role in implementing the Labor Value Content provi-
sion to the Rules of Origin Chapter within the United States-Mex-
ico-Canada Agreement. The increase will also support additional
investigators to combat wage theft and protect workers. The Com-
mittee urges WHD to explore and expand strategic enforcement ap-
proaches to the agency’s work to make the most of this increase.
In the fiscal year 2022 Congressional Budget Justification, WHD
is directed to continue providing annual and historical information
on the Payroll Audit Independent Determination (PAID) program,
including administrative expenditures on PAID, amounts recovered
through PAID, and the number of businesses participating in
PAID.
On January 16, 2020, the WHD finalized its interpretative regu-
lation narrowing joint employment liability under the FLSA, effec-
tive March 16, 2020. The Committee is concerned that the Depart-
ment acted beyond its authority by issuing an interpretive rule
that conflicts with the law and congressional intent by so narrowly
restricting its interpretation of joint employment liability to a ques-
tion of control and rejecting the economic dependence inquiry. As
an interpretive regulation, this rule does not have the force of law,
but will dictate how and if the Department will continue to hold
employers accountable when they are jointly liable for FLSA viola-
tions. This could leave workers in low-wage, high-violation indus-
tries vulnerable.
In response to concerns about the Department’s overreach and
negative impact on workers, the Committee includes new bill lan-
guage to prohibit the use of funds to implement or enforce the final
interpretative regulation. Further, the Committee directs the De-
partment to submit a report no later than 90 days of enactment of
this Act to the Committees on Appropriations, the House Com-
mittee on Education and Labor, and the Senate Committee on
Health, Education, Labor, and Pensions detailing the impact of the
final interpretive rule on the WHD’s enforcement actions involving
joint employment liability under the FLSA. Such report shall in-
clude the number of findings of joint employment liability under
the FLSA the WHD made in fiscal years 2017, 2018, and 2019,
disaggregated by industry; the number of investigations and the
number of cases in Department-initiated litigation involving joint
employment liability, disaggregated by industry, that were ongoing
as of March 16, 2020; how the Department has proceeded with
such cases and investigations between March 16, 2020 and the date
of enactment of this Act; and the number of investigations and the
number of cases in Department-initiated litigation involving joint
employment liability, disaggregated by industry, that commenced
on or after March 16, 2020 through the date of enactment of this
Act. This report will provide transparency to the Committee to un-
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derstand the extent to which WHD no longer pursued joint employ-
ment cases that it otherwise would have under the previous inter-
pretation, leaving workers worse off.
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26
The Committee is deeply concerned by WHD Field Bulletin No.
2020–2, which scales back the agency’s use of liquidated damages
to compensate workers who have been denied their earned wages.
Victims of wage theft deserve to not only be compensated for the
wages they were denied, but for the cost of not having access to
their pay over time. Further, WHD’s decision to scale back its use
of enforcement tools sends a strong signal to businesses that they
can expect a slight slap on the wrist if any wrongdoing occurs. That
approach is unacceptable, and it undermines WHD’s core mission
of protecting workers from wage theft. The Committee strongly
urges WHD to adjust course and abandon Field Bulletin No. 2020–
2 so that workers can be appropriately compensated for their losses
and so employers understand there are meaningful consequences
for flagrant, repeated violations of the FLSA.
OFFICE OF LABOR MANAGEMENT STANDARDS
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $43,187,000
Budget request, fiscal year 2021 ....................................................... 50,410,000
Committee Recommendation ............................................................. 42,187,000
Change from enacted level ......................................................... ¥1,000,000
Change from budget request ...................................................... ¥8,223,000
The Office of Labor Management Standards (OLMS) administers
the Labor-Management Reporting and Disclosure Act (LMRDA),
which establishes safeguards for union democracy and union finan-
cial integrity, and requires public disclosure reporting by unions,
union officers, employees of unions, labor relations consultants, em-
ployers, and surety companies.
The Committee is concerned about OLMS’ administration of the
LMRDA, specifically efforts to utilize reporting and transparency
requirements as tools to undermine, rather than strengthen, union
democracy and integrity. The Department is encouraged to partner
in good faith with those entities covered by the LMRDA to ensure
compliance.
OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $105,976,000
Budget request, fiscal year 2021 ....................................................... 106,412,000
Committee Recommendation ............................................................. 105,976,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... ¥436,000
The Office of Federal Contract Compliance Programs (OFCCP)
ensures equal employment opportunity in the Federal contracting
community through enforcement, regulatory work, outreach and
education to workers and their advocates.
OFCCP is responsible, per Executive Order 11246 (EO 11246),
for ensuring Federal contractors and subcontractors take affirma-
tive action to ensure that all individuals have an equal opportunity
for employment, without regard to race, color, religion, sex, or na-
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tional origin. The Committee supports OFCCP’s efforts to make
sure contractors and subcontractors are adhering fully to EO
11246.
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In the fiscal year 2022 Congressional Budget Justification,
OFCCP is directed to detail the agency’s compliance and enforce-
ment efforts with regard to promoting equal opportunities for em-
ployment by contractors and subcontractors to the Federal govern-
ment, including technology contractors and subcontractors.
The Committee strongly opposes OFCCP’s proposed rule on Im-
plementing Legal Requirements Regarding the Equal Opportunity
Clause’s Religious Exemption, (RIN 1250–AA09), which would give
taxpayer funded contractors, including for-profit corporations, the
extraordinary power to hire and fire employees based on religion
and the employer’s understanding of religious tenets and beliefs. In
response to these concerns, new bill language is included to pro-
hibit funds from being used to implement, enforce, or give effect to
this proposed rule.
OFFICE OF WORKERS’ COMPENSATION PROGRAMS
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $117,601,000
Budget request, fiscal year 2021 ....................................................... 119,312,000
Committee Recommendation ............................................................. 117,601,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... ¥1,711,000
The Office of Workers’ Compensation Programs (OWCP) admin-
isters the Federal Employees’ Compensation Act, the Longshore
and Harbor Workers’ Compensation Act, the Energy Employees Oc-
cupational Illness Compensation Program Act, and the Black Lung
Benefits Act. These programs provide eligible injured and disabled
workers and their survivors with compensation, medical benefits,
and services including rehabilitation, supervision of medical care,
and technical and advisory counseling.
The Committee recommendation includes $115,424,000 in Gen-
eral Funds from the Treasury, which is the same as the fiscal year
2020 enacted level and $462,000 above the fiscal year 2021 request,
and $2,177,000 from the Special Fund established by the
Longshore and Harbor Workers’ Compensation Act.
SPECIAL BENEFITS
Appropriation, fiscal year 2020 ......................................................... $234,600,000
Budget request, fiscal year 2021 ....................................................... 239,000,000
Committee Recommendation ............................................................. 239,000,000
Change from enacted level ......................................................... +4,400,000
Change from budget request ...................................................... –––
These funds provide mandatory benefits under the Federal Em-
ployees’ Compensation Act.
SPECIAL BENEFITS FOR DISABLED COAL MINERS
Appropriation, fiscal year 2020 ......................................................... $34,970,000
Budget request, fiscal year 2021 ....................................................... 54,970,000
Committee Recommendation ............................................................. 54,970,000
Change from enacted level ......................................................... +20,000,000
Change from budget request ...................................................... –––
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These funds provide mandatory benefits to coal miners disabled
by black lung disease, to their survivors and eligible dependents,
and for necessary administrative costs.
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The Committee recommends a mandatory appropriation of
$40,970,000 in fiscal year 2021 for special benefits for disabled coal
miners. This is in addition to the $14,000,000 appropriated last
year as an advance for the first quarter of fiscal year 2021, for a
total program level of $54,970,000 in fiscal year 2021.
The Committee recommendation also provides $14,000,000 as an
advance appropriation for the first quarter of fiscal year 2022.
These funds ensure uninterrupted payments to beneficiaries.
ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL
ILLNESS COMPENSATION FUND
Appropriation, fiscal year 2020 ......................................................... $59,846,000
Budget request, fiscal year 2021 ....................................................... 62,507,000
Committee Recommendation ............................................................. 62,507,000
Change from enacted level ......................................................... +2,661,000
Change from budget request ...................................................... –––
These funds provide mandatory benefits to eligible employees or
survivors of employees of the Department of Energy (DOE); its con-
tractors and subcontractors; companies that provided beryllium to
DOE; atomic weapons employees who suffer from a radiation-re-
lated cancer, beryllium-related disease, or chronic silicosis as a re-
sult of their work in producing or testing nuclear weapons; and
uranium workers covered under the Radiation Exposure Com-
pensation Act.
The Committee recognizes the vital role the Energy Employees
Occupational Illness Compensation Program Act (EEOICPA) plays
in the lives of former DOE employees and contractors and
prioritizes policies that ensure efficient and effective medical care
for these individuals. The Committee requests the Department sub-
mit a report to the Committees within 180 days of enactment of
this Act on the policy changes the Department made to the pro-
gram in fiscal years 2018, 2019 and 2020, and the overall impact
these changes have had on program beneficiaries and medical pro-
viders. The report shall include information on how these policy
changes have impacted the quality of care for program beneficiaries
and how the policy changes have impacted operational efficiencies
for medical providers.
The Department shall ensure the Advisory Board on Toxic Sub-
stances and Worker Health has sufficient funding and staffing to
meet its obligations.
BLACK LUNG DISABILITY TRUST FUND
Appropriation, fiscal year 2020 ......................................................... $365,240,000
Budget request, fiscal year 2021 ....................................................... 382,991,000
Committee Recommendation ............................................................. 382,991,000
Change from enacted level ......................................................... +17,751,000
Change from budget request ...................................................... –––
The Black Lung Disability Trust Fund, supported with manda-
tory funding, pays black lung compensation, medical and survivor
benefits, and administrative expenses when no mine operator can
be assigned liability for such benefits, or when mine employment
ceased prior to 1970. The Black Lung Disability Trust Fund is fi-
nanced by an excise tax on coal, reimbursements from responsible
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mine operators, and short-term advances from the Treasury. The
Emergency Economic Stabilization Act of 2008 authorized a re-
structuring of the Black Lung Disability Trust Fund debt and re-
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29
quired that annual operating surpluses be used to pay down the
debt until all remaining obligations are retired.
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $581,787,000
Budget request, fiscal year 2021 ....................................................... 576,813,000
Committee Recommendation ............................................................. 593,787,000
Change from enacted level ......................................................... +12,000,000
Change from budget request ...................................................... +16,974,000
The Occupational Safety and Health Act of 1970 established the
Occupational Safety and Health Administration (OSHA) to assure
safe and healthy working conditions by setting and enforcing
standards and by providing training, outreach, education and as-
sistance.
Within the total for OSHA, the Committee provides the following
amounts:
FY 2021
Budget Activity Committee
Safety and Health Standards ......................................................................................................................... $18,000,000
Federal Enforcement ....................................................................................................................................... 231,711,000
Whistleblower Programs ................................................................................................................................. 18,564,000
State Programs ............................................................................................................................................... 108,575,000
Technical Support ........................................................................................................................................... 24,469,000
Federal Compliance Assistance ..................................................................................................................... 74,481,000
State Consultation Grants .............................................................................................................................. 61,500,000
Training Grants .............................................................................................................................................. 13,537,000
Safety and Health Statistics .......................................................................................................................... 32,900,000
Executive Direction and Administration ......................................................................................................... 10,050,000
The Committee directs OSHA to publish Funding Opportunity
Notices for the Susan Harwood Training Grant program no later
than June 30, 2021. Further, the Committee directs OSHA to pro-
vide technical assistance, guidance, and support for applicants in
order to reduce the proportion of applicants that did not meet eligi-
bility and program requirements included in Funding Opportunity
Notices in previous fiscal years.
The Committee encourages the Department to include hazards
facing domestic workers as a topic for training in its announce-
ments for Susan Harwood Training Grants.
In the fiscal year 2022 Congressional Budget Justification, OSHA
is directed to include annual expenditures on the Voluntary Protec-
tion Program for each year since fiscal year 2015 as well as
planned expenditures in fiscal year 2022.
The Committee recognizes the risks posed by the COVID–19 pan-
demic to our nation’s essential farm workforce as they continue to
ensure the availability of the food supply. OSHA must use all avail-
able resources provided by this Committee to fully protect workers
from getting sick. That should start with issuing an Emergency
Temporary Infectious Disease Standard. Clear, effective, com-
prehensive requirements from OSHA is the only way to guarantee
that all workers, including farmworkers, receive the protections
from COVID–19 that will keep them safe. Fortunately, much work
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has been done over the past decade on an infectious disease rule-
making that can be used to issue the Emergency Temporary Infec-
tious Disease Standard. In the interim, to protect workers from
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30
coronavirus infection, OSHA should be fully enforcing all applicable
standards and directives, including the Personal Protective Equip-
ment standard (29 CFR 1910.132), the Respiratory Protection
standard (29 CFR 1910.134), the General Duty Clause (Section
5(a)(1) of the Occupational Safety and Health Act of 1970), and the
Bloodborne Pathogens standard (29 CFR 1910.1030). Particular
emphasis should be placed on workplaces where workers are
deemed essential and also face a higher risk of infection, such as
slaughterhouses, poultry processing plants, and agricultural work-
places.
To minimize the risk of a future COVID–19 outbreak and miti-
gate the impacts of having to shut down operations and decontami-
nate a worksite if a case of COVID–19 is detected among their
workforce, the Committee urges OSHA to create clear requirements
and guidance for manufacturers and other employers on best prac-
tices for protecting workers from infectious diseases.
The Committee recognizes the challenge of ensuring adequate en-
forcement in remote geographical areas, such as the Pacific terri-
tories, and that there have been worker fatalities and injuries in
areas where there is no permanent enforcement presence. The
Committee encourages OSHA to ensure compliance safety and
health officers are adequately serving these territories and to pro-
vide an assessment of need for areas with no permanent enforce-
ment presence in its fiscal year 2022 Congressional Budget Jus-
tification.
The Committee is deeply concerned that OSHA is failing to move
forward to develop and issue needed standards on major safety and
health problems. One issue of particular concern is workplace vio-
lence, a serious and growing problem that has reached epidemic
levels. Workplace violence is now the third leading cause of death
and is responsible for nearly 30,000 serious injuries every year.
Nurses, medical assistants, emergency responders and social work-
ers face some of the greatest threats, suffering more than 70 per-
cent of all workplace assaults. Workers who are women are at par-
ticular risk, suffering two out of every three serious workplace vio-
lence injuries. In January 2017, OSHA committed to developing
and issuing a workplace violence standard, but the agency has not
yet completed a required small business review, and there is no es-
timated date for the issuance of a proposed or final rule. The Com-
mittee believes issuing a workplace violence standard to protect
workers in health care and social services should be a top priority
for the Department. In order to monitor the agency’s progress on
this important rule, the Committee directs OSHA to brief the Com-
mittees on Appropriations, within 90 days of enactment of this Act,
on a schedule for moving this rule to completion, including the
dates on which a proposed rule and final rule will be issued.
MINE SAFETY AND HEALTH ADMINISTRATION
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $379,816,000
Budget request, fiscal year 2021 ....................................................... 381,587,000
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Committee Recommendation ............................................................. 379,816,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... ¥1,771,000
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31
The Mine Safety and Health Administration (MSHA) enforces
the Federal Mine Safety and Health Act in underground and sur-
face coalmines and metal/non-metal mines.
MSHA is directed to include in the fiscal year 2022 Congres-
sional Budget Justification and all future Congressional Budget
Justifications historical and budget year information on enforce-
ment activities and outcomes, distinguishing between coal and
metal/non-metal mines. To promote transparency in agency spend-
ing on its enforcement activities, MSHA shall continue to sepa-
rately present annual spending on coal and metal/non-metal mines
as it has in past Congressional Budget Justifications.
BUREAU OF LABOR STATISTICS
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $655,000,000
Budget request, fiscal year 2021 ....................................................... 658,318,000
Committee Recommendation ............................................................. 655,000,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... ¥3,318,000
The Bureau of Labor Statistics (BLS) is an independent national
statistical agency that collects, processes, analyzes, and dissemi-
nates essential economic data to the Congress, Federal agencies,
State and local governments, businesses, and the public. Its prin-
cipal surveys include the Consumer Price Index and the monthly
unemployment series.
The Committee recommendation includes $587,000,000 from the
General Fund of the Treasury and $68,000,000 from the Employ-
ment Security Administration Account in the Unemployment Trust
Fund.
Within the total for BLS, the Committee provides the following
amounts:
FY 2021
Budget Activity Committee
Employment and Unemployment Statistics ................................................................................................... $221,000,000
Labor Market Information ............................................................................................................................... 68,000,000
Prices and Cost of Living .............................................................................................................................. 210,000,000
Compensation and Working Conditions ......................................................................................................... 83,500,000
Productivity and Technology ........................................................................................................................... 10,500,000
Executive Direction and Staff Services .......................................................................................................... 62,000,000
The Committee is supportive of BLS’ workplan for implementing
investments included in the explanatory statement accompanying
the Department of Labor Appropriations Act, 2020, which includes:
• An annual supplement to the Current Population Survey
to allow for collection of data on contingent and alternative
work arrangements every two years and data on other topics
related to the labor force in alternate years, including an occa-
sional veterans supplement;
• Restoration of the production and publication of employ-
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ment, unemployment, and labor force data under the Local
Area Unemployment Statistics program for New England
Minor Civil Divisions with populations less than 1,000; and,
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32
• Investment into the planning, development, and imple-
mentation of a new National Longitudinal Survey of Youth
(NLSY) cohort.
BLS shall brief the Committees on Appropriations with updated
estimates for the annual costs and five-year plan for implementing
the new NLSY cohort within 90 days of enactment of this Act. The
Committee is supportive of BLS’ interest in improving the Job
Openings and Labor Turnover Survey (JOLTS) and Consumer Ex-
penditure (CE) program poverty measurement; however, BLS must
ensure it has adequate resources for the planning, development,
and implementation of the new NLSY cohort before moving to new
investments for JOLTS and CE.
When implementing these investments, BLS shall not reduce or
eliminate existing statistical work. Further, BLS shall not reduce
the number of full-time equivalent positions beyond the appor-
tioned fiscal year 2020 full-time equivalent ceiling.
Within the total amount for BLS, the Committee includes
$13,000,000 to continue the relocation of the BLS headquarters,
which was initiated in fiscal year 2020. BLS is strongly urged to
consider the needs of its employees throughout this transition and
to work with the General Services Administration (GSA) to address
any outstanding safety concerns and office space considerations for
the development of sensitive economic indicators. In addition, BLS,
in coordination with the Administrator of GSA, shall follow appro-
priate CDC guidance and take such actions as are necessary to
mitigate and reduce the potential for airborne transmission of
COVID–19 through air conditioning, heating, ventilating, water
systems, and floor plans in facilities owned or leased by the GSA
and occupied by BLS, to ensure safe and healthy indoor environ-
ments for BLS employees. Such plans should include consideration
of worker health and safety during the move to the Suitland Fed-
eral Center. Within 120 days of enactment of this Act, the GSA
shall provide a report to the Committees on Appropriations on all
plans to mitigate the spread of COVID–19 in all facilities controlled
by the GSA and occupied by BLS.
The Committee encourages BLS to consider expanding the Con-
tingent Worker and Alternative Work Arrangement Supplement
(CWS) to the Current Population Survey (CPS) to measure both
workers engaged in alternative work as a primary form of occupa-
tion as well as workers who engage in alternative work in a supple-
mentary or informal capacity. This could include, but is not limited
to, traditional employees who engage in alternative work, including
as independent contractors, in addition to their primary occupa-
tions. The Committee is aware that BLS forecasts labor-market
trends using historical data and is supportive of any efforts that
would incorporate a wider and more forward-looking range of in-
puts to better project how rapidly changing technology and automa-
tion will impact the workforce of the future. In the fiscal year 2022
Congressional Budget Justification, the Committee requests that
BLS include its views on the merits of developing more forward-
looking estimates.
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Furthermore, the Committee is aware of the development of arti-
ficial intelligence and encourages BLS to examine this trend’s im-
pact on the economy.
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OFFICE OF DISABILITY EMPLOYMENT POLICY
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $38,500,000
Budget request, fiscal year 2021 ....................................................... 27,100,000
Committee Recommendation ............................................................. 38,500,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... +11,400,000
The Office of Disability Employment Policy (ODEP) provides pol-
icy guidance and leadership to eliminate employment barriers to
people with disabilities.
The Committee recommendation is the same as the fiscal year
2020 enacted level and $11,400,000 above the fiscal year 2021
budget request.
Given the high number of young adults with disabilities who ex-
perience significant challenges to live independently and achieve
gainful employment, the Committee encourages ODEP to quantify
and evaluate the efficacy of experiential learning work-life pro-
grams that serve young adults with developmental disabilities, in-
cluding those with Autism Spectrum Disorder (ASD), which is the
fastest growing developmental disability in the U.S. with approxi-
mately 1 in 59 children diagnosed each year, and more than 50,000
young adults with ASD turning 18 in the next fiscal year. Further,
the Committee encourages ODEP to evaluate barriers to both at-
taining and sustaining employment and career development within
this population, and the financial impact that long-term gainful
employment will have on increasing the number of young adults
with developmental disabilities who are able to achieve economic
self-sufficiency.
DEPARTMENTAL MANAGEMENT
SALARIES AND EXPENSES
Appropriation, fiscal year 2020 ......................................................... $348,364,000
Budget request, fiscal year 2021 ....................................................... 271,952,000
Committee Recommendation ............................................................. 349,364,000
Change from enacted level ......................................................... +1,000,000
Change from budget request ...................................................... +77,412,000
The Departmental Management appropriation provides funds for
the staff responsible for Departmental operations, management,
and policy development.
The Committee recommendation includes $349,056,000 from the
General Fund of the Treasury, $1,000,000 above the fiscal year
2020 enacted level and $77,412,000 above the fiscal year 2021
budget request, and $308,000 from the Employment Security Ad-
ministration Account in the Unemployment Trust Fund.
In addition, the CARES Act (P.L. 116–136) included $15,000,000
for Departmental Management to prevent, prepare for, and respond
to the coronavirus, including to implement paid family and medical
leave, paid sick leave, worker protection and Unemployment Insur-
ance stabilization activities.
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Within the total for Departmental Management, the Committee
provides the following amounts:
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FY 2021
Budget Activity Committee
Program Direction and Support ..................................................................................................................... $30,250,000
Departmental Evaluation ................................................................................................................................ 8,040,000
Legal Services ................................................................................................................................................ 124,053,000
International Labor Affairs ............................................................................................................................. 96,125,000
Administration and Management ................................................................................................................... 28,450,000
Adjudication .................................................................................................................................................... 35,000,000
Women’s Bureau ............................................................................................................................................. 15,050,000
Civil Rights Activities ..................................................................................................................................... 6,880,000
Chief Financial Officer ................................................................................................................................... 5,516,000
Of the $96,125,000 recommended for the International Labor Af-
fairs Bureau (ILAB), the Committee directs the Secretary to allo-
cate not less than $13,500,000 in grants to build the capacity of
countries to enforce labor rights to promote a more level playing
field for workers in the U.S. while maintaining critical funding for
combatting child labor. ILAB is directed to continue its work on
three key reports, including: DOL’s Findings on the Worst Forms
of Child Labor; the List of Goods Produced by Child Labor or
Forced Labor; and, the List of Products Produced by Forced or In-
dentured Child Labor.
In fiscal year 2020, the Committee provided additional resources
to the Office of Trade and Labor Affairs to bolster monitoring and
enforcement activities around the world and to hire additional
labor attaches in critical U.S. Embassies to increase field-based and
international monitoring. ILAB is in urgent need of attachés in
Bangladesh, Vietnam, and Geneva, Switzerland for engagement
with the International Labor Organization (ILO).
The Committee is very supportive of ILAB’s efforts to hire addi-
tional attachés in Mexico to support the U.S.’s enforcement of the
United States-Mexico-Canada Agreement (USMCA); however, those
expenses should be supported by resources this Committee pro-
vided in Title IX of the USMCA Implementation Act (P.L. 116–
113), which included $210,000,000 for ILAB. Resources provided in
this Act should support ILAB’s efforts to add additional attachés in
other areas of strategic importance, such as Bangladesh, Vietnam,
and ILO engagement in Geneva, Switzerland.
Finally, the Committee urges ILAB to use USMCA Implementa-
tion Act funding to directly support workers’ rights and capacity to
organize independent unions in Mexico. These activities must be
central to ILAB’s monitoring, enforcement, and capacity-building
roles in USMCA implementation. ILAB can also advance this crit-
ical work through technical assistance that strengthens the capac-
ity of independent unions in USMCA priority sectors. Further,
ILAB can fund research and legal teams, including through aca-
demic institutions, to develop sustainable programs that train and
support labor lawyers and researchers in priority sectors. Finally,
ILAB can support key USMCA objectives by funding innovative
supply chain monitoring and accountability mechanisms, focused
on ensuring the effective recognition of workers’ rights to organize
and collective bargaining in USMCA priority sectors. Such efforts
to develop necessary research, legal assistance and monitoring
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mechanisms will collectively supplement and strengthen core ILAB
program to directly educate and train workers to build independent
unions.
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In the fiscal year 2022 Congressional Budget Justification, ILAB
is directed to include spending plans for resources provided in the
USMCA Implementation Act for fiscal years 2020, 2021, and 2022.
Spending plans should include descriptions and amounts for
projects and staffing.
The Committee directs the Department to notify and brief the
Committees on Appropriations, the House Committee on Ways and
Means, and the Senate Committee on Finance, no later than seven
days in advance of any action to transfer funds provided in the
USMCA Implementation Act.
Of the $15,050,000 appropriated to the Women’s Bureau, the
Committee provides no less than $1,794,000 for the Women in Ap-
prenticeship and Nontraditional Occupations (WANTO) program,
which is $500,000 above the fiscal year 2020 enacted level. The
Committee once again rejects the fiscal year 2021 budget request’s
proposal to eliminate WANTO. This program helps employers and
labor unions recruit, train, and retain women for nontraditional
employment opportunities. These resources are essential in helping
women overcome traditional barriers to entry and supporting wom-
en’s full participation in the labor force.
The Committee directs the Department to submit its annual Op-
erating Plan to the Committees on Appropriations within the 45-
day statutory deadline.
The Committee understands that, as the largest advertiser in the
U.S., the Federal Government should work to ensure fair access to
its advertising contracts for small disadvantaged businesses and
businesses owned by minorities and women. The Committee directs
the Department to include the following information in its fiscal
year 2022 Congressional Budget Justification: Expenditures for fis-
cal year 2020 and expected expenditures for fiscal years 2021 and
2022, respectively, for (1) all contracts for advertising services; and,
(2) contracts for the advertising services of (I) socially and economi-
cally disadvantaged small business concerns (as defined in section
8(a)(4) of the Small Business Act (15 U.S.C. 637(a)(4)); and (II)
women- and minority-owned businesses.
The Committee directs the Department to provide a report not
later than 30 days after the conclusion of each quarter detailing
the number of full-time equivalent employees and attrition by prin-
cipal office and appropriations account.
The Committee directs the Department to provide a report to the
Committees on Appropriations within 120 days of enactment of this
Act on the number of full-time equivalent employees and funds ob-
ligated for personnel, training, equipment and travel to provide se-
curity for the Secretary and others covered under applicable secu-
rity detail provisions within this Act for fiscal years 2019 and 2020.
In addition, the Department shall include projected costs for fiscal
years 2021 and 2022 in the fiscal year 2022 Congressional Budget
Justification.
The Committee supports targeted investments in impoverished
areas, particularly in persistent poverty counties and in other high
poverty census tracts. To understand how programs funded
through the Department are serving these particular areas, the
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Committee directs the Department to submit a report to the Com-
mittees on Appropriations on the percentage of funds allocated by
all competitive grant programs and other anti-poverty programs in
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36
fiscal years 2018, 2019 and 2020 and estimates for fiscal year 2021
to serve individuals living in persistent poverty counties, as defined
as a county that has had 20 percent or more of its population living
in poverty over the past 30 years, as measured by the 1990 and
2000 decennial censuses and the most recent Small Area Income
and Poverty estimates, or any territory or possession of the U.S.,
and high-poverty areas, as defined as any census tract with a pov-
erty rate of at least 20 percent as measured by the 2014–2018 5-
year data series available from the American Community Survey
of the Census Bureau. The Department shall report this informa-
tion to the Committees within 90 days of such data being available
and provide a briefing to the Committees not later than 180 days
of enactment of this Act on how the Department is carrying out
this directive. In the case of any program for which at least 10 per-
cent of the funds allocated in fiscal year 2020 were not allocated
to persistent poverty counties or for which the percentage allocated
to high-poverty areas in fiscal year 2020 was less than the average
percentage of Federal assistance allocated to high-poverty areas
awarded under the program in fiscal years 2017, 2018, and 2019,
such report and briefing shall explain why such a benchmark is un-
able to be met.
The Committee is supportive of efforts by the Department to con-
sider evidence of effectiveness in grant competitions and requests
an update in the fiscal year 2022 Congressional Budget Justifica-
tion on implementation of the Foundations for Evidence-based Pol-
icymaking Act (P.L. 115–435) and implementation plans for the
coming year. The Committee encourages the Secretary to develop
guidance to ensure relevant participants and grantees are involved
in the Department-wide process of prioritizing evidence needs, in-
cluding participating in Department led evaluations. Consistent
with program statutes, the Committee encourages the Secretary to
ensure that evidence of effectiveness is a consideration in grant op-
portunities.
The Committee directs the Department to comply with title 31
of the United States Code, including the development of organiza-
tional priority goals and outcomes such as performance outcome
measures, output measures, efficiency measures, and customer
service measures. The Committee further directs the Department
to include an update on the progress of these efforts in the fiscal
year 2022 Congressional Budget Justification.
The Committee continues to support efforts to improve customer
service in accordance with Executive Order 13571—Streamlining
Service Delivery and Improving Customer Service. The Committee
directs the Secretary to develop standards to improve customer
service and incorporate the standards into the performance plans
required under 31 U.S.C. 1115. The Committee further directs the
Department to include an update on the progress of these efforts
in the fiscal year 2022 Congressional Budget Justification.
The Committee is concerned by the Department’s implementa-
tion of Executive Orders 13836, 13837, and 13839 and eagerness to
bring disputes with employee bargaining units before the Federal
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Service Impasses Panel. The Committee urges the Department to
negotiate in good faith with Department’s employees and cease ef-
forts that curtail their ability to collectively bargain and organize.
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The Committee is concerned by reports of widespread workplace
harassment and mistreatment of vulnerable workers, including do-
mestic workers. To address these concerns, the Committee directs
GAO to study and recommend improvements to Federal support
programs for survivors of workplace harassment in low-wage, vul-
nerable, and marginalized sectors like domestic work. This would
include recommendations to ensure that domestic workers can safe-
ly access housing, health care, mental health, and counseling serv-
ice supports; as well as workers compensation, unemployment in-
surance, disability benefits, transportation stipends, and other sup-
port. The Committee recognizes that menstrual hygiene products
are basic health necessities and supports efforts by employers to
provide menstrual hygiene products free of charge for employees.
The Committee is deeply concerned about the 11.9 million chil-
dren, including 7.5 million Black and Latino children, living in pov-
erty as of 2018. Now, millions more are projected to live in poverty
due to the COVID–19 pandemic. Without robust Federal support,
a Columbia University study estimates that child poverty could
balloon from an already shameful 13.6 percent to nearly 21 per-
cent, with Black and Latino children bearing a disproportionate
risk of falling into or deeper into poverty. More than 50 percent of
low-income households report they or someone in their household
has experienced job loss or a pay cut, and more nearly 40 million
Americans have lost their jobs to date. During the pandemic, fami-
lies are stretched thinner than ever and far too many families, es-
pecially in communities of color, are struggling to pay the bills and
keep the lights on. The Committee recognizes that resources pro-
vided for the Department are critical now more than ever to reduc-
ing child poverty and racial disparities. However, there is concern
that especially with tight budget caps for fiscal year 2021, funding
for programs to help children in poverty is not enough. Deep in-
equities remain for children of color who are often more segregated
by neighborhood, lower socioeconomic status, and in K–12 school-
ing. The Committee requests that the Department looks for oppor-
tunities to target resources to communities with the highest child
poverty rates to help reduce child poverty and racial disparities, es-
pecially in the context of COVID–19, and as the pandemic threat-
ens to increase child poverty for years to come.
The Committee encourages the Department to consider using
local media in their advertising, including local television, radio
broadcast stations, and newspapers to the greatest extent possible.
The Committee directs the Department to include in its fiscal year
2022 Congressional Budget Justification details on expenditures on
local media advertising for the prior two fiscal years.
The Committee directs the Department’s Division of Protective
Operations, to the extent it has not already done so, to submit its
use of force data to the Federal Bureau of Investigation’s National
Use of Force Data Collection database. The Committee further di-
rects, within 90 days of enactment of this Act, the Department to
brief the Committees on Appropriations on its current efforts to
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tabulate and submit its use of force data to the FBI.
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VETERANS EMPLOYMENT AND TRAINING
Appropriation, fiscal year 2020 ......................................................... $311,341,000
Budget request, fiscal year 2021 ....................................................... 312,000,000
Committee Recommendation ............................................................. 313,841,000
Change from enacted level ......................................................... +2,500,000
Change from budget request ...................................................... +1,841,000
The recommendation includes $57,500,000 from the General
Fund of the Treasury and $256,341,000 from the Employment Se-
curity Administration Account in the Unemployment Trust Fund.
The Veterans Employment and Training (VETS) program serves
America’s veterans and separating service members by preparing
them for meaningful careers, providing employment resources and
expertise, and protecting their employment rights.
Within the total for VETS, the Committee provides the following
amounts:
FY 2021
Budget Activity Committee
State Administration Grants .......................................................................................................................... $180,000,000
Transition Assistance Program ...................................................................................................................... 29,379,000
Federal Administration ................................................................................................................................... 43,548,000
Veterans Employment and Training Institute ................................................................................................ 3,414,000
Homeless Veterans Reintegration Program .................................................................................................... 57,500,000
The Committee recommendation includes $29,379,000 for the
Transition Assistance Program, which is the same as the fiscal
year 2020 enacted level and the fiscal year 2021 budget request.
This funding will enhance the quality of employment support serv-
ices for transitioning service members and allow VETS to develop
and implement a course curriculum to help military spouses over-
come the challenges they face related to employment and career de-
velopment.
The Committee includes $57,500,000 for the Homeless Veterans
Reintegration Program, which is $2,500,000 more than the fiscal
year 2020 enacted level and the fiscal year 2021 budget request.
Funds will be used to further support the needs of veterans experi-
encing homelessness.
The Committee includes $500,000, which is the same as the fis-
cal year 2020 enacted level and the fiscal year 2021 budget request,
to support the HIRE Vets Medallion Program authorized by the
Honoring Investments in Recruiting and Employing American Mili-
tary Veterans Act of 2017.
The Committee recommendation includes $300,000 within Fed-
eral Administration, which is the same as the fiscal year 2020 en-
acted level and the fiscal year 2021 budget request, to continue the
operation of the Disabled Veteran Program (DVP), which was initi-
ated by the Committee last year. The DVP addresses the high un-
employment and low labor force participation rate of veterans with
service-connected and non-service-connected disabilities. The DVP
helps increase employment and advancement opportunities for vet-
erans with disabilities by working with Federal, State, and private
partners to promote the hiring of veterans with disabilities, im-
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prove coordination of available employment services and supports,
and to identify and share employment best practices for hiring, re-
taining, and advancing veterans with disabilities in the workforce.
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Equity and Access for Homeless Veterans.—The Committee di-
rects the Department to include an update on racial equity and ac-
cess to programs at the Department providing services to homeless
veterans in its fiscal year 2022 Congressional Budget Justification.
The update shall also track departmental expenditures within the
Homeless Veteran Programs, specifically with regard to minority,
female, and LGBTQ populations. Where available, the Department
shall disaggregate data by ethnicity, age, gender identity, and dis-
charge status.
INFORMATION TECHNOLOGY MODERNIZATION
Appropriation, fiscal year 2020 ......................................................... $25,269,000
Budget request, fiscal year 2021 ....................................................... 37,000,000
Committee Recommendation ............................................................. 25,269,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... ¥11,731,000
Information Technology (IT) Modernization provides a dedicated
source of funding for Department-wide IT modernization projects
together with funding through the Department’s Working Capital
Fund.
OFFICE OF INSPECTOR GENERAL
Appropriation, fiscal year 2020 ......................................................... $90,847,000
Budget request, fiscal year 2021 ....................................................... 93,493,000
Committee Recommendation ............................................................. 91,847,000
Change from enacted level ......................................................... +1,000,000
Change from budget request ...................................................... ¥1,646,000
The Office of Inspector General (OIG) conducts audits of Depart-
ment programs and operations in order to determine that they
comply with the applicable laws and regulations, that they use re-
sources effectively, and that they are achieving their intended re-
sults.
The recommendation includes $85,187,000 from the General
Fund of the Treasury, which is $1,000,000 more than the fiscal
year 2020 enacted level and $1,646,000 below the fiscal year 2021
budget request, and $5,660,000 from the Employment Security Ad-
ministration Account in the Unemployment Trust Fund.
The CARES Act (P.L.116–136) included $26 million, including
$1,000,000 in discretionary funding, for the OIG to conduct over-
sight of activities supported with funds appropriated to the Depart-
ment to prevent, prepare for, and respond to COVID–19.
GENERAL PROVISIONS
Sec. 101. The Committee continues a provision to prohibit the
use of Job Corps funds for the salary of an individual at a rate in
excess of Executive Level II.
(TRANSFER OF FUNDS)
Sec. 102. The Committee modifies a provision regarding transfer
authority.
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Sec. 103. The Committee continues a prohibition on use of funds
to purchase goods that are in any part produced by indentured chil-
dren.
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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 recipi-
ents of funds provided to the Employment and Training Adminis-
tration from using such funds for the compensation of any indi-
vidual at a rate in excess of Executive Level II.
(TRANSFER OF FUNDS)
Sec. 106. The Committee continues a provision providing the Sec-
retary with the authority to transfer funds made available to the
Employment and Training Administration to Program Administra-
tion for technical assistance and program integrity activities.
(TRANSFER OF FUNDS)
Sec. 107. The Committee continues a provision allowing up to
0.75 percent of discretionary appropriations provided in this Act for
specific Department of Labor agencies to be used by the Office of
the Chief Evaluation Officer for evaluation purposes consistent
with the terms and conditions in this Act applicable to such office.
Sec. 108. The Committee continues a provision relating to sur-
plus property and apprenticeship programs.
Sec. 109. The Committee modifies a provision relating to the Sec-
retary’s security detail.
Sec. 110. The Committee continues a provision relating to the
Treasure Island Job Corps Center.
(RESCISSION)
Sec. 111. The Committee modifies a provision relating to H–1B
fees.
Sec. 112. The Committee continues a provision relating to Job
Corps.
Sec. 113. The Committee includes a new provision relating to the
Joint Employer Status regulation.
Sec. 114. The Committee includes a new provision relating to the
Implementing Legal Requirements Regarding the Equal Oppor-
tunity Clause’s Religious Exemption regulation.
Sec. 115. The Committee includes a new provision related to the
Wagner-Peyser Act Staffing Flexibility regulation.
TITLE II—DEPARTMENT OF HEALTH AND HUMAN
SERVICES
HEALTH RESOURCES AND SERVICES ADMINISTRATION
Appropriation, fiscal year 2020 ......................................................... $7,037,259,000
Budget request, fiscal year 2021 ....................................................... 6,289,085,000
Committee Recommendation ............................................................. 7,195,758,000
Change from enacted level ......................................................... +158,499,000
Change from budget request ...................................................... +906,673,000
The Health Resources and Services Administration (HRSA) sup-
ports programs that provide health services to disadvantaged,
medically underserved, and special populations; decrease infant
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mortality rates; assist in the education of health professionals; and
provide technical assistance regarding the utilization of health re-
sources and facilities.
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The Committee recommendation for HRSA includes
$7,195,758,000 in discretionary budget authority, and $265,600,000
in mandatory funding and $10,200,000 in trust fund appropriations
for the Vaccine Injury Compensation Program Trust Fund.
In addition, the Coronavirus Preparedness and Response Supple-
mental Appropriations Act (P.L. 116–123) included $100,000,000
and the CARES Act (P.L. 116–136) included $275,000,000 in discre-
tionary appropriations and $1,320,000,000 in mandatory funding to
support health centers, Ryan White HIV/AIDS clinics, and hos-
pitals respond to the COVID–19 pandemic.
PRIMARY HEALTH CARE
Appropriation, fiscal year 2020 ......................................................... $1,626,522,000
Budget request, fiscal year 2021 ....................................................... 1,728,522,000
Committee Recommendation ............................................................. 1,651,522,000
Change from enacted level ......................................................... 25,000,000
Change from budget request ...................................................... ¥77,000,000
Health Centers
The Committee recommends $1,650,522,000 for the Health Cen-
ters program, $25,000,000 above the fiscal year 2020 enacted level
and $77,000,000 below the fiscal year 2021 budget request.
In addition, the Coronavirus Preparedness and Response Supple-
mental Appropriations Act included $100,000,000 and the CARES
Act included $1,320,000,000 in mandatory funding to support
COVID–19 testing and treatment as well as maintain other critical
services at Health Centers.
The Committee includes bill language providing up to
$120,000,000 for the Federal Tort Claims Act program, the same
as the fiscal year 2020 enacted level and the fiscal year 2021 budg-
et request.
Ending the HIV Epidemic Initiative.—The Committee provides
$65,000,000 within the Health Centers program for the Ending the
HIV Epidemic (EHE) Initiative, $15,000,000 above the fiscal year
2020 enacted level and $72,000,000 below the fiscal year 2021
budget request. This investment builds on an increase of
$50,000,000 included in fiscal year 2020, bringing the two-year in-
vestment in Health Centers for their role in the EHE Initiative to
a total of $115,000,000. This initiative provides funding to Health
Centers in high-need jurisdictions to increase the use of pre-expo-
sure prophylaxis (PrEP) among people at high risk for HIV trans-
mission.
Native Hawaiian Health Care Program.—The Committee pro-
vides $19,000,000 within the total for Health Centers for the Na-
tive Hawaiian Health Care Program, the same as the fiscal year
2020 enacted level and the fiscal year 2021 budget request. The
Native Hawaiian Healthcare Systems help improve the health sta-
tus of Native Hawaiians by making health education, health pro-
motion, disease prevention, and Native Hawaiian traditional heal-
ing services available.
Health Care for the Homeless.—Recognizing the complex and se-
rious health challenges homeless individuals face, the Committee
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urges HRSA to prioritize access to expanded behavioral health
services, including mental health services and substance use dis-
order treatment services.
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Health Center Guidelines for Hepatitis B (HBV) and Hepatitis C
(HCV).—Funded health centers are expected to follow the USPSTF
Guidelines for testing of HBV and HCV, vaccination against Hepa-
titis A (HAV) and HBV, and offering appropriate care and treat-
ment for those clients who test positive for these viruses. The Com-
mittee requests that HRSA submit a status report within 180 days
of enactment of Act on the number of annual viral hepatitis tests
conducted and adult vaccinations administered by Community
Health Centers, and the number of clients treated for HBV and
cured of HCV. The Committee requests that HRSA provide guid-
ance to Federally-Qualified Health Centers (FQHCs) outlining how
primary care doctors ought to manage and treat HCV.
Health Centers and Home Visiting Programs.—The Committee
supports HRSA’s continued promotion of expanded partnerships be-
tween Health Centers and evidence-based home visiting programs
to improve maternal and child health outcomes in high-need com-
munities. Home visiting programs can also provide cost-effective
benefits such as care coordination and service referral that help
Health Centers achieve community health goals. As such, the Com-
mittee directs the Bureau to issue written guidance on how these
partnerships fit within Health Centers’ scope of practice.
Health Centers as Primary Dental Homes.—The Committee rec-
ognizes the importance of Health Centers in providing integrated
care to the nation’s underserved communities. Health Centers
serve as a primary dental home for many who would otherwise face
barriers to dental care. The Committee is aware that some Health
Centers have partnered with Community Dental Health Coordina-
tors (CDHCs) to provide patients with greater access to dental care.
CDHCs provide community-based prevention, care coordination,
and patient navigation to underserved populations in rural, urban,
and Native American communities. The Committee encourages
HRSA to work with Health Centers to expand their work in this
area.
HRSA Strategy to Address Intimate Partner Violence and Project
Catalyst.—The Committee includes no less than $1,500,000 for the
HRSA Strategy to Address Intimate Partner Violence, an increase
of $500,000 over the fiscal year 2020 enacted level. The Committee
particularly supports training, technical assistance, and resource
development to assist public health and health care professionals
to better serve individuals and communities impacted by intimate
partner violence.
School-Based Health Centers.—The Committee includes an in-
crease of $10,000,000 within the total for Health Centers to in-
crease the number of and services provided at SBHCs. SBHCs pro-
vide a convenient access point to high-quality, comprehensive pri-
mary health care, mental health services, preventive care, social
services, and youth development to primarily children and adoles-
cents from low-income families.
Free Clinics Medical Malpractice
The Committee recommends $1,000,000 for carrying out respon-
sibilities under the Federal Tort Claims Act, the same as the fiscal
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year 2020 enacted level and the fiscal year 2021 budget request.
The program provides medical malpractice coverage to individuals
involved in the operation of free clinics to expand access to health
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43
care services to low-income individuals in medically underserved
areas.
HEALTH WORKFORCE
Appropriation, fiscal year 2020 ......................................................... $1,194,506,000
Budget request, fiscal year 2021 ....................................................... 370,425,000
Committee Recommendation ............................................................. 1,242,505,000
Change from enacted level ......................................................... +47,999,000
Change from budget request ...................................................... +872,080,000
The Bureau of Health Workforce strengthens the health care
workforce by providing grants, scholarships, and loan repayment
programs to help communities recruit and retain health care pro-
viders where they are most needed.
Rural Health Workforce.—The Committee encourages HRSA to
explore opportunities for collaboration and partnership with schools
and programs that offer rural residencies, rural health certificates,
or otherwise recognized rural curriculum in order to increase the
placement of health care providers and professionals with rural
health training in HRSA Health Workforce Programs. The agency
shall report to the Committees on these efforts within 60 days of
enactment of this Act.
Health Professions
The Committee recommends $847,505,000 for the Health Profes-
sions programs, $42,999,000 above the fiscal year 2020 enacted
level and $477,080,000 above the fiscal year 2021 budget request.
The Health Professions programs support grants for the develop-
ment of the health workforce in fields challenged by a high need
and insufficient supply of health professionals. Given that colleges
and universities serve the dual role of training students and car-
rying out a majority of Federally-funded biomedical research, the
Committee believes these institutions serve as an ideal setting to
expose future clinicians to the evidence base that underlies their
intended profession.
Within the total for Health Professions, the Committee rec-
ommends the following amounts:
FY 2021
Budget Activity Committee
National Health Service Corps ....................................................................................................................... $120,000,000
Health Professions Training for Diversity
Centers of Excellence ............................................................................................................................ 23,711,000
Health Careers Opportunity Program .................................................................................................... 15,000,000
Faculty Loan Repayment ....................................................................................................................... 1,190,000
Scholarships for Disadvantaged Students ............................................................................................ 51,470,000
Primary Care Training and Enhancement ...................................................................................................... 48,924,000
Oral Health Training Programs ...................................................................................................................... 40,673,000
Interdisciplinary, Community-Based Linkages
Area Health Education Centers ............................................................................................................. 43,249,000
Geriatric Programs ................................................................................................................................ 42,737,000
Mental and Behavioral Health .............................................................................................................. 38,916,000
Behavioral Health Workforce Education and Training .......................................................................... 127,000,000
Workforce Information and Analysis .............................................................................................................. 5,663,000
Public Health and Preventive Medicine Programs ......................................................................................... 19,000,000
Nursing Programs
Advanced Education Nursing ................................................................................................................ 78,581,000
Nurse Education, Practice, and Retention ............................................................................................ 45,913,000
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Nurse Practitioner Optional Fellowship Program .................................................................................. 5,000,000
Nursing Workforce Diversity .................................................................................................................. 20,343,000
NURSE Corps Scholarship and Loan Repayment .................................................................................. 91,635,000
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44
FY 2021
Budget Activity Committee
Nursing Faculty Loan Program .............................................................................................................. 28,500,000
Attracting Health Care Providers to the Non-Contiguous States.—
Non-contiguous States are continually challenged by a shortage of
health care providers. Due to the geographic challenges of these
two States, including large rural areas, areas of sparse population,
fragmentation, duplication due to roadless areas (including ocean
geography), and higher costs due to the volume of patients served,
non-contiguous areas have geographic challenges that make it dif-
ficult to provide access to quality health care. The Committee re-
quests a report, not later than 180 days of enactment of this Act,
on best practices and strategies to attract health care practitioners
to non-contiguous States, especially in the areas with health care
professional shortages.
Health Professionals Staffing Shortages Report.—The Committee
recognizes the current and growing shortage of primary care physi-
cians, psychiatrists, behavioral health specialists, and geriatric
medical professionals. The Committee looks forward to receiving
the Health Professional Staffing Shortages report requested in
House Report 116–62, which was due by June 20, 2020.
HRSA Diversity Programs.—The Committee supports programs
that improve the diversity of the healthcare workforce. HRSA’s di-
versity pipeline programs, including the Health Careers Oppor-
tunity Program, Centers for Excellence, Faculty Loan Repayment,
Nursing Workforce Diversity, and Scholarships for Disadvantaged
Students help advance patient care and ensure opportunity for all
healthcare providers. The Committee requests a report within 180
days of enactment of this Act on how these programs can be fur-
ther strengthened to address mental health disparities.
Pediatric Nephrology Workforce.—The Committee is concerned
about the growing shortage of pediatric nephrologists, particularly
in rural parts of the country. If these trends continue, there will
not be enough pediatric nephrologists to treat children with kidney
disease. The Committee requests a report within 120 days of enact-
ment of this Act on ways HRSA can support efforts to recruit,
train, and support pediatric nephrologists, including existing work-
force training opportunities and recommendations to address
health professional staffing shortages.
Rural Medical Provider Shortages.—The Committee is concerned
with the large medical provider shortage in rural areas around the
country. The Committee directs HRSA to submit a report to the
Committee and the Committee on Ways and Means within 180
days of enactment of this Act detailing specific strategies and the
associated costs that could be used to eliminate medical provider
shortages in rural communities, including but not limited to ex-
panding the National Health Service Corps. This report should
place an emphasis on both recruitment and retention of medical
providers in rural communities.
National Health Service Corps
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The Committee directs HRSA to examine the application proc-
esses and eligibility requirements for both NHSC recruits and pro-
vider locations, including the HPSA qualification and scoring. The
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45
Committee looks forward to receiving the report, as directed in
House Report 116–62, with recommendations on how the NHSC
program, including the HPSA application and scoring process, may
be modified to increase recruitment and field strength as well as
diversify provider sites on the roles of Department agencies in ad-
dressing gaps in maternal mental health, within 60 days of enact-
ment of this Act.
Centers of Excellence (COEs)
The Committee notes that COEs disproportionately educate
health professionals from minority and underserved backgrounds
and address the need for a diverse and culturally competent Amer-
ican healthcare workforce. The Committee looks forward to receiv-
ing the report requested in House Report 116–32 on achievements
and challenges faced by COEs and the contribution COEs make to
workforce development.
Health Careers Opportunity Program (HCOP)
The Committee notes that HCOPs assist students from minority
and economically disadvantaged backgrounds navigate careers into
the health professions. Given the volume of HCOP scholars that re-
turn or remain in medically underserved communities, the Com-
mittee encourages HRSA’s Bureau of Health Workforce to continue
its improvement of the diversity and distribution of needed health
care professionals through National Health Career Opportunity
Program Academies and urges HRSA to report updates on HCOP
pipeline activity back to Congress within 120 days of the enactment
of this Act.
Scholarships for Disadvantaged Students
Within the total funding for Scholarships for Disadvantaged Stu-
dents, the Committee directs $2,500,000, the same as the fiscal
year 2020 enacted level, to be set aside to educate midwives to ad-
dress the national shortage of maternity care providers and the
lack of diversity in the maternity care workforce.
Oral Health Training
Oral Health Training and Dental Faculty Loan Repayment Pro-
gram.—Within the total for Oral Health Training, the Committee
includes not less than $12,000,000 for General Dentistry Programs
and not less than $12,000,000 for Pediatric Dentistry Programs.
The Committee directs HRSA to provide continuation funding for
section 748 Dental Faculty Loan Program (DFLRP) grants initially
awarded in fiscal years 2016, 2017, and 2018. The Committee con-
tinues to support DFLRP awards with a preference for pediatric
dentistry faculty supervising dental students or residents and pro-
viding clinical services in dental clinics located in dental schools,
hospitals, and community-based affiliate sites.
Area Health Education Centers (AHEC)
AHEC Oral Health Projects.—The Committee encourages HRSA
to support AHEC oral health projects that establish primary points
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of service and address the need to help patients find treatment out-
side of hospital emergency rooms. The Committee encourages
HRSA to work with programs that have already been initiated by
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46
some State dental associations to refer emergency room patients to
dental networks.
Mental and Behavioral Health Education Training (MBHET) Pro-
grams
Graduate Psychology Education.—Within the total for MBHET,
the Committee recommendation includes $20,000,000, $2,000,000
above the fiscal year 2020 enacted level and the fiscal year 2021
budget request, for the interprofessional Graduate Psychology Edu-
cation (GPE) Program to support health service psychologists
trained to provide integrated services to high-need, underserved
populations in rural and urban communities. In addressing the
opioid epidemic, the Committee recognizes the growing need for
highly trained mental and behavioral health professionals to de-
liver evidence-based behavioral interventions for pain management.
The Committee encourages HRSA to help integrate health service
psychology trainees at FQHCs.
Behavioral Health Workforce Education and Training (BHWET)
The Committee includes $127,000,000 for the BHWET Program,
$25,000,000 above the fiscal year 2020 enacted level and the fiscal
year 2021 budget request. This program establishes and expands
internships or field placement programs in behavioral health serv-
ing populations in rural and medically underserved areas.
BHWET Support in Rural Settings.—The Committee is con-
cerned about the utilization of BHWET programs by rural resi-
dents and in rural areas. In the 2017–2018 academic year, only 27
percent of BHWET trainees were from rural areas, 25 percent of
BHWET clinical sites were located in rural settings, and 20 percent
of BHWET trainees were receiving training in rural areas. The
Committee encourages HRSA to increase the number of trainees
from rural areas, clinical sites located in rural areas, and trainees
receiving training in rural areas. The Committee directs HRSA to
update the Committee on such efforts within 180 days of enact-
ment of this Act.
Peer Support Specialists in the Opioid Use Disorder Workforce.—
Within the total for BHWET, the Committee includes $15,000,000,
an increase of $5,000,000 above the fiscal year 2020 enacted level
and $15,000,000 above the fiscal year 2021 budget request, to fund
training, internships, and national certification for mental health
and substance abuse peer support specialists to create an advanced
peer workforce prepared to work in clinical settings. The Com-
mittee further recommends that consideration should be given to
community-based experiential training for students focusing on vet-
erans, first responders, or marginalized populations.
Loan Repayment Program for Substance Use Disorder Treatment
Workforce.—The Committee includes $17,000,000 for the Loan Re-
payment Program for Substance Use Disorder Treatment Work-
force, $5,000,000 above the fiscal year 2020 enacted level and the
fiscal year 2021 budget request. This program addresses shortages
in the substance use disorder (SUD) workforce by providing for the
repayment of education loans for individuals working in a full-time
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SUD treatment job that involves direct patient care in either a
Mental Health Professional Shortage Area or a county where the
overdose death rate exceeds the national average. This program
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47
contributes to increasing the ranks of a well-trained SUD work-
force in communities across America and helps save lives by equip-
ping the frontline professionals who prevent and treat addiction,
provide recovery support, and help reduce the negative con-
sequences associated with substance use.
Mental and Substance Use Disorder Workforce Training Dem-
onstration.—The Committee includes $41,700,000 for the Mental
and Substance Use Disorder Workforce Training Demonstration
program, $15,000,000 above the fiscal year 2020 enacted level and
$12,000,000 above the fiscal year 2021 budget request. This pro-
gram makes grants to institutions, including but not limited to
medical schools and FQHCs, to support training for medical resi-
dents and fellows in psychiatry and addiction medicine, as well as
nurse practitioners, physician assistants, and others, to provide
SUD treatment in underserved communities. Within the total, the
Committee includes an additional $15,000,000 for new grants to ex-
pand the number of nurse practitioners, physician assistants,
health service psychologists, and social workers trained to provide
mental and substance use disorder services in underserved commu-
nity-based settings that integrate primary care and mental and
substance use disorder services, which may include establishing,
maintaining, or improving academic units or programs to support
those activities, as authorized under section 760 of the PHS Act.
The Committee remains concerned by the lack of pediatric and
adolescent addiction medicine and addiction psychiatry expertise.
Currently, there are insufficient opportunities to effectively train a
robust mental health and substance use disorder workforce. Only
75 of the nation’s 179 accredited medical schools offer addiction
medicine fellowships, and only one program focuses on fellowship
opportunities for pediatric and adolescent addiction medicine and
addiction psychiatry. This gap is even more troubling given that
the onset of mental health disorders and substance use disorders
are most likely to occur at a young age. Substance use disorders
prevent children and adolescents from reaching their full potential
and are antecedent to addiction in adulthood, and it is evident that
our nation is not equipped to support this population. Therefore,
the Committee strongly encourages HRSA to include an adequate
number of funding awards to fellowship programs focused on in-
creasing the number of board-certified pediatric and adolescent ad-
diction medicine and addiction psychiatry subspecialists.
Public Health And Preventive Medicine Programs
The Committee includes $19,000,000 for Public Health and Pre-
ventive Medicine Training Grant Programs, $2,000,000 above the
fiscal year 2020 enacted level and $19,000,000 above the fiscal year
2021 budget request. Within this total, the Committee provides an
increase of $1,000,000 for the Preventive Medicine Residency
Training Program and an increase of $1,000,000 for Public Health
Training Centers.
Nurse Practitioner Optional Fellowship Program
The Committee provides $5,000,000, the same as the fiscal year
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2020 enacted level and $5,000,000 above the fiscal year 2021 budg-
et request, to make grants to establish or expand optional commu-
nity-based nurse practitioner fellowship programs that are accred-
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ited for practicing postgraduate nurse practitioners (NPs) in pri-
mary care or behavioral health. The Committee directs HRSA to
give preference to FQHCs, as defined by section 1861(aa)(4) of the
Social Security Act. The Committee is concerned the nation is un-
prepared for healthcare provider shortages and recognizes that op-
tional postgraduate programs with this focus, integrating primary
care and behavioral health, will help to address this problem. Pa-
tients need expert primary care and behavioral health providers
prepared to manage the social and clinical complexities experienced
in FQHCs. A key focus of the program will be training and profes-
sional development in the integration of primary care and behav-
ioral health. The program will provide original fellowships for
transitioning to an integrated model of care consistent with the
current high standards of NP education and practice meeting the
needs of our nation’s most vulnerable populations.
Nursing Education, Practice, Quality, and Retention (NEPQR)
Experiential Learning Opportunities.—Within the total for
NEPQR, the Committee includes not less than $2,000,000, the
same as the fiscal year 2020 enacted level and $2,000,000 above
the fiscal year 2021 budget request, for competitive grants to en-
hance nurse education and strengthen the nursing workforce
through the expansion of experiential learning opportunities. The
Committee encourages HRSA to support qualifying nurse education
training programs at community colleges throughout the country.
The Committee directs HRSA to ensure that these grants include
as an allowable use the purchase of simulation training equipment.
The Committee also directs HRSA to give priority to grantees lo-
cated in a health professional shortage area in a State with an age-
adjusted high burden of stroke, heart disease, and obesity, and to
prioritize submissions that support high poverty rate communities.
Children’s Hospitals Graduate Medical Education
The Committee recommends $340,000,000 for the Children’s Hos-
pitals Graduate Medical Education (CHGME) Payment program,
the same as the fiscal year 2020 enacted level and $340,000,000
above the fiscal year 2021 budget request. The CHGME Payment
program helps eligible hospitals maintain graduate medical edu-
cation programs, which support the training of residents to care for
the pediatric population and enhance the supply of primary care
and pediatric medical and surgical subspecialties.
Medical Student Education
The Committee recommends $55,000,000, $5,000,000 above the
fiscal year 2020 enacted level and $55,000,000 above the fiscal year
2021 budget request, to support colleges of medicine at public uni-
versities located in the top quintile of States projected to have a
primary care provider shortage. The Committee directs HRSA to
give priority to applications from universities located in States with
the greatest number of Federally-recognized Tribes. The Committee
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also directs HRSA to give priority to applications from public uni-
versities with a demonstrated public-private partnership.
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National Practitioner Data Bank (NPDB)
The Committee recommendation includes $18,814,000 for the
NPDB, the same as the fiscal year 2020 enacted level and the fiscal
year 2021 budget request. The NPDB is a workforce tool that col-
lects and discloses information to authorized entities on past ad-
verse actions of health care practitioners, providers, and suppliers
to reduce fraud and abuse and improve health care quality.
MATERNAL AND CHILD HEALTH
Appropriation, fiscal year 2020 ......................................................... $943,784,000
Budget request, fiscal year 2021 ....................................................... 919,018,000
Committee Recommendation ............................................................. 980,784,000
Change from enacted level ......................................................... +37,000,000
Change from budget request ...................................................... +61,766,000
The mission of the Maternal and Child Health Bureau is to im-
prove the physical and mental health, safety, and well-being of the
Nation’s women, infants, children, adolescents, and their families.
Hereditary Hemorrhagic Telangiectasia (HHT).—In fiscal years
2017 and 2018, the committee provided $200,000 to CDC to sup-
port a collaborative pilot model that enables up to three existing
Federally-funded Hemophilia Treatment Centers (HTC) to serve as
specialty centers for the evaluation and management of HHT. If
proven effective, these joint HTC–HHT Centers have the potential
to provide critical diagnostic and treatment services to both hemo-
philia and HHT populations. The Committee encourages HRSA to
work closely with CDC and stakeholder organizations to track the
progress of this pilot initiative for potential replication.
Maternal and Child Health (MCH) Block Grant
The Committee recommends $712,700,000 for the MCH Block
Grant, $25,000,000 above the fiscal year 2020 enacted level and
$48,000,000 below the fiscal year 2021 budget request. States use
the MCH Block Grant to improve access to care for mothers, chil-
dren, and their families; reduce infant mortality; provide pre- and
post-natal care; support screening and health assessments for chil-
dren; and provide systems of care for children with special health
care needs.
Maternal, Infant, and Early Childhood Home Visiting Pro-
gram.—The Committee recognizes that good oral health is an im-
portant component for improving the health and well-being of chil-
dren and families. The Committee encourages HRSA to explore op-
portunities to integrate oral health in the agency’s Home Visiting
Program and provide the home visitors with the training to become
a Community Dental Health Coordinator. The Committee also en-
courages HRSA to work with oral health initiatives such as Com-
munity Dental Health Coordinators that have already been initi-
ated by dental organizations to provide dental education, commu-
nity-based prevention, care coordination, and patient navigation to
children and vulnerable families.
Special Projects of Regional and National Significance
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The Committee continues bill language identifying specific
amounts for Special Projects of Regional and National Significance
(SPRANS). The Committee provides the following within SPRANS:
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FY 2021
Budget Activity Committee
Set-aside for Oral Health ............................................................................................................................... $5,250,000
Set-aside for Epilepsy .................................................................................................................................... 3,642,000
Set-aside for Sickle Cell Disease ................................................................................................................... 5,000,000
Set-aside for Fetal Alcohol Syndrome ............................................................................................................ 1,000,000
State Oral Health Programs.—The Committee continues to in-
clude $250,000 to continue demonstration projects to increase the
implementation of integrating oral health and primary care prac-
tice. The projects should model the core clinical oral health com-
petencies for non-dental providers that HRSA published and ini-
tially tested in its 2014 report Integration of Oral Health and Pri-
mary Care Practice. The Committee encourages the Chief Dental
Officer to continue to direct the design, monitoring, oversight, and
implementation of these projects.
Fetal Alcohol Syndrome (FAS) Set-Aside.—Recognizing that as
many as one in 20 school-age children are affected by fetal alcohol
spectrum disorders (FASD), yet few have access to essential diag-
nostic and multidisciplinary services, the Committee includes no
less than the fiscal year 2020 level for HRSA to continue activities
funded by the FAS set-aside. The Committee also encourages
HRSA to consider support for an established FASD-specific na-
tional network to improve the well-being of children and families
with FASD.
Adverse Childhood Experiences.—The Committee is aware that
childhood trauma and toxic stress have been linked to negative
health outcomes through adulthood, including higher rates of dia-
betes, stroke, depression, lapses in cognitive abilities, and develop-
mental delays, suicide, and substance misuse, among others. The
Committee recognizes that promoting awareness to parents and
health care providers around the impact of trauma on the devel-
oping brain and the importance of encouraging supportive and re-
sponsive relationships with caring adults as two promising strate-
gies. The Committee supports efforts to improve child health by de-
veloping screening protocols and evidence-based interventions to in-
dividuals suffering from adverse childhood experiences (ACEs) such
as child abuse and neglect, witnessing interpersonal violence, fam-
ily substance abuse, family separation, parental divorce, parental
loss, and mental illness, to promote developmental resiliency. The
end goal of such efforts should be to yield a model for integrating
ACEs screening and trauma-informed onsite services into primary
care settings.
The Committee includes $1,000,000 within SPRANS to fund a
study focused on improving child health by implementing screening
protocols and evidence-based interventions to individuals who have
experienced adverse childhood experiences (ACEs) such as child
abuse and neglect, witnessing interpersonal violence, family sub-
stance abuse, family separation, parental divorce, parental loss,
and mental illness, to promote developmental resiliency. The end
goal of the study should be to yield a model for integrating ACEs
screening and trauma-informed strength based care into primary
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care settings. The Committee directs HRSA to submit a report with
the results of this study to the Committee within three years of en-
actment of this Act.
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Alliance for Maternal Health Safety Bundles.—The Committee
includes $7,000,000, an increase of $2,000,000 above the fiscal year
2020 enacted level and $8,000,000 below the fiscal year 2021 budg-
et request, to expand implementation of the Alliance for Innovation
on Maternal Health program’s maternal safety bundles to all U.S.
States, the District of Columbia, U.S. territories, and tribal enti-
ties. Maternal safety bundles are a set of targeted and evidence-
based best practices that, when implemented, improve patient out-
comes and reduce maternal mortality and severe maternal mor-
bidity.
Children’s Health and Development.—The Committee continues
to provide $3,500,000 to continue studies focused on identifying
interventions that could result in systemic change that would posi-
tively impact the policy of child-health-related institutions and sys-
tems in States with the highest levels of childhood poverty.
Hemophilia Treatment Centers.—The Committee provides
$4,800,000 for Hemophilia Treatment Centers, the same as the fis-
cal year 2020 enacted level. The Regional Hemophilia Network Pro-
gram uses a regional infrastructure of hemophilia treatment cen-
ters to promote and improve the comprehensive care of individuals
with hemophilia and related bleeding disorders or clotting dis-
orders.
Infant-Toddler Court Teams.—The Committee includes
$10,000,000, the same as the fiscal year 2020 enacted level, for the
fourth year of a cooperative agreement to support research-based
infant-toddler court teams to change child welfare practices to im-
prove well-being for infants, toddlers, and their families. The Com-
mittee encourages HRSA to use these funds to: (1) build upon the
work of sites established or currently supported through the Infant-
Toddler Court Program, including by providing training, technical
assistance, and additional support for such court teams’ efforts
across the country; and (2) plan and support additional infant-tod-
dler court teams.
Maternal Mental Health Hotline.—The U.S. suffers from one of
the highest maternal death rates in the developed world. Suicide
and overdose have been identified as the leading causes of death
during the first year postpartum and depression is the most com-
mon complication of pregnancy in the first year postpartum. To
help address these issues, the Committee includes $3,000,000 to
contract with a qualified entity to establish and maintain a mater-
nal mental health hotline to be staffed by qualified counselors, 24
hours a day. Funding may also be used for outreach to raise aware-
ness about maternal mental health issues and the hotline.
State Maternal Health Innovation Grants.—The Committee in-
cludes $23,000,000, the same as the fiscal year 2019 enacted level,
for State Maternal Health Innovation Grants that will establish
demonstrations to implement evidence-based interventions to ad-
dress critical gaps in maternity care service delivery and reduce
maternal mortality. The demonstrations will be representative of
the demographic and geographic composition of communities most
affected by maternal mortality.
Maternal and Child Health Programs
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In addition to the Maternal and Child Health Block Grant, the
Maternal and Child Health Bureau supports several programs to
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improve the health of all mothers, children, and their families.
These programs support activities that develop systemic mecha-
nisms for the prevention and treatment of sickle cell disease; pro-
vide information and research on and promote screening of autism
and other developmental disorders; provide newborn and child
screening of heritable disorders; provide grants to reduce infant
mortality and improve perinatal outcomes; fund States to conduct
newborn hearing screening; and provide grants to improve existing
emergency medical services.
Within the total for Maternal and Child Health Programs, the
Committee recommends the following amounts:
FY 2021
Budget Activity Committee
Sickle Cell Anemia Program ........................................................................................................................... $7,205,000
Autism and Other Developmental Disorders .................................................................................................. 53,344,000
Heritable Disorders ......................................................................................................................................... 21,883,000
Healthy Start .................................................................................................................................................. 130,500,000
Universal Newborn Hearing ............................................................................................................................ 17,818,000
Emergency Medical Services for Children ...................................................................................................... 22,334,000
Screening and Treatment for Maternal Depression. ...................................................................................... 5,000,000
Pediatric Mental Health Access ..................................................................................................................... 10,000,000
Autism and Other Developmental Disorders
The Committee recommends $53,344,000 for Autism and Other
Developmental Disorders, $1,000,000 above the fiscal year 2020 en-
acted level and $53,344,000 above the fiscal year 2021 budget re-
quest. 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 devel-
opmental disabilities.
Leadership Education in Neurodevelopmental and Related Dis-
abilities (LEND).—The Committee provides $36,245,000,
$1,000,000 above the fiscal year 2020 enacted level, for the LEND
program to allow the existing 52 LEND sites to maintain their ca-
pacity to train interdisciplinary professionals to screen, diagnose,
and provide evidence-based interventions to individuals with au-
tism spectrum disorder and other developmental disabilities. (ASD/
DD) as authorized by the Autism CARES Act. This funding will en-
able the LEND network to fulfill its expanded statutory mandate
to train interdisciplinary providers who will serve individuals
across the lifespan, addressing a critical shortage of health care
professionals for adults with autism and other developmental dis-
abilities. This funding will also enable the LEND network to assist
in ongoing developmental monitoring, especially for children im-
pacted by pressing public health crises, such as opioids, lead and
other environmental toxins, the Zika virus, COVID–19, and other
new or emerging issues, with resulting complications. The LENDs
are a strong community link to services and supports for these
newest members of the disability community and their families.
This funding is critical to the LEND’s role in providing direct clin-
ical assessment and evidence-based interventions. In addition, the
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funding will allow these programs to develop innovative strategies
to integrate and enhance existing investments, including trans-
lating research findings on interventions, guidelines, tools, and sys-
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53
tems management approaches to interdisciplinary training set-
tings, to communities, and into practice, and promote life-course
considerations—from developmental screening in early childhood to
transition to adulthood issues.
Heritable Disorders
The Committee provides $21,883,000 for the Heritable Disorders
program, $4,000,000 above the fiscal year 2020 enacted level and
$21,883,000 above the fiscal year 2021 budget request. This pro-
gram supports activities that strengthen the newborn screening
system to ensure infants born in every State receive rapid identi-
fication, early intervention, and potentially life-saving treatment.
Severe Combined Immune Deficiency (SCID).—Within the total
amount for Heritable Disorders, the Committee provides
$3,000,000, the same as the fiscal year 2020 enacted level, to sup-
port wider implementation, education, and awareness of newborn
screening and follow-up for SCID and other newborn screening dis-
orders. The Committee applauds HRSA’s ongoing work to ensure
screening of all newborns for Severe Combined Immune Deficiency
(SCID), including through initiatives that help parents of newborns
diagnosed with SCID understand the disease and treatment op-
tions and to navigate the path forward. The Committee encourages
HRSA to support efforts to develop telehealth approaches to link
families in rural and underserved communities with support and
resources, engage providers in education or training related to
SCID, and establish mechanisms to obtain long-term outcomes in-
formation on infants with SCID through newborn screening.
Healthy Start
The Committee recommends $130,500,000 for the Healthy Start
program, $5,000,000 above the fiscal year 2020 enacted level and
the fiscal year 2021 budget request. The program provides grants
to communities with high rates of infant mortality to support pri-
mary and preventive health care services for mothers and their in-
fants.
Maternal Mortality.—The Committee recognizes the rising ma-
ternal mortality rate in the U.S. as a pressing public health issue.
Analysis of maternal mortality review committee data indicates
that over 60 percent of pregnancy-related deaths are preventable.
The Committee continues to provide no less than $15,000,000, the
same as the fiscal year 2020 enacted level and the fiscal year 2021
budget request, for Healthy Start grantees to support nurse practi-
tioners, certified nurse midwives, physician assistants, and other
maternal-child advance practice health professionals within all pro-
gram sites nationwide. Clinical staff will provide direct access to
well-woman care and maternity care services to reduce barriers in
access to maternity care and help address maternal health dispari-
ties among high-risk and underserved women. Clinical staff will
also support health educators by conducting training on maternal
early warning signs.
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RYAN WHITE HIV/AIDS PROGRAM
Appropriation, fiscal year 2020 ......................................................... $2,388,781,000
Budget request, fiscal year 2021 ....................................................... 2,483,781,000
Committee Recommendation ............................................................. 2,413,781,000
Change from enacted level ......................................................... +25,000,000
Change from budget request ...................................................... ¥70,000,000
In addition to the funds above, the CARES Act included
$90,000,000 for the Ryan White HIV/AIDS program to prevent and
respond to coronavirus and maintain care for patients.
The Ryan White Human Immunodeficiency Virus/Acquired Im-
munodeficiency Syndrome (HIV/AIDS) program funds activities to
address the care and treatment of persons living with HIV/AIDS
who are either uninsured or underinsured and need assistance to
obtain treatment. The program provides grants to States and eligi-
ble metropolitan areas to improve the quality, availability, and co-
ordination of health care and support services to include access to
HIV-related medications; grants to service providers for early inter-
vention outpatient services; grants to organizations to provide care
to HIV infected women, infants, children, and youth; and grants to
organizations to support the education and training of health care
providers.
Within the total for the Ryan White HIV/AIDS program, the
Committee provides the following amounts:
FY 2021
Budget Activity Committee
Emergency Assistance .................................................................................................................................... $655,876,000
Comprehensive Care Programs ...................................................................................................................... 1,315,005,000
AIDS Drug Assistance Program ............................................................................................................. 900,313,000
Early Intervention Program ............................................................................................................................. 201,079,000
Children, Youth, Women, and Families .......................................................................................................... 75,088,000
AIDS Dental Services ...................................................................................................................................... 13,122,000
Education and Training Centers .................................................................................................................... 33,611,000
Special Projects of National Significance ...................................................................................................... 25,000,000
Domestic HIV Initiative ................................................................................................................................... 95,000,000
Ending the HIV Epidemic Initiative.—The Committee includes
$95,000,000 within the Ryan White HIV/AIDS Program for the
EHE Initiative, an increase of $25,000,000 above the fiscal year
2020 enacted level and $70,000,000 below the fiscal year 2021
budget request. This investment builds on an increase of
$70,000,000 included in fiscal year 2020, bringing the two-year in-
vestment in Ryan White for the EHE Initiative to a total of
$165,000,000. Funds are distributed to high-need jurisdictions to
increase linkage, engagement, and retention in care with the goal
of increasing viral suppression among people living with HIV.
HEALTH CARE SYSTEMS
Appropriation, fiscal year 2020 ......................................................... $123,593,000
Budget request, fiscal year 2021 ....................................................... 115,418,000
Committee Recommendation ............................................................. 131,093,000
Change from enacted level ......................................................... +7,500,000
Change from budget request ...................................................... +5,060,000
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In addition to the funds above, the CARES Act included
$5,000,000 to support increased demand for services from Poison
Control Centers.
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The Health Care Systems Bureau supports national activities
that enhance health care delivery in the U.S., including maintain-
ing a national system to allocate and distribute donor organs to in-
dividuals awaiting transplant; building an inventory of cord blood
units; maintaining a national system for the recruitment of bone
marrow donors; operating the 340B drug discount program; and op-
erating a national toll-free poison control hotline.
Within the total for Health Care Systems, the Committee pro-
vides the following amounts:
FY 2021
Budget Activity Committee
Organ Transplantation ................................................................................................................................... $33,049,000
National Cord Blood Inventory ....................................................................................................................... 17,266,000
C.W. Bill Young Cell Transplantation Program .............................................................................................. 30,009,000
Office of Pharmacy Affairs ............................................................................................................................. 10,238,000
Poison Control Centers ................................................................................................................................... 24,846,000
Hansen’s Disease Program ............................................................................................................................ 13,706,000
Hansen’s Disease Buildings and Facilities ................................................................................................... 122,000
Hansen’s Payment to Hawaii ......................................................................................................................... 1,857,000
Organ Transplantation
The Committee includes $33,049,000 for the Organ Transplan-
tation program, $5,500,000 above the fiscal year 2020 enacted level
and $2,500,000 above the fiscal year 2021 budget request.
Maximizing Deceased Donor Organ Recovery, Acceptance, and
Utilization.—The Committee supports the goal of significantly in-
creasing kidney transplants, established by the President’s Execu-
tive Order on Advancing American Kidney Health, and supports ef-
forts to establish objective outcome measures for Organ Procure-
ment Organizations (OPO) as well as efforts to decertify underper-
forming OPOs at the conclusion of the current contract cycles. The
Committee encourages HHS and HRSA to monitor transplant cen-
ter listing and acceptance practices as recorded with the Organ and
Procurement and Transplantation Network (OPTN), and to make
publicly available its findings based on one calendar year of data.
The listed screening criteria for each patient receiving an organ
offer should be compared to center refusals codes for those organs
not accepted for transplant by the patient’s transplant center. Fur-
ther, the utilization rates by center should be reported for all organ
offers and for both the brain dead and donation after circulatory
death subcategories. The Committee supports HHS’s Request for
Information for the technology system over which these organ of-
fers are facilitated and encourages HHS to promote competition for
this contract.
Reimbursement of Travel and Subsistence Expenses Toward Liv-
ing Organ Donation Program.—The Committee includes
$10,000,000, an increase of $5,500,000 above the fiscal year 2020
enacted level and $500,000 above the fiscal year 2021 budget re-
quest, for expansion of the program administered via the National
Living Donor Assistance Center to reimburse a comprehensive
range of living donor expenses for the greatest possible number of
donors, including lost wages, childcare, eldercare, similar expenses
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for donor caretakers, and removing other disincentives to donation.
The Committee supports significant expansion of income eligibility
for the program to allow as many donors as possible to qualify and
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to ensure that financial reimbursement and monetary exchange
take place outside of the organ donor-organ recipient relationship
to the greatest extent possible.
Office of Pharmacy Affairs
The Committee includes $10,238,000 for the Office of Pharmacy
Affairs, the same as the fiscal year 2020 enacted level and the fis-
cal year 2021 budget request. The Committee recognizes 340B re-
mains important and allows providers to stretch scarce Federal re-
sources to reach more eligible patients and provide comprehensive
services. The 340B drug pricing program was designed to help safe-
ty net providers maintain, improve, and expand patient access to
healthcare services. The 340B program has lowered the cost of out-
patient drugs to health clinics and nonprofit and public hospitals
that serve a disproportionate share of low-income and rural pa-
tients. These entities provide additional services and benefits to
their communities with the savings realized.
The Committee acknowledges the request for additional regu-
latory authority and notes that HRSA already has existing over-
sight authority that allows the agency to conduct audits of stake-
holders who participate in the program to ensure compliance. The
Committee recognizes that HRSA has used this authority to con-
duct 1,300 audits of covered entities, but only 20 audits of manu-
facturers. The Committee is concerned that HRSA is not using
their existing oversight authority to pursue balanced oversight of
both providers and drug manufacturers. We encourage HRSA to
use its existing oversight authority to pursue more balanced over-
sight of both providers and manufacturers to ensure compliance
and integrity of the 340B program.
Poison Control Centers
In addition to the amounts provided in this bill, the CARES Act
included $5,000,000 for Poison Control Centers to accommodate in-
creased demand due to the COVID–19 pandemic.
The Committee recommends $24,846,000 for Poison Control Cen-
ters, which is $2,000,000 above the fiscal year 2020 enacted level
and the fiscal year 2021 budget request. This program funds poison
centers, supports a national emergency poison toll-free number
(800–222–1222), and implements public education and outreach
programs to educate and serve the public and health care pro-
viders. The Committee notes the impact of COVID–19, and signifi-
cant State and hospital revenue loss, to the poison control program
nationally. Poison centers are experiencing dramatic increases in
intentional suspected suicides among youth, the misuse of house-
hold cleaners, bleach, and rubbing alcohol, and COV1D–19 related
anxiety, isolation, and depression, which is leading to increased use
of substances and risk of self-harm and suicide.
RURAL HEALTH
Appropriation, fiscal year 2020 ......................................................... $318,294,000
Budget request, fiscal year 2021 ....................................................... 246,834,000
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Committee Recommendation ............................................................. 334,294,000
Change from enacted level ......................................................... +16,000,000
Change from budget request ...................................................... +87,460,000
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In addition to the funds above, the CARES Act included
$180,000,000 for Rural Health programs to expand telehealth and
support rural hospitals amid the COVID–19 pandemic.
The Federal Office of Rural Health Policy’s programs provide
funding to improve access, quality, and coordination of care in
rural communities; for research on rural health issues; for technical
assistance and recruitment of health care providers; for screening
activities for individuals affected by the mining, transport, and
processing of uranium; for the outreach and treatment of coal min-
ers and others with occupation-related respiratory and pulmonary
impairments; and for the expansion of telehealth services.
Within the total for Rural Health activities, the Committee pro-
vides the following amounts:
FY 2021
Budget Activity Committee
Rural Outreach Programs ............................................................................................................................... $79,500,000
Rural Health Research. .................................................................................................................................. 10,351,000
Rural Hospital Flexibility Grants .................................................................................................................... 55,609,000
State Offices of Rural Health ........................................................................................................................ 12,500,000
Black Lung Clinics ......................................................................................................................................... 11,500,000
Radiation Exposure Screening and Education ............................................................................................... 1,834,000
Telehealth ....................................................................................................................................................... 42,000,000
Rural Communities Opioid Response ............................................................................................................. 110,000,000
Rural Health Residency Program ................................................................................................................... 11,000,000
Rural Health Liaison.—The Committee directs HRSA to submit
a report to the Committee describing how HRSA is coordinating
with the Department of Agriculture Rural Health Liaison within
180 days of enactment of this Act.
GAO Study on Obstetrics (OB) Closures.—According to the Rural
Health Research Gateway, between 2004 and 2014, 179 rural coun-
ties lost hospital-based OB services. The Committee directs the
Government Accountability Office (GAO) to submit a report on
ways to improve access to obstetrics care in rural areas and pre-
vent OB unit hospital closures in rural areas.
Rural Health Outreach Programs
Community Health Workers.—The Committee recognizes the im-
portance of community health workers, particularly in rural and
underserved areas, to help address persistent health issues tied to
social determinants of health. The Committee is aware that many
States would like to better incorporate community health workers
into their systems, but there is currently a lack of a unified train-
ing and certification resource available to them. The Committee en-
courages HRSA to consider supporting a national center, based at
an academic medical center with expertise in integrating commu-
nity health workers into health systems, to assist States and pro-
viders through workshops, consultations, certifications and con-
tinuing education credits.
Southwest States Rural Development Network Grant Program.—
The Committee encourages HRSA to consider funding a new South-
west States Rural Development Network Grant Program, within
the Southwest Border Region as defined by 40 U.S.C. § 15732, to
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promote the development of integrated health care networks in
order to: (1) achieve efficiencies; (2) expand access to, coordinate,
and improve the quality of essential health care services; and (3)
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58
strengthen the rural health care system as a whole. The Com-
mittee also encourages HRSA to consider a pilot program to help
underserved rural communities in the region identify and better
address their health care needs and to help small rural hospitals
improve their financial and operational performance.
Rural Health Research and Policy Development Telementoring
Training Center.—The Committee continues to include $1,000,000
within the total for Rural Health Research and Policy Development
to support a telementoring training center to train academic med-
ical centers and other centers of excellence in the creation of tech-
nology-enabled telementoring learning programs that facilitate the
dissemination of best practice specialty care to primary care pro-
viders and care teams across the country.
Rural Health Flexibility Grants
The Committee includes $55,609,000 for Rural Health Flexibility
Grants, $2,000,000 above the fiscal year 2020 enacted level and
$55,609,000 above the fiscal year 2021 budget request.
Small Rural Hospital Improvement Program (SHIP).—The Com-
mittee recommendation includes $21,942,000 for SHIP, an increase
of $2,000,000 over the fiscal year 2020 enacted level and
$21,942,000 above the fiscal year 2021 budget request.
Radiation Exposure Screening and Education
The Committee commends the work of the Radiation Exposure
Screening and Education Program, which supports States most af-
fected by the mining, transport, and processing of uranium and the
testing of nuclear weapons for the Nation’s weapons arsenal.
Telehealth
The Committee includes $42,000,000 for Telehealth, $13,000,000
above the fiscal year 2020 enacted level and the fiscal year 2021
budget request.
In addition to the amounts provided in this bill, the CARES Act
included $15,000,000 for the Telehealth program to expand services
amid the COVID–19 pandemic.
Rural Telemedicine Projects.—The Committee strongly supports
expanded use of effective and secure telemedicine platforms and re-
mote capabilities to provide expanded health care and related be-
havior health monitoring and surveillance services in areas that
have been hard hit by the opioid epidemic and related substance
use disorders. Such technology is needed to augment care and pro-
vide access to high quality medical services and monitoring capa-
bilities that decrease geographic barriers and reduce the cost of
care, especially for individuals at risk for incarceration and recidi-
vism. To bolster current efforts and address current and antici-
pated needs surrounding infections disease outbreaks such as the
novel coronavirus of 2019, as well as other medication-assisted
treatments and related mental health monitoring services, the
Committee supports efforts that use telemedicine platforms to ex-
pand access to rural regions and communities disproportionately
impacted by the lack of much needed health care delivery services.
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Technology-Enabled Collaborative Learning Capacity Building
Models Grants.—The Committee includes $10,000,000 within the
total for Telehealth to support grants to connect specialists at aca-
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demic medical centers with primary care providers in rural and un-
derserved areas, providing evidence-based training and support to
help them treat patients with complex conditions in their commu-
nities.
Telehealth Centers of Excellence.—The Committee recommenda-
tion includes $7,000,000, an increase of $1,000,000 over the fiscal
year 2020 enacted level, to support the continued development of
Telehealth Centers of Excellence. Telehealth can provide rural pa-
tient access to quality primary and specialty care that would other-
wise require patients to travel long distances for diagnosis and
treatment. Many States have invested in telehealth networks in
order to provide rural, medically underserved areas with access to
primary and emergency care. Specialists from a central location
can help rural providers with critical care for stroke and heart at-
tack that can literally mean the difference between life and death.
The Centers of Excellence serve to promote the adoption of tele-
health programs across the country by validating technology, estab-
lishing training protocols, and by providing a comprehensive tem-
plate for States to integrate telehealth into their State health pro-
vider network. Additional funding for the Centers of Excellence will
serve to promote the adoption of telehealth services nation-wide
and thus address the access to care issue faced by rural America.
Rural Health Residency Program
The Committee includes $11,000,000 for Rural Health Residency
Program, $1,000,000 above the fiscal year 2020 enacted level and
$11,000,000 above the fiscal year 2021 budget request.
Rural Residency Planning and Development Program.—The Com-
mittee commends the Office of Rural Health Policy for its efforts
to expand the physician workforce in rural areas and supports con-
tinuation and expansion of the program to develop new rural resi-
dency programs, or Rural Training Tracks (RTTs). The Committee
encourages HRSA to expand the current program to include RTTs
in obstetrics and gynecology. Women in rural communities are
more likely to begin prenatal care late and are more likely to expe-
rience maternal mortality and severe maternal morbidity. The ex-
pansion of this program would align with the agency’s goals of im-
proving maternal health outcomes and eliminating preventable ma-
ternal mortality.
FAMILY PLANNING
Appropriation, fiscal year 2020 ......................................................... $286,479,000
Budget request, fiscal year 2021 ....................................................... 286,479,000
Committee Recommendation ............................................................. 286,479,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... –––
The Committee includes $286,479,000 for the Family Planning
program, the same as the fiscal year 2020 enacted level and the
2021 budget request. The Family Planning program administers
Title X of the Public Health Service Act. This program plays a vital
role not only in ensuring access to affordable contraceptive edu-
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cation, services, and supplies, but also in STD prevention, screen-
ing, and treatment; cervical and breast cancer screenings; first-line
infertility services; and other community and health care services.
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The bill includes language directing the Secretary to carry out
the Title X Family Planning program in accordance with the regu-
lations that were in place on January 18, 2017 and provide new
grants to grantees whose awards were relinquished or terminated
before the planned end of the performance period in fiscal year
2019. The Committee directs the Secretary to ensure that grantees
certify that they: (1) provide medically accurate and complete coun-
seling, including referral as requested, on all matters; (2) shall not
condition the receipt of Title X-supported services on patients re-
maining sexually abstinent until marriage; and (3) will not make
any appointments or referrals for patients that are contrary to the
patient’s wishes.
PROGRAM MANAGEMENT
Appropriation, fiscal year 2020 ......................................................... $155,300,000
Budget request, fiscal year 2021 ....................................................... 151,993,000
Committee Recommendation ............................................................. 155,300,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... +3,307,000
Program management supports the cost of Federal staff and re-
lated activities to coordinate, direct, and manage the programs of
HRSA.
Chief Dental Officer.—The Committee is pleased that HRSA has
restored the position of Chief Dental Officer (CDO) and looks for-
ward to learning how the agency has ensured that the CDO is
functioning at an executive level authority with resources and staff
to oversee and lead all oral health programs and initiatives across
HRSA. The Committee requests an update by February 2021 on
how the CDO is serving as the agency representative with execu-
tive level authority on oral health issues to international, national,
State and/or local government agencies, universities, and oral
health stakeholder organizations.
Investments in Impoverished Areas.—The Committee supports
targeted investments in impoverished areas, particularly in per-
sistent poverty counties and in other high-poverty census tracts. To
understand how programs funded through HRSA are serving these
particular areas, the Committee directs HRSA to submit a report
to the Committee on the percentage of funds allocated by all com-
petitive grant programs and other anti-poverty programs in fiscal
years 2018, 2019 and 2020 and estimates for fiscal year 2021 to
serve individuals living in persistent poverty counties, as defined
as a county that has had 20 percent or more of its population living
in poverty over the past 30 years, as measured by the 1990 and
2000 decennial censuses and the most recent Small Area Income
and Poverty estimates, or any territory or possession of the U.S.,
and high-poverty areas, as defined as any census tract with a pov-
erty rate of at least 20 percent as measured by the 2014–2018 5-
year data series available from the American Community Survey
of the Census Bureau. HRSA shall report this information to the
Committee within 90 days of such data being available and provide
a briefing to the Committee not later than 180 days of enactment
of this Act on how HRSA is carrying out this directive. In the case
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of any program for which at least 10 percent of the funds allocated
in fiscal year 2020 were not allocated to persistent poverty counties
or for which the percentage allocated to high-poverty areas in fiscal
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61
year 2020 was less than the average percentage of Federal assist-
ance allocated to high-poverty areas awarded under the program in
fiscal years 2017, 2018, and 2019, such report and briefing shall ex-
plain why such a benchmark is unable to be met.
Oral Health Literacy.—The Committee includes $300,000 to con-
tinue the development of an oral health awareness and education
campaign across relevant HRSA divisions, including the Health
Centers Program, Oral Health Workforce, Maternal and Child
Health, Ryan White HIV/AIDS Program, and Rural Health. The
Committee directs HRSA to identify oral health literacy strategies
that are evidence-based and focused on oral healthcare prevention
and education, including prevention of oral disease such as early
childhood and other caries, periodontal disease, and oral cancer.
The Committee encourages the Chief Dental Officer to play a key
role in the design, monitoring, oversight, and implementation of
this project.
CENTERS FOR DISEASE CONTROL AND PREVENTION
Appropriation, fiscal year 2020 ......................................................... $7,749,554,000
Budget request, fiscal year 2021 ....................................................... 7,056,264,000
Committee Recommendation ............................................................. 7,981,654,000
Change from enacted level ......................................................... +232,100,000
Change from budget request ...................................................... +925,390,000
The Committee recommendation for the Centers for Disease Con-
trol and Prevention (CDC) program level includes $7,070,146,000
in discretionary budget authority, $55,358,000 in mandatory funds
under the terms of the Energy Employees Occupational Illness
Compensation Program Act, and $856,150,000 in transfers from the
Prevention and Public Health (PPH) Fund.
In addition, the Committee includes $9,000,000,000 in emergency
appropriations for CDC programs and activities, including emer-
gency appropriations for State and local health departments, State
and local public health laboratories, global health and global dis-
ease detection, vaccination campaigns, public health data mod-
ernization, public health workforce development, and the Infectious
Diseases Rapid Response Reserve Fund. The emergency appropria-
tion is further described under Title VI of this committee report.
Further, the Coronavirus Preparedness and Response Supple-
mental Appropriations Act (P.L. 116–123) included $2,200,000,000;
the CARES Act (P.L. 116–136) included $4,300,000,000; and the
Paycheck Protection Program and Health Care Enhancement Act
(P.L. 116–139) included $1,000,000,000 for CDC to support public
health and emergency response activities, domestically and inter-
nationally, in response to the COVID–19 pandemic.
CDC’s mission is to protect Americans from health, safety, and
security threats, which it accomplishes by supporting core public
health functions at State, local, and Tribal health departments, de-
tecting and responding to new and emerging health threats, pro-
moting health and safety, and providing leadership in the public
health workforce.
CDC Guidance for COVID–19.—The Committee recognizes that
CDC does not have independent regulatory authority. However, the
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Committee strongly urges CDC to work closely with State and local
health departments, as well as the Occupational Safety and Health
Administration, to ensure that State and local health regulations
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are aligned with CDC guidance for mask wearing, schools and day
camps, child care programs, employers with workers at high risk,
restaurants and bars, mass transit, crowded public events, and any
other CDC guidance intended to mitigate the spread of COVID–19.
IMMUNIZATION AND RESPIRATORY DISEASES
Appropriation, fiscal year 2020 ......................................................... $790,005,000
Budget request, fiscal year 2021 ....................................................... 830,005,000
Committee Recommendation ............................................................. 840,005,000
Change from enacted level ......................................................... +50,000,000
Change from budget request ...................................................... +10,000,000
The Committee recommendation includes $469,705,000 in discre-
tionary budget authority and $370,300,000 in transfers from the
PPH Fund.
Immunization cooperative agreements are awarded to State and
local public health departments for planning, developing, and con-
ducting childhood, adolescent, and adult immunization programs,
including enhancement of the vaccine delivery infrastructure. CDC
directly maintains a stockpile of vaccines, supports consolidated
purchase of vaccines for State and local health agencies, and con-
ducts surveillance, investigations, and research into the safety and
efficacy of new and presently used vaccines.
Within the total for Immunization and Respiratory Diseases, the
Committee recommends the following amounts:
FY 2021
Budget Activity Committee
Section 317 Immunization Program ............................................................................................................... $613,647,000
National Immunization Survey .............................................................................................................. 12,864,000
Acute Flaccid Myelitis .................................................................................................................................... 10,000,000
Influenza Planning and Response ................................................................................................................. 216,358,000
Acute Flaccid Myelitis.—The Committee includes $10,000,000 to
identify the cause, prevention, and treatment of acute flaccid myeli-
tis, a rare but serious condition that affects the nervous system.
Cost Estimates.—The Committee looks forward to reviewing the
fiscal year 2022 report on estimated funding needs of the Section
317 Immunization Program and urges that the report be updated
and submitted not later than February 1, 2021. The updated report
should include an estimate of optimum State and local operations
funding, as well as a discussion of the role of the 317 Program, as
coverage for vaccination under public and private resources con-
tinues to evolve. The fiscal year 2022 report should include specific
information on the estimated cost to fully address evidence-based
public health strategies that could be funded through CDC to im-
prove coverage for human papillomavirus and influenza.
Immunization Rates.—As communities follow stay-at-home or-
ders to reduce transmission of the coronavirus, there have been re-
ductions in vaccination coverage that leave young children and
communities vulnerable to vaccine-preventable diseases. The Com-
mittee is concerned that areas where immunization rates have fall-
en below the threshold necessary to prevent future outbreaks put
the public health at risk. The Committee believes that it is impor-
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tant to public health to increase the rate at which people in the
U.S. choose to vaccinate themselves and their children. Within the
funding provided, the Committee supports CDC’s efforts to under-
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stand and address obstacles to vaccination including access, hesi-
tancy and misinformation.
Influenza Planning and Response.—The Committee includes an
increase of $40,000,000 to enhance CDC’s influenza activities, in-
cluding expanding vaccine effectiveness monitoring and evaluation,
and increasing influenza vaccine acceptance by removing barriers
to vaccination and promoting vaccination coverage. The Committee
is very concerned about the 2020–2021 influenza season and the
impact of the double wave of influenza and COVID–19.
Influenza Vaccine.—The Committee encourages CDC to consider
including vaccines produced through recombinant DNA technology
in addition to traditionally-produced vaccines in future solicitations
to facilitate the competitive process for all vaccine manufacturers.
Measles Immunization.—The Committee recognizes the growing
risk with measles and its impact on the Pacific Region. The Com-
mittee urges CDC to work through emergency responders, Centers
of Excellence, Community Health Centers, and other applicable
providers to provide education and training on proper protocols to
prevent and treat measles, including immunization.
Respiratory Syncytial Virus.—The Committee applauds the ongo-
ing development of passive and active immunization candidates for
the prevention of respiratory syncytial virus (RSV) which is the
leading cause of infant hospitalization, a major cause of outpatient
and emergency medical visits in the U.S. and for which there is no
current preventive measure available for use in infants, except for
high risk. As new vaccines and immunoprophylaxis products are in
the late stages of development, it is important to have robust infor-
mation on the existing burden of RSV to properly evaluate the ben-
efit to patients and the healthcare system. Therefore, the Com-
mittee encourages CDC to continue to explore surveillance ap-
proaches with the Council of State and Territorial Epidemiologists.
Section 317 Immunization Program.—The Committee views the
317 Immunization Program, including the Vaccines for Children
Program, as a pivotal part of the U.S. public health infrastructure.
The Committee is aware that public health experts expect SARS–
CoV–2, the novel coronavirus that causes COVID–19, to continue
to circulate in the U.S. during the fall 2020 and winter 2020–2021.
While the timing of availability of a vaccine to prevent COVID–19
remains unclear, one strategy to decrease stress on the healthcare
system is to increase vaccination coverage with seasonal influenza
vaccine beginning in early fall 2020. Although the impact of in-
creased coverage varies season-to-season, higher influenza vaccine
coverage would be expected to result in decreases in doctor visits
and hospitalizations during the influenza season, making more ca-
pacity available for persons with COVID–19. In order to reduce
health care utilization for influenza and protect populations vulner-
able to severe COVID–19 outcomes, CDC should launch an en-
hanced influenza campaign in time for the 2020–21 season, includ-
ing messages targeting those at higher risk for COVID–19. In addi-
tion, in order to prepare for a national SARS–CoV–2 vaccination
program, the Committee urges CDC to initiate planning and ex-
pansion of vaccination infrastructure in coordination with State,
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local, territorial and tribal public health authorities.
Shared Clinical Decision Making.—The Committee encourages
CDC to work with Advisory Committee on Immunization Practices
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and the National Vaccine Advisory Committee (NVAC) to provide
further explanation and guidelines around the recommendation of
shared clinical decision-making in the context of immunizing older
adult populations, and develop and disseminate guidance and re-
sources to help to ensure that medical professionals and patients
continue to have a clear understanding of and continued access to
the immunizations they should receive across the lifespan. The
Committee further encourages the Assistant Secretary for Health
to consider appointing Geriatric specialists to the NVAC so that
vaccine recommendations will be informed by providers with a his-
tory of caring for senior populations.
HIV/AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND
TUBERCULOSIS PREVENTION
Appropriation, fiscal year 2020 ......................................................... $1,273,556,000
Budget request, fiscal year 2021 ....................................................... 1,552,556,000
Committee Recommendation ............................................................. 1,287,556,000
Change from enacted level ......................................................... +14,000,000
Change from budget request ...................................................... ¥265,000,000
CDC provides national leadership and support for prevention re-
search and the development, implementation, and evaluation of
evidence-based HIV, viral hepatitis, sexually transmitted diseases
(STD), and tuberculosis (TB) prevention programs serving persons
affected by, or at risk for, these infections. Activities include sur-
veillance, epidemiologic and laboratory studies, and prevention ac-
tivities. CDC provides funds to State, local, and Tribal health de-
partments and community-based organizations to develop and im-
plement integrated community prevention plans.
Within the total for HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention, the Committee recommends the following amounts:
FY 2021
Budget Activity Committee
Domestic HIV/AIDS Prevention and Research ................................................................................................ $940,712,000
HIV Initiative .......................................................................................................................................... 150,000,000
School Health-HIV .................................................................................................................................. 35,081,000
Viral Hepatitis ................................................................................................................................................ 39,000,000
Sexually Transmitted Diseases ....................................................................................................................... 162,810,000
Tuberculosis .................................................................................................................................................... 135,034,000
Infectious Diseases & the Opioid Epidemic .................................................................................................. 10,000,000
Community-Based Organizations.—The Committee recognizes
that community-based organizations play a crucial role because of
their capacity to reach communities highly impacted by HIV. The
Committee directs CDC to ensure that Ending the HIV Epidemic
advisory groups or committees reflect their local epidemic by in-
cluding community-based organizations and people living with
HIV. The Committee further requests CDC’s progress of engaging
such communities be included in the fiscal year 2022 Congressional
Budget Justification.
Congenital Syphilis.—The Committee is concerned that the cases
of congenital syphilis (CS) are at the highest rate in 20 years. The
Committee urges CDC to work with State and local authorities to
design an initiative that will strengthen prenatal outreach pro-
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grams. The Committee further urges CDC to increase awareness of
CS through community organizations and STD and drug addiction
clinics of the importance of multi-testing throughout pregnancy.
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Emphasis on Comprehensive Services.—In recent fiscal years, the
Committee has provided historic resources to combat the opioid epi-
demic, with a particular focus on expanding access to treatment,
and treating and preventing comorbidities that can be associated
with injection drug use. At the Committee’s urging, the Depart-
ment has rightfully prioritized efforts that increase access to treat-
ment and recovery services. For all programs not focused exclu-
sively on prevention of substance abuse, the Committee directs the
Department to continue its emphasis on evidence-based medical
interventions, and to ensure that all such interventions, including
programs that focus on harm reduction, provide referral to treat-
ment and recovery services.
HIV/AIDS Data Sharing Platform.—The Committee encourages
CDC to enhance the Collaborative Advanced Analytics and Data
Sharing system to lower overall operating costs and reduce report-
ing burdens on Federal and State health departments.
HIV Initiative.—The Committee includes an increase of
$10,000,000. This investment builds on an increase of $140,000,000
included in fiscal year 2020, bringing the two-year investment in
CDC’s role in the Eliminating HIV/AIDS Initiative to a total of
$290,000,000. CDC will focus on areas of the country that con-
stitute the majority of new HIV infections annually to diagnose
people with HIV as early as possible after infection, link people to
effective treatment and prevention strategies, and respond rapidly
to clusters and outbreaks of new HIV infections. By working with
State and local health departments, along with community-based
organizations, there will be intensive testing and rapid referral to
care and treatment. The initiative will develop and deploy innova-
tive data management solutions, increase access to Pre-Exposure
Prophylaxis (PrEP), and improve detection and response to HIV
clusters. The Committee recognizes that sexually transmitted dis-
eases are associated with increased risk of HIV acquisition. The
Committee urges CDC to include an expansion of sexually trans-
mitted infections programs and initiatives designed to increase HIV
testing; PrEP and condom availability at STD clinics; increase the
number of Disease Intervention Specialists to prevent the spread of
STIs and HIV; and implement HIV and STI education and preven-
tion programs in schools.
Historically Black Colleges and Universities.—The Committee en-
courages increased engagement with Historically Black Colleges
and Universities.
Infectious Diseases and the Opioid Epidemic.—The Committee in-
cludes funding to strengthen efforts to conduct surveillance to im-
prove knowledge of the full scope of the burden of infectious dis-
eases (including viral, bacterial and fungal pathogens) associated
with substance use disorders, and in collaboration with state and
local health departments, health care facilities, and providers, de-
ploy existing authorities to prevent and detect infectious diseases
associated with substance use disorder and strengthen linkages to
addiction, mental health and infectious diseases treatment. The
Committee urges CDC to support the development and evaluation
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of innovative interventions to enable hospitals to link people with
opioid-use related infections to community-based treatment and
harm reduction services.
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School Health.—The Committee includes an increase of
$2,000,000 to bolster school capacity for sexual health education,
and access to sexual health services and safe and supportive envi-
ronments.
Sexually Transmitted Infections.—The Committee includes an in-
crease of $2,000,000 in recognition that the number of combined
cases of syphilis, gonorrhea, and chlamydia have reached an all-
time high in the U.S. The Committee is concerned by the adverse
consequences that a rise in STDs has on women, especially during
pregnancy. According to CDC, undiagnosed STDs cause infertility
in more than 24,000 women each year. Among newborns, Syphilis
cases increased by 40 percent, to more than 1,300 cases across the
country. The Committee commends CDC for providing resources to
state and local health departments for STD prevention and surveil-
lance.
Sexually Transmitted Diseases Program Administration.—The
Committee is concerned regarding CDC’s practice of diverting an
increasing percentage of STD program dollars away from State and
local health departments. While the Committee understands the
need to cover basic administrative costs, the percentage being di-
verted has continued to rise over the past several years, leaving
State and local authorities and the Division of STD Prevention at
CDC with fewer resources to address the STI epidemic.
Tuberculosis.—The Committee is concerned that there is a lack
of resources to reach, test, and treat the millions of people in the
U.S. who have longstanding latent tuberculosis infection (LTBI).
The Committee urges CDC to provide additional resources that will
enable CDC, along with State and local entities, to expand testing
and preventive treatment of individuals with LTBI.
Viral Hepatitis and Opioids.—The Committee is concerned that
as a result of the opioid crisis, infections of viral hepatitis have
spiked at alarming rates in many parts of the nation. The Com-
mittee urges CDC to develop a plan for a national chronic hepatitis
B (HBV) and hepatitis C (HCV) surveillance infrastructure and in-
crease grant funding to States for viral hepatitis surveillance, test-
ing, linkage to care, and hepatitis A (HAV) and HBV vaccination
among all populations at risk for infection. The Committee also
urges CDC to incorporate infectious disease prevention, testing,
and linkage to care into the agency’s response to the opioid crisis.
Given that HBV and HCV are the most common drivers of liver
cancer in the U.S., the incidence and mortality of which are in-
creasing more rapidly than any other cancers, the Committee urges
that CDC raise awareness of and encourage awardees to address
this link. The Committee requests that CDC submit a status report
of the above efforts in the fiscal year 2022 Congressional Justifica-
tion.
The Committee is concerned about invasive mycological or fungal
infections. These infections are a major cause of morbidity and
mortality worldwide. leading to approximately 500.000 deaths an-
nually. The overall disease burden is over 180 million people world-
wide, and in the US. approximately one million new infections
occur annually in a variety of immtmocompetent and
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immunocompromised individuals.
Viral Hepatitis Vaccination.—The Committee is concerned that
despite the availability of an effective hepatitis B (HBV) vaccine,
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less than 25 percent of adults age 19 and older are vaccinated. Ac-
cording to CDC’s most recent survey of Vaccination Coverage
Among Adults, this poor vaccination rate remains flat and has not
improved in several years. The Committee recognizes that CDC is
evaluating new universal HBV vaccination recommendations in-
cluding a comprehensive plan to increase adult HBV vaccinations.
CDC is further urged to promote awareness about the importance
of HBV vaccination among medical and health professionals, com-
munities at high risk, and the general public and to improve col-
laboration and coordination across CDC to achieve this goal. Fur-
thermore, the Committee recognizes that viral hepatitis can cause
serious health consequences for people living with HIV and that 25
percent of people living with HIV are also living with hepatitis C
virus (HCV), and about 10 percent of people living with HIV are
also living with hepatitis B virus (HBV). The Committee directs
CDC to submit a report on the plan to increase the rate of HBV
adult vaccination to the levels necessary to eliminate new infec-
tions of HBV in the U.S. in the fiscal year 2022 Congressional Jus-
tification.
EMERGING AND ZOONOTIC INFECTIOUS DISEASES
Appropriation, fiscal year 2020 ......................................................... $635,772,000
Budget request, fiscal year 2021 ....................................................... 550,464,000
Committee Recommendation ............................................................. 645,972,000
Change from enacted level ......................................................... +10,200,000
Change from budget request ...................................................... +95,508,000
The Committee recommendation includes $593,972,000 in discre-
tionary appropriations and $52,000,000 in transfers from the PPH
Fund. Programs funded under Emerging and Zoonotic Infectious
Diseases (EZID) support the prevention and control of infectious
diseases through surveillance, outbreak investigation and response,
research, and prevention.
Within the total for EZID, the Committee recommends the fol-
lowing amounts:
FY 2021
Budget Activity Committee
Antibiotic Resistance Initiative ...................................................................................................................... $175,000,000
Vector-borne Diseases .................................................................................................................................... 38,603,000
Lyme Disease .................................................................................................................................................. 16,000,000
Prion Disease .................................................................................................................................................. 7,000,000
Chronic Fatigue Syndrome ............................................................................................................................. 5,400,000
Food Safety ..................................................................................................................................................... 65,000,000
Emerging Infectious Diseases ........................................................................................................................ 191,197,000
National Health Care Safety Network ............................................................................................................ 21,000,000
Quarantine ...................................................................................................................................................... 42,772,000
Advanced Molecular Detection ....................................................................................................................... 30,000,000
Epidemiology and Laboratory Capacity .......................................................................................................... 40,000,000
Healthcare-Associated Infections ................................................................................................................... 12,000,000
Harmful Algal Blooms .................................................................................................................................... 2,000,000
Advanced Molecular Detection.—The Committee recognizes that
the Advanced Molecular Detection (AMD) Initiative provides crit-
ical funding for rapid technological innovation, such as genomic se-
quencing of pathogens, to allow for better prevention and control
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of infectious diseases and more rapid identification and character-
ization of antibiotic resistant infections. In addition, AMD is help-
ing CDC to understand, characterize, and control antibiotic resist-
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ance and develop and target prevention measures, including vac-
cines. Technology being developed in the AMD program will ulti-
mately make it possible for state public health officials to take the
DNA fingerprint of foodborne bacteria like Salmonella and E coli,
understand whether they are antibiotic-resistant, and identify re-
lated strains to solve outbreaks, all without relying on the slow and
expensive process of clinical culture.
Antibiotic Resistance.—The Committee includes an increase of
$5,000,000. The Committee recognizes the importance of effectively
combatting antibiotic resistant bacteria as part of CDC’s broader
efforts to mitigate the clinical and public health impacts of the
COVID–19 outbreak. Furthermore, the Committee recognizes the
importance of the addressing the problem of antibiotic-resistant
bacteria through a ‘‘One Health’’ approach and by tracking resist-
ance through local, regional, national, and global surveillance. The
Committee encourages CDC to competitively award research activi-
ties that address aspects of antibiotic resistance related to ‘‘One
Health,’’ including global surveillance and research and develop-
ment for new tools to counter antibiotic resistance among entities,
including public academic medical centers, veterinary schools with
agriculture extension services, and public health departments
whose proposals are in line with CDC’s strategy for addressing an-
tibiotic resistant bacteria.
Emerging Infectious Diseases.—The Committee recognizes the
significant threat that emerging infectious diseases pose for both
military and civilian populations and operations. The Committee
urges CDC to sustain and optimize infrastructure at existing aca-
demic centers for emerging infectious diseases in States with high
tourism and vital military assets to ensure preparedness and re-
sponse measures for the diagnosis, treatment and prevention of
emerging infectious diseases.
Harmful Algal Blooms.—The Committee includes funding to sup-
port monitoring and health reporting concerns related to harmful
algal blooms (HABs). The Committee urges CDC to continue work
on affected waters, with a focus on freshwater and the related dan-
gers to drinking water supplies. CDC has a unique role in better
understanding the intersection of public health and environmental
impacts of HABs to: (1) Increase outreach efforts to States and
local public health officials to use these monitoring and reporting
systems; (2) work with a variety of agencies that currently collabo-
rate on HABs such as the HABARCA Task-Force and the Great
Lakes Restoration Initiative. The scope of future research may ex-
pand to include improving laboratory methods for HAB-related tox-
ins in biological specimens and clinical diagnostic methods to iden-
tify HAB-related symptoms and illnesses, optimizing emergency re-
sponse capacities, and identifying and addressing the impacts of
harmful algal toxins to humans. There is an important nexus be-
tween freshwater and health through drinking water and recre-
ation, and CDC is encouraged to expand their work regionally to
understand HABs impact on our nation’s largest fresh bodies of
water.
Food Safety.—The Committee includes an increase of $2,000,000
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to help address the critical unmet needs in the nation’s food safety
system, in part through programs that enhance state and local
public health capacity to support vital national surveillance, im-
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prove foodborne outbreak detection and investigations, enhance
food safety prevention efforts, and maintain vigilance for emerging
threats to our nation’s food supply.
Lyme Disease.—The Committee includes an increase of
$2,000,000 to support CDC’s efforts to develop improved
diagnostics and surveillance networks so that disease burden can
be more accurately determined, and bolster critical prevention and
provider and public awareness efforts.
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.—The
Committee commends CDC for its recent progress in myalgic
encephalomyelitis/chronic fatigue syndrome (ME/CFS) medical edu-
cation and in the Multisite Clinical Assessment of ME/CFS
(MCAM) study, including the expansion of this study into pediatric
research. The Committee is concerned that there is a lack of infor-
mation about ME/CFS onset and requests an update in the fiscal
year 2022 Congressional Justification.
Mycotic Diseases.—The Committee is concerned about invasive
mycological or fungal infections. These infections are a major cause
of morbidity and mortality worldwide, leading to approximately
500,000 deaths annually. The overall disease burden is over 100
million people worldwide, and in the US, approximately one million
new infections occur annually in a variety of immunocompetent
and immunocompromised individuals. The Committee provides an
additional $200,000 in Emerging Infectious Diseases for mycotic
diseases, including, but not limited to, surveillance and prevention,
building capacity in the State and local health departments, coop-
erative agreements, education of the public and healthcare pro-
viders, and laboratory support. The Committee requests an update
in the fiscal year 2022 Congressional Justification on how this
funding is being utilized.
National One Health Framework.—As the coronavirus pandemic
has proven, zoonotic diseases pose a significant threat and the
Committee recognizes the need to improve the nation’s response ca-
pacity. The Committee directs CDC to develop a national one-
health framework to combat the threat of zoonotic diseases and ad-
vance emergency preparedness. The Committee directs the Sec-
retary of Health and Human Services and the Secretary of Agri-
culture in coordination with the Environmental Protection Agency,
the Department of Homeland Security, the Department of the Inte-
rior, the Department of Defense, the Department of Commerce, and
other departments and agencies as appropriate, to develop, publish,
and shall report to the Committee no later than 180 days after en-
actment of this Act on a national One Health Framework for co-
ordinated Federal Activities.
One Health Federal Interagency Coordination Committee.—The
Committee directs CDC to work with the Department of Agri-
culture and Department of Interior to develop a One Health coordi-
nation mechanism at the federal level. This mechanism will be
used to strengthen One Health collaboration related to prevention,
detection, control, and response for the prioritized zoonotic diseases
and related One Health work across the federal government. HHS
shall report to the Committee no later than 180 days after enact-
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ment of this Act on the National One Health Framework and the
One Health Coordination Mechanism regarding the steps being
taken to implement the recommendations detailed in the U.S. One
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Health Zoonotic Disease Prioritization Workshop summary, entitled
Prioritizing Zoonotic Diseases for Multisectoral, One Health Col-
laboration in the U.S.
Prion.—The Committee includes an increase of $1,000,000 to ad-
vance efforts on prion diseases, which occur in both humans and
animals, primarily affecting the central nervous system. This group
of degenerative neurological disorders is currently incurable and in-
variably fatal. CDC supports the only Federally provided resources
to monitor human prion diseases in the U.S. The Committee sup-
ports these efforts and recognizes the critical work of the National
Prion Disease Pathology Surveillance Center. The workload related
to chronic wasting disease (CWD) in deer and elk populations in
the U.S. is in addition to the Center’s ongoing efforts related to
human prion diseases that includes research, surveillance, tissue
banking, and technical and supportive assistance to providers to
families. Accordingly, the Committee provides increased funding to
support this work.
Sepsis.—The Committee is concerned that sepsis continues to be
a leading public health threat that is responsible for the death of
approximately 270,000 adults and 7,000 children annually in U.S.
The Committee encourages CDC to increase coordination within
the Department of Health and Human Services, with the Depart-
ment of Education, and with the Department of Labor to increase
the dissemination of and the utilization of sepsis educational mate-
rials, including the Get Ahead of Sepsis Campaign. Coordination
should focus on increasing utilization of the campaign by school
nurses, company nurses and health care providers. The Committee
also encourages enhanced outreach to health departments, aca-
demic partners, healthcare providers and systems, professional and
quality improvement organizations, and patient representatives to
increase utilization of sepsis educational materials, including the
Get Ahead of Sepsis Campaign. In addition, the Committee encour-
ages CDC to enhance outreach to national, state, and local hospital
associations to increase usage of the Get Ahead of Sepsis Campaign
and the CDC Sepsis Prevention Toolkit by medical staff. The Com-
mittee directs CDC to report to the House and Senate Committees
on Appropriations on coordination efforts, utilization rates, and the
results of enhanced outreach efforts 180 days after the enactment
of this Act.
Vector-Borne Disease Centers of Excellence.—The Committee is
concerned about the Pacific Northwest being an underserved region
for funding and representation in the Regional Centers of Excel-
lence in Vector-Borne Diseases network. The ecology, disease trans-
mission dynamics, and resources for vector-borne disease training,
surveillance, and control in the Northwest differ significantly from
those in the five regional centers currently funded. The Committee
encourages CDC to examine options to provide greater coverage of
the Northwest region for vector-borne disease resources.
CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION
Appropriation, fiscal year 2020 ......................................................... $1,239,914,000
Budget request, fiscal year 2021 ....................................................... 813,250,000
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Committee Recommendation ............................................................. 1,306,414,000
Change from enacted level ......................................................... +66,500,000
Change from budget request ...................................................... +493,164,000
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The Committee recommendation includes $1,049,564,000 in dis-
cretionary appropriations and $256,850,000 in transfers from the
PPH Fund. Programs supported within Chronic Disease Prevention
and Health Promotion (CDPHP) provide national leadership and
support for State, Tribal, and community efforts to promote health
and well-being through the prevention and control of chronic dis-
eases.
The recommendation for CDPHP maintains the existing program
line items as they were funded in fiscal year 2020 and does not
provide funding for the America’s Health Block Grant proposed
again in the fiscal year 2021 budget request. The Committee sup-
ports evidence-based strategies to address public health priorities
through proven State-based grant programs, utilizing related na-
tional organizations for technical assistance, and encourages CDC
to continue and expand these successful approaches. Within the
total provided, the Committee recommends the following amounts:
FY 2021
Budget Activity Committee
Tobacco ........................................................................................................................................................... $240,000,000
Nutrition, Physical Activity, and Obesity ........................................................................................................ 56,920,000
High Obesity Rate Counties .................................................................................................................. 15,000,000
School Health ................................................................................................................................................. 15,400,000
Health Promotion ............................................................................................................................................ 36,600,000
Glaucoma ............................................................................................................................................... 4,000,000
Vision and Eye Health ........................................................................................................................... 1,000,000
Alzheimer’s Disease ............................................................................................................................... 20,000,000
Inflammatory Bowel Diseases ............................................................................................................... 1,000,000
Interstitial Cystitis ................................................................................................................................. 1,100,000
Excessive Alcohol Use ........................................................................................................................... 4,000,000
Chronic Kidney Disease ......................................................................................................................... 2,500,000
Chronic Disease Education & Awareness ............................................................................................. 3,000,000
Prevention Research Centers ......................................................................................................................... 26,461,000
Heart Disease and Stroke .............................................................................................................................. 145,105,000
Diabetes .......................................................................................................................................................... 148,129,000
National Diabetes Prevention Program .......................................................................................................... 30,300,000
Cancer Prevention and Control ...................................................................................................................... 386,049,000
Breast and Cervical Cancer .................................................................................................................. 225,000,000
WISEWOMAN .................................................................................................................................. 28,120,000
Breast Cancer Awareness for Young Women ........................................................................................ 4,960,000
Cancer Registries .................................................................................................................................. 51,440,000
Colorectal Cancer .................................................................................................................................. 44,294,000
Comprehensive Cancer .......................................................................................................................... 19,675,000
Johanna’s Law ....................................................................................................................................... 10,000,000
Ovarian Cancer ...................................................................................................................................... 12,000,000
Prostate Cancer ..................................................................................................................................... 14,205,000
Skin Cancer ........................................................................................................................................... 4,000,000
Cancer Survivorship Resource Center ................................................................................................... 475,000
Oral Health ..................................................................................................................................................... 19,500,000
Safe Motherhood/Infant Health ...................................................................................................................... 68,000,000
Maternal Mortality Review Committees ................................................................................................ 22,000,000
Preterm Birth ......................................................................................................................................... 2,000,000
Other Chronic Diseases .................................................................................................................................. 30,000,000
Arthritis .................................................................................................................................................. 11,000,000
Epilepsy ................................................................................................................................................. 10,500,000
National Lupus Patient Registry ........................................................................................................... 8,500,000
Racial and Ethnic Approaches to Community Health ................................................................................... 66,950,000
Good Health and Wellness in Indian Country ....................................................................................... 23,000,000
Social Determinants of Health ....................................................................................................................... 10,000,000
Healthy Aging ................................................................................................................................................. 10,000,000
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Million Hearts ................................................................................................................................................. 4,000,000
National Early Child Care Collaboratives ...................................................................................................... 4,000,000
Hospitals Promoting Breastfeeding ................................................................................................................ 9,000,000
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72
Alzheimer’s Disease.—The Committee includes an increase of
$4,500,000 to support provisions enacted in the Building Our Larg-
est Dementia (BOLD) Infrastructure for Alzheimer’s Act (P.L. 115–
406), including establishing Centers of Excellence and building a
robust Alzheimer’s and other dementias public health infrastruc-
ture across the country.
Arthritis.—The Committee recognizes the serious issue of arthri-
tis in communities across the country, which affects one in four
Americans and is the number one cause of disability in the U.S.
The Committee commends the ongoing work of the CDC Arthritis
Program to provide existing investments in data and intervention
and prevention research. The Committee urges CDC to support ro-
bust investment to expand the number of state-based arthritis pro-
grams, provide access to proven arthritis self-management and
physical activity programs, and improve data collection and surveil-
lance. The Committee requests a report on the resources necessary
to fully scale the Arthritis Program and identify gaps in arthritis
public health research and data collection in the fiscal year 2022
Congressional Justification.
Breast and Cervical Cancer.—The National Breast and Cervical
Cancer Early Detection Program provides, critical, lifesaving breast
cancer screening and diagnostic services to low-income, uninsured
and underinsured women, providing exams to more than 5.6 mil-
lion women since its creation in 1991, diagnosing nearly 5,000
invasive cervical cancers and 215,000 premalignant cervical le-
sions, and almost 70,000 invasive breast cancers. Previous funding
levels allowed 15 percent of women eligible for breast cancers
screening and approximately 7 percent of women eligible for cer-
vical cancer screening to be served. The Committee encourages
CDC to work with States and stakeholders to implement strategies
to maximize the number of women in the program.
Chronic Disease Education and Awareness.—The Committee rec-
ognizes CDC’s work with stakeholders to expand public health edu-
cation and awareness activities that help to improve surveillance,
diagnosis, and proper treatment for chronic diseases. The Com-
mittee includes $3,000,000 to establish a Chronic Disease Edu-
cation and Awareness competitive grant program to expand and
advance CDC’s work with stakeholders on education, outreach, and
public awareness activities for a variety of chronic diseases for
which there is a clear disparity in public and professional aware-
ness that are not already specified under CDC in this report. This
approach would utilize a competitive grant process to strengthen
the science base for prevention, education, and public health
awareness for a variety of chronic diseases, such as lymphatic dis-
eases, that do not currently have dedicated resources that would
lead to meaningful patient outcomes.
Chronic Obstructive Pulmonary Disease.—The Committee urges
CDC to do more to address Chronic Obstructive Pulmonary Disease
(COPD), the nation’s fourth leading cause of death, including fully
engaging with the timely implementation of the COPD National
Action Plan, developed by the National Heart, Lung, Blood Insti-
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tute in coordination with CDC, such as fully integrating COPD sur-
veillance, research, prevention, and management strategies into ex-
isting chronic disease efforts. The Committee requests a written re-
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73
port on the updates to the COPD Action Plan no later than 180
days after enactment of this Act.
Chronic Pain.—The Committee previously encouraged CDC to
analyze data collected from the chronic pain questions included in
the 2017 National Health Interview Survey and to clarify the inci-
dence and prevalence of various pain syndromes differentiated by
patient age, comorbidities, socioeconomic status, race and gender.
The Committee also encouraged CDC to collect data on direct and
indirect costs of pain treatment and the effectiveness of evidence-
based treatment approaches (S. Rept. 115–150—Departments of
Labor, Health and Human Services, and Education, and Related
Agencies Appropriation Bill, 2018). In light of the issuance of the
HHS Pain Management Best Practices Task Force report identi-
fying gaps in access to care, and the importance of utilizing inter-
ventional procedures such as nerve blocks, injections and surgical
devices; behavioral health approaches such as cognitive behavioral
therapy; and complementary and integrative health therapies such
as massage therapy and acupuncture to address pain, the Com-
mittee again encourages CDC to collect this needed data and pub-
lish it annually. Furthermore, the Committee directs CDC to pro-
vide an update on pain statistics in the fiscal year 2022 Congres-
sional Justification.
Colorectal Cancer.—The Committee includes an increase of
$1,000,000 for colorectal cancer. The Committee is concerned with
the increasing rate of colorectal cancer among younger adults. The
Committee urges CDC to identify risk factors that may be associ-
ated with this increase among younger adults and further identify
trends of increase by race and socioeconomic status.
Diabetes.—The Committee includes funding to prevent diabetes,
its complications, and to reduce inequities through prevention
strategies, translational research, and education. The Committee
also includes an increase of $3,000,000 for the Diabetes Prevention
Program to expand efforts of this public-private partnership that
provides diabetes prevention for people with prediabetes. The Com-
mittee encourages CDC to support diabetes screening programs lo-
cated in hospital settings.
E-Cigarette or Vaping Product Use—Associated Lung Injury.—
The Committee remains concerned about the impacts of utilizing e-
cigarettes or vaping products that lead to hospitalizations and
deaths across the country. The Committee requests an update of
CDC’s findings relating to this topic in the fiscal year 2022 Con-
gressional Justification.
Early Child Care Collaboratives.—The Committee recognizes
that the early care and education setting is important for pro-
moting healthy habits in young children. The Committee includes
funding for the National Early Child Care Collaboratives Program
to support direct provider-level training in implementation of com-
prehensive programming to support healthy eating and physical ac-
tivity best practices and technical assistance to States for inte-
grating such best practices into existing State and local systems for
early care and education.
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Eating Disorders.—The Committee encourages CDC to assist
States in collecting data by including standard questions on
unhealthy weight control practices for eating disorders, including
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74
binge eating, through the Youth Risk Behavior Surveillance Sys-
tem and the Behavioral Risk Factor Surveillance System.
Epilepsy.—The Committee includes an increase of $1,000,000 to
support epidemiologic studies, national dissemination of evidence-
based programs to improve access of care and expand provider edu-
cation and public awareness campaigns to reduce stigma.
Food and Health.—The Committee understands that many
chronic medical conditions, such as diabetes, asthma, arthritis and
inflammatory diseases, and maternal health and child develop-
ment, can be managed cost effectively by improved nutrition. The
Committee supports efforts to provide information on how cul-
turally appropriate, food-based solutions integrated into the
healthcare system, using the latest knowledge in nutrition, can im-
prove medical effectiveness resulting in cost savings.
Healthy Aging.—The Committee includes $10,000,000 for CDC to
expand its healthy aging work to include coordinating healthy
aging efforts across the agency, funding applied research and
translation for public health practice, and awarding cooperative
agreements to build capacity in state, tribal and territorial public
health departments to promote the health of older adults within an
age-friendly public health system. The Committee recognizes the
role of public health in promoting healthy aging. As the nation’s
population rapidly ages, the U.S. public health system must adapt
accordingly. Isolation and loneliness, financial struggles, multiple
chronic conditions, including loss of bone density, hearing, decline
in vision, and access to transportation, healthy food, and affordable
housing are challenges many older people face. Social isolation
alone increases the risk of heart disease, infections, depression,
cognitive decline and death among older people. The impact of so-
cial isolation is particularly important to consider as the U.S. re-
sponds to the outbreak of COVID–19. Age-friendly public health
interventions can optimize the health and well-being of adults 65
and over, prolong their independence, and reduce their use of ex-
pensive healthcare services.
Heart Disease and Stroke.—The Committee includes an increase
of $3,000,000 to support, strengthen, and expand evidence-based
initiatives, given that almost half of the U.S. population has some
form of cardiovascular disease.
Inflammatory Bowel Diseases.—The Committee commends CDC
for continuing to support research on the incidence and prevalence
of inflammatory bowel diseases (IBD) in the U.S., including on dis-
parities in patterns of care within minority populations. The Com-
mittee encourages CDC to begin planning an educational campaign
to increase awareness among healthcare providers and patients in
order to reduce disparate health outcomes among minority popu-
lations with IBD.
Interstitial Cystitis.—The Committee requests an update on edu-
cation, outreach, and public awareness activities in the fiscal year
2022 Congressional Justification.
Johanna’s Law.—The Committee includes an increase of
$1,000,000 for CDC’s Inside Knowledge Campaign that raises
awareness of the five main types of gynecological cancer: cervical,
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ovarian, uterine, vaginal, and vulvar. This campaign educates
women of all ages, races, and ethnic groups, and healthcare pro-
viders.
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Kidney Disease.—The Committee is deeply troubled by the sig-
nificant and growing burden of chronic kidney disease (CKD),
which affects an estimated 37 million Americans. Unfortunately, 90
percent of individuals with CKD are unaware they have the illness,
only learning of it when there is a need for dialysis or kidney
transplantation. With timely awareness, diagnosis, and treatment,
the progression of kidney disease and its comorbidities can be
slowed.
Lung Cancer.—The Committee remains concerned about the high
morbidity and mortality of lung cancer. Early detection and treat-
ment of lung cancer translates into higher survival rates, but only
16 percent of lung cancer cases are diagnosed early when the dis-
ease is most treatable. The Committee urges CDC to promote lung
cancer screening awareness as part of its tobacco prevention and
control activities.
Nutrition, Physical Activity and Obesity.—The Committee sup-
ports CDC’s efforts to protect the health of Americans at every
stage of life by encouraging regular physical activity, good nutri-
tion, and preventing adult and childhood obesity. The Committee
is concerned that the eligibility for the High Obesity Program is
limited to communities with high obesity rates solely among adults,
without taking into account childhood obesity rates. This exclusion
represents a missed opportunity to address the important public
health problem of childhood obesity, which can lead to high blood
pressure, sleep apnea, high cholesterol, fatty liver disease, psycho-
logical problems and more. In addition, by focusing only on obesity
rates at the county level, the program misses high-risk commu-
nities within healthier counties. The Committee encourages that
CDC consider including high childhood obesity rates in its eligi-
bility criteria for the High Obesity Program, as well as consider
opening eligibility to program sites in census tracts with high obe-
sity rates.
Oral Health.—The Committee is aware that there are some Com-
munity Dental Health Coordinators (CDHCs) that serve in school-
based settings where they provide oral health education,
screenings, cleanings and dental sealants. The Committee encour-
ages CDC to engage federal partners, external stakeholders, includ-
ing current and former grantees of the program, to determine how
CDHCs can be used to continually educate and provide preventa-
tive care in school-based settings.
Ovarian Cancer.—The Committee includes an increase of
$1,000,000 for ovarian cancer, which causes more deaths each year
than any other gynecological cancer in the U.S., to advance ovarian
cancer prevention, early detection, risk assessment, and access to
the standard of care.
Prostate Cancer.—The Committee support’s CDC’s efforts to in-
crease the public’s awareness of prostate cancer risks, screening
and treatment, and improve surveillance of this disease, which is
the most commonly diagnosed cancer in men and the second lead-
ing cause of cancer deaths among men in the U.S. The Committee
encourages CDC to increase outreach and education among high-
risk men, especially African-American men.
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Pregnancy Risk Assessment Monitoring System for Fathers
Pilot.—The Committee is aware of the pilot Pregnancy Risk Assess-
ment Monitoring System (PRAMS) for Fathers with state and local
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76
public health agencies. Building on the successful PRAMS surveil-
lance system that provides data from women during pregnancy and
the first few months after birth, the pilot program extending this
surveillance to fathers has provided paternal data with immense
value for public health interventions.
Prevention Research Centers.—The Committee includes funding
for the national network committed to conducting prevention re-
search and translating research results into policy and public
health practice that address local public health needs.
Racial and Ethnic Approaches to Community Health.—The Com-
mittee includes an increase of $7,000,000 for the only Federal pro-
gram addressing the nation’s racial and ethnic health disparities.
The Committee recommends that all racial and ethnic target popu-
lations are represented. The Committee’s recommended level in-
cludes an increase of $2,000,000 for Good Health and Wellness in
Indian Country.
Safe Motherhood and Infant Health.—The Committee includes
an increase of $10,000,000 and recognizes CDC’s ongoing efforts to
address the pressing public health issue of rising maternal mor-
tality rate in the U.S. Black, American Indian and Alaska Native
women are two to three times more likely to die from pregnancy-
related causes than white women, and this disparity increases with
age. The Committee encourages CDC to work with States to estab-
lish and continue Maternal Mortality Review Committees, and to
provide assistance for all Committees to collect, analyze, and report
data collected through the Maternal Mortality Review Information
Application (MMRIA) System. CDC is encouraged to analyze the
MMRIA data from all States, to the extent possible, issue a report
of findings, and provide follow up technical assistance to support
States to develop and implement strategies to improve data collec-
tion and analysis and to reduce maternal mortality. The Committee
requests a report in the fiscal year 2022 Congressional Justifica-
tion, analyzing the necessary costs and resources needed to enable
State or regional databases to institute a policy nation-wide of
monitoring death records 365 days after a birth record is issued for
an individual’s newborn. Furthermore, the Committee commends
CDC for funding State-based Perinatal Quality Collaboratives
(PQCs) that focus on improving maternal and neonatal outcomes
using known prevention strategies such as reducing early elective
deliveries. CDC is encouraged to continue support for PQCs par-
ticularly due to the rise in maternal mortality rates and neonatal
abstinence syndrome (NAS) as a result of the opioid crisis. To
maintain the notable work of the PREEMIE CDC-funded state-
based PQCs around the country, the Committee urges CDC to ex-
pand their work in States disproportionately affected by the opioid
crisis and focus efforts in the top five States affected by opioid mis-
use.
Social Determinants of Health Pilot Program.—The Committee
recognizes the role of public health in working across sectors on so-
cial determinants of health. The Committee includes $10,000,000
for CDC to establish a Social Determinants of Health pilot program
to award competitive grants to State, local, Territorial, or Tribal ju-
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risdictions to support the development of Social Determinants of
Health Accelerator Plans. Such plans should include a description
of the health and social outcome objectives of the Social Deter-
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77
minants Accelerator Plan; identify target populations that would
benefit from implementation of the plan; and identify non-govern-
mental public health organizations and community organizations
that would participate in the development of the plan. Grantees
may use a portion of grant funding to convene government entities
and stakeholders and to engage qualified research experts in devel-
oping Social Determinants Accelerator Plans. The Committee di-
rects CDC to submit a report within 120 days of enactment of this
Act on how such grants will be administered.
Sudden Unexpected Infant Death and Sudden Unexplained Death
in Childhood.—The Committee is aware that currently, there is no
known way to prevent sudden unexpected infant death syndrome
(SIDS), but there are ways to reduce the risk. Several factors
present during pregnancy, at birth, and throughout the first year
after birth can impact SIDS risk. The Committee urges CDC to im-
prove data and prevention strategies, including by revising stand-
ardized death investigation forms, incorporating scene investigation
and doll-reenactments.
Tobacco.—The Committee is deeply troubled by the dramatic in-
crease in e-cigarette use among youth and concurs with the Sur-
geon General that youth use of e-cigarettes has reached epidemic
levels. The Committee is also concerned that certain populations
and regions of the country continue to experience high rates of to-
bacco use and are disproportionately burdened by tobacco-related
disease and premature death. The Committee urges CDC to con-
tinue its efforts to reduce this and other disparities in tobacco use
prevalence. Accordingly, the Committee includes an increase of
$10,000,000 so that CDC and States can use evidence-based strate-
gies to respond to the public health risk caused by the dramatic in-
crease of youth use of e-cigarettes, including school-based interven-
tions as part of a comprehensive strategy, enhance efforts to reduce
tobacco use among certain populations and in areas with high to-
bacco use rates and tobacco-related mortality, as well as expand its
highly effective Tips from Former Smokers campaign.
Tobacco and COVID–19.—The Committee is aware that smoking
and use of e-cigarettes harm the lungs, and that researchers and
public health officials are increasingly concerned that users of such
products may be at increased risk for poorer health outcomes re-
lated to COVID–19. The Committee urges CDC to improve the col-
lection of data on whether individuals who have tested positive for
the novel coronavirus are current smokers, former smokers, or e-
cigarette users, and to assess whether smokers and e-cigarette
users are at higher risk for developing severe illness and death
from COVID–19 than non-users. The Committee urges CDC to
begin tracking this information within 90 days of enactment and
to make such data and assessments publicly available.
Vision and Eye Health.—The Committee includes funding to en-
hance programs that prevent blindness and preserve sight. The
Committee is aware that vision impairments and eye disease con-
tribute to or complicate many other serious and costly chronic
health conditions, including diabetes, cardiovascular disease, inju-
ries and death related to falling, depression, and cognitive decline.
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State and community-level intervention are vital, as 75 percent of
incidents of vision loss are preventable through early detection and
treatment.
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WISEWOMAN.—The Committee recognizes the vital importance
of addressing cardiovascular disease among women by raising
awareness of rising cardiovascular mortality among women, par-
ticularly women of color, and including an increase of $2,000,000
to support a comprehensive public awareness initiative that estab-
lishes best practices for identifying and treating cardiovascular in-
cidents in women. The Committee further recognizes that the re-
sulting costs to the health care system of unrecognized symptoms
in the treatment of women can be substantially reduced with ap-
propriate public policy and prevention efforts.
BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND
HEALTH
Appropriation, fiscal year 2020 ......................................................... $160,810,000
Budget request, fiscal year 2021 ....................................................... 112,250,000
Committee Recommendation ............................................................. 162,810,000
Change from enacted level ......................................................... +2,000,000
Change from budget request ...................................................... +50,560,000
This account supports efforts to conduct research on and address
the causes of birth defects and developmental disabilities, as well
as reduce the complications of blood disorders and improve the
health of people with disabilities.
Within the total, the Committee recommends the following
amounts:
FY 2021
Budget Activity Committee
Child Health and Development ...................................................................................................................... $65,800,000
Birth Defects ......................................................................................................................................... 19,000,000
Fetal Death ............................................................................................................................................ 900,000
Fetal Alcohol Syndrome ......................................................................................................................... 11,000,000
Folic Acid ............................................................................................................................................... 3,150,000
Infant Health ......................................................................................................................................... 8,650,000
Autism ................................................................................................................................................... 23,100,000
Health and Development for People with Disabilities ................................................................................... 69,660,000
Disability & Health incl. Child Development ........................................................................................ 35,000,000
Tourette Syndrome ................................................................................................................................. 2,000,000
Early Hearing Detection and Intervention ............................................................................................. 10,760,000
Muscular Dystrophy ............................................................................................................................... 6,000,000
Attention Deficit Hyperactivity Disorder ................................................................................................ 1,900,000
Fragile X ................................................................................................................................................ 2,000,000
Spina Bifida .......................................................................................................................................... 6,000,000
Congenital Heart ................................................................................................................................... 6,000,000
Public Health Approach to Blood Disorders ................................................................................................... 4,400,000
Hemophilia Activities ...................................................................................................................................... 3,500,000
Hemophilia Treatment Centers ....................................................................................................................... 5,100,000
Thalassemia ................................................................................................................................................... 2,100,000
Neonatal Abstinence Syndrome ...................................................................................................................... 2,250,000
Surveillance for Emerging Threats to Mothers and Babies .......................................................................... 10,000,000
Congenital Heart Defects.—The Committee includes funding for
grants or cooperative agreements to provide technical assistance to
State and local agencies to complement intramural programs and
to conduct applied research related to screening, evaluation, diag-
nosis, results reporting, data collection, surveillance, intervention
programs, systems, and follow-up of children identified through
Critical Congenital Heart Defects (CCHD) screening to better un-
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derstand the long-term outcomes and needs of this population.
Duchenne Muscular Dystrophy.—The Committee is aware of the
development and dissemination of the Duchenne Muscular Dys-
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trophy Care Considerations. In order to understand their impact,
the Committee urges CDC to consider how widely the Care Consid-
erations have been adopted across the country and whether this
has led to changes in practice or an improvement in patient out-
comes, particularly in rural and underserved areas, and the pres-
ence of a Certified Duchenne Care Center.
Fetal Alcohol Spectrum Disorders.—The Committee is concerned
about the rising trend of prenatal alcohol consumption and in-
creased rates of fetal alcohol spectrum disorders (FASD) and urges
CDC to increase support to: expand prevention efforts to heighten
awareness of FASD and the risks associated with prenatal alcohol
exposure; and strengthen existing national community-based and
professional FASD networks to expand access to diagnostic, treat-
ment, intervention, and other essential services.
Improving the Health of People with Intellectual Disabilities.—
The Committee includes an increase of $2,000,000 for the expanded
provision of year-round, grassroots activities in communities to cre-
ate opportunities for health screenings and access to quality
healthcare, and health and wellness programming for people with
intellectual disabilities. These efforts enhance the lives of individ-
uals while eliminating stigmas and stereotypes.
Infant and Maternal Health Surveillance.—The Committee di-
rects, within 90 days of enactment of this Act, an update on
adaptions that have been made to the Surveillance for Emerging
Threats to Mothers and Babies Program, Pregnancy Risk Assess-
ment Monitoring System, and other infant and maternal health
surveillance efforts to evaluate the risks for and effects of COVID–
19 on infants and pregnant and lactating individuals.
Pregnancy-Status COVID–19 Data Collection and Reporting.—
The Committee directs, within 90 days of enactment of this Act, a
report be submitted describing the specific steps taken to ensure
that pregnancy status be included in COVID–19 data collection,
documentation, and reporting from health care providers to public
health agencies, particularly at the time of the initial or first re-
port.
Sickle Cell Disease.—The Committee urges the Division of Blood
Disorders plan to establish a population-based surveillance system
to collect and analyze longitudinal data on people living in the U.S.
with sickle cell disease and established a separate budget account
for sickle cell disease.
Spina Bifida.—The Committee is aware of a growing incidence
of sudden death in the adult spina bifida population, and under-
stands that there is a significant need to study this issue and to
develop medical interventions that lead to optimal outcomes and to
address the transitional and adult care needs of the growing, aging
Spina Bifida community. Therefore, the Committee encourages
CDC to use funding for the National Spina Bifida Program (NSBP)
to be used to support the continuation of the Spina Bifida Clinical
Care Monitoring and Tracking Program which works with the Na-
tional Spina Bifida Registry to guide the health care community in
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best treatment options for people living with Spina Bifida.
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PUBLIC HEALTH SCIENTIFIC SERVICES
Appropriation, fiscal year 2020 ......................................................... $578,497,000
Budget request, fiscal year 2021 ....................................................... 521,000,000
Committee Recommendation ............................................................. 593,497,000
Change from enacted level ......................................................... +15,000,000
Change from budget request ...................................................... +72,497,000
This account supports programs that provide leadership and
training for the public health workforce, support infrastructure to
modernize public health surveillance, promote and facilitate science
standards and policies, and improve access to information on dis-
ease outbreaks and other threats.
In addition, the CARES Act (P.L. 116–136) included
$500,000,000 for the public health data modernization initiative.
Within the total, the Committee recommends the following
amounts:
FY 2021
Budget Activity Committee
Health Statistics ............................................................................................................................................. $174,397,000
Surveillance, Epidemiology, and Informatics ................................................................................................. 363,100,000
Public Health Workforce ................................................................................................................................. 56,000,000
Birth Settings.—The Committee notes that the 2020 Consensus
Study Report ‘‘Birth Settings in America: Outcomes, Quality, Ac-
cess, and Choice’’ conducted by the National Academies of Sciences,
Engineering and Medicine found that ‘‘Modifications to the birth
certificate that allow inquiry into birth settings based on models in-
dicating intended setting of birth, including planned attended and
planned unassisted home births in the U.S. and intended birth at-
tendants are needed to better understand and assess outcomes by
birth settings.’’ The Committee urges the National Center for
Health Statistics to explore ways to collect more detailed records
on birth settings as part of its collection of vital statistics.
Familial Hypercholesterolemia.—The Committee includes
$100,000 to support efforts focused on this inherited genetic dis-
order that causes early, aggressive, heart disease. The Committee
is concerned that more than 85 percent of those in the U.S. who
are affected with familial hypercholesterolemia (FH) are completely
unaware of their condition. The Committee supports CDC address-
ing FH as a public health concern in order to improve diagnosis
and care delivery and prevent heart disease.
Forecasting.—The Committee encourages CDC to identify a re-
search institution capable of developing a Center of Excellence that
can model public health response, preparation, and planning of a
coronavirus outbreak, and has experience participating in or
hosting an influenza forecasting center of excellence. The Com-
mittee encourages CDC to work in collaboration with leading re-
search institutions that provide national leadership in creating
methodologies and technologies to produce safe, effective AI sys-
tems that are fair, accountable, transparent, and protect individual
privacy.
National Neurological Conditions Surveillance System.—The
Committee includes $5,000,000 within Surveillance, Epidemiology,
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and Informatics to continue efforts on the two initial conditions.
Primary Immunodeficiencies.—The Committee includes funding
at the fiscal year 2020 level to continue the existing program of
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education and awareness related to primary immunodeficiencies.
This program has proven effective in identifying undiagnosed pa-
tients and linking them to centers of care. With NIH estimating
that one to two percent of the U.S. population is affected by these
disorders, a greater commitment is required to maximize the bene-
fits of this effort.
Public Health Data Modernization Initiative.—The Coronavirus
Pandemic and the outbreak of lung injury associated with the use
of e-cigarette, or vaping, products brought to national attention
that more needs to be done to ensure that CDC can develop and
deploy world-class data and analytics that scale rapidly in emer-
gencies, provide predictive capacity to identify emerging threats,
reduce burden on public health partners who are reporting data
and ensure bidirectional information flows. In addition, public
health professionals are faced with rapid advances in data science
and evolving cybersecurity threats that require the necessary skills
to securely integrate health data. The Committee initiated the
funding for this effort in fiscal year 2020 and provided significant,
multi-year resources in the CARES Act (P.L. 116–136); the Com-
mittee directs these funds to be thoughtfully planned and invested
for a comprehensive, crosscutting effort to advance CDC’s capabili-
ties to respond to all public health threats not limited to COVID–
19. This is the opportunity for there to be significant improvement
in public health data and analytics. The Committee includes
$50,000,000 to continue to modernize systems, and recruit and re-
tain skilled data scientists to improve public health data including
at the National Center for Health Statistics, and State, local, tribal
and territorial partners. Furthermore, the Committee encourages
CDC to consider the acceleration of predictive modeling and use of
artificial intelligence to more rapidly transform how CDC collects
and uses data to understand various situations in real time.
Public Health Workforce.—The bill includes an increase of
$5,000,000 to support workforce and training programs, including
the Epidemic Intelligence Service, that provide HHS, and State and
local health departments with skilled staff, technical assistance,
and education services. The Committee recognizes that a robust
and well-trained public health workforce is critical to maintaining
a highly-effective public health system.
Strengthening Public Health Infrastructure.—The Committee in-
cludes an increase of $10,000,000 for CDC to assist States and eli-
gible local public health agencies by strengthening basic epidemio-
logic and laboratory capacity.
ENVIRONMENTAL HEALTH
Appropriation, fiscal year 2020 ......................................................... $213,850,000
Budget request, fiscal year 2021 ....................................................... 182,000,000
Committee Recommendation ............................................................. 236,850,000
Change from enacted level ......................................................... +23,000,000
Change from budget request ...................................................... +54,850,000
The Committee recommendation includes $219,850,000 in discre-
tionary appropriations and $17,000,000 in transfers from the PPH
Fund.
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Programs supported within Environmental Health conduct sur-
veillance and data collection to detect and address emerging patho-
gens and environmental toxins that pose significant challenges to
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public health, as well as determine whether and at what level of
exposure these substances are harmful to humans.
Within the total, the Committee recommends the following
amounts:
FY 2021
Budget Activity Committee
Environmental Health Laboratory.. ................................................................................................................. $68,750,000
Newborn Screening Quality Assurance Program ................................................................................... 19,000,000
Newborn Screening /Severe Combined Immunodeficiency Diseases .................................................... 1,250,000
Environmental Health Activities.. ................................................................................................................... 16,000,000
Safe Water ...................................................................................................................................................... 8,600,000
Amyotrophic Lateral Sclerosis (ALS) Registry ................................................................................................ 10,000,000
Climate and Health ........................................................................................................................................ 15,000,000
Environmental and Health Outcome Tracking Network ................................................................................. 34,000,000
Asthma ........................................................................................................................................................... 33,000,000
Trevor’s Law ................................................................................................................................................... 1,500,000
Childhood Lead Poisoning .............................................................................................................................. 40,000,000
Lead Exposure Registry .................................................................................................................................. 10,000,000
Asthma.—The Committee includes an increase of $3,000,000 for
the National Asthma Control Program. The Committee recognizes
that millions of people in the U.S. suffer from asthma, and that it
disproportionately affects African American children.
Childhood Lead Poisoning.—The Committee includes an increase
of $3,000,000 to strengthen blood lead surveillance by supporting
state and local program to improve blood lead screening test rates,
identify high-risk populations, and ensure effective follow-up for
children with elevated blood lead levels. The Committee encourages
CDC to require that States receiving funding for lead prevention
report all blood tests in a standardized format through the Nation-
ally Notifiable Noninfectious Diseases and Conditions reporting
system. The Committee directs the Lead Exposure and Prevention
Advisory Committee to produce a report about the prevalence and
impact of leaded paint manufacturing plants. The report should
identify the leaded paint manufacturers, public health hazards
posed by the plants (including but not limited to the environmental
hazards), and how the leaded paint is being circulated. The report
shall be included in the fiscal year 2022 Congressional Justifica-
tion.
Climate and Health.—The Committee recognizes that commu-
nities are on the front line of responding to climate-related health
effects, including health threats from increased spread of vector-
borne diseases, higher levels of air pollution, hotter temperatures,
extreme weather events and longer allergy seasons. The Committee
includes an increase of $5,000,000 to expand investments to a larg-
er number of States, cities, or tribes to plan for public health
threats caused by climate change, and to conduct an analysis of
grantee programs to allow for broad sharing of best practices and
strategies that best protect public health.
Lead Exposure Registry.—The Committee supports CDC’s imple-
mentation of the Flint, Michigan Lead Exposure Registry and di-
rects $10,000,000 for the continuation of the Registry beyond fiscal
year 2021.
Newborn Screening.—The Committee includes an increase of
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$2,000,000 to further support newborn screening efforts so that af-
fected newborns can receive early and often life-saving treatment
through the timely implementation for all Recommended Uniform
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Screening Panel conditions. The Committee is aware that State
laboratories need specialized support to begin screening for addi-
tional newborn conditions and recognizes CDC’s expertise in work-
ing with laboratories to implement accurate newborn screening
tests. The Committee supports the Newborn Screening Quality As-
surance Program to support State laboratories as they implement
screening for new disorders. This funding will support evaluation
of testing methods for new conditions, expansion of CDC’s quality
assurance materials, and critical infrastructure and development of
tests for rare conditions.
INJURY PREVENTION AND CONTROL
Appropriation, fiscal year 2020 ......................................................... $677,379,000
Budget request, fiscal year 2021 ....................................................... 730,159,000
Committee Recommendation ............................................................. 694,879,000
Change from enacted level ......................................................... +17,500,000
Change from budget request ...................................................... ¥35,280,000
Programs supported within Injury Prevention and Control pro-
vide national leadership on violence and injury prevention, conduct
research and surveillance, and promote evidence-based strategies
to inform real-world solutions to prevent premature death and dis-
ability and to reduce human suffering and medical costs caused by
injury and violence.
The Committee does not accept the proposal to include
$100,000,000 for the Drug-Free Communities program in the In-
jury Prevention and Control appropriation. The Committee directs
the program to remain in the Office of National Drug Control Pol-
icy.
Within the total, the Committee recommends the following
amounts:
FY 2021
Budget Activity Committee
Domestic Violence and Sexual Violence ......................................................................................................... 34,700,000
Child Maltreatment ............................................................................................................................... 7,250,000
Child Sexual Abuse Prevention ............................................................................................................. 2,000,000
Youth Violence Prevention .............................................................................................................................. 15,100,000
Domestic Violence Community Projects ......................................................................................................... 7,500,000
Rape Prevention ............................................................................................................................................. 52,750,000
Suicide Prevention .......................................................................................................................................... 10,000,000
Adverse Childhood Experiences ...................................................................................................................... 4,000,000
National Violent Death Reporting System ...................................................................................................... 23,500,000
Traumatic Brain Injury ................................................................................................................................... 6,750,000
Elderly Falls .................................................................................................................................................... 2,050,000
Injury Prevention Activities ............................................................................................................................. 28,950,000
Opioid Overdose Prevention and Surveillance ............................................................................................... 475,579,000
Injury Control Research Centers .................................................................................................................... 9,000,000
Firearm Injury and Mortality Prevention Research ........................................................................................ 25,000,000
Adverse Childhood Experiences.—The Committee encourages
CDC to prioritize the collection and reporting of data on adverse
childhood experiences (ACEs), including exposure to violence, ne-
glect, and living in a home with mental health or substance use
problems, and to use these data to support the implementation of
comprehensive ACEs prevention strategies at the State, territorial,
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tribal and local levels. The Committee also encourages CDC to re-
port on the prevalence of adverse childhood experiences across ge-
ography, race and ethnicity, disability and socioeconomic status.
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Child Sexual Abuse Prevention.—The Committee includes an in-
crease of $1,000,000 and recognizes the severe and often life-long
physical, cognitive and emotional impact of child sexual abuse and
appreciates CDC’s report outlining the gaps in current child sexual
abuse prevention research. These opportunities include the need to
improve surveillance systems and data collection, increase the un-
derstanding of risk and protective factors, and develop and dissemi-
nate effective prevention efforts.
Domestic Violence and Sexual Violence.—The Committee encour-
ages CDC to prioritize the collection and reporting of data on do-
mestic violence and sexual violence. The Committee also encour-
ages CDC to work with State and local governments, as well as
nonprofit organizations, to implement the necessary mechanism for
sharing data as well as provide technical assistance when needed
to ensure that the data is properly understood and utilized cor-
rectly.
Domestic Violence Prevention.—The Committee includes an in-
crease of $2,000,000 for the Domestic Violence Prevention En-
hancements and Leadership Through Alliances (DELTA) program
to expand efforts. DELTA is the only dedicated federal funding
source for the primary prevention of domestic violence.
Drowning Prevention.—About one in five people who die from
drowning are children aged 14 and younger. For every child who
dies from drowning, another five receive emergency department
care for nonfatal submersion injuries. The Committee strongly sup-
ports efforts by CDC to educate families and youth serving organi-
zations on the best practices to avoid injuries related to drowning,
and to support State drowning surveillance efforts and a national
plan on water safety.
Firearm Injury and Mortality Prevention Research.—The Com-
mittee includes an increase of $12,500,000 for research on firearm
injury and mortality through a public health approach that focuses
on data to understand its causes and to inform prevention strate-
gies. The Committee directs CDC to focus on activities that will
have the greatest potential public health impact. Furthermore, the
Committee recognizes that community gun violence, such as gang
violence, constitutes a significant portion of gun homicides in the
U.S. There is a disproportionate impact of community gun violence
on low-income communities of color, which is not often reflected in
the national narrative surrounding gun violence. The Committee
encourages CDC to support research on community gun violence
and to select grantees that reflect the diversity of the victims of
gun violence and that work in or near the impacted communities.
National Violent Death Reporting System.—The Committee in-
cludes funding for the only State-based surveillance system that
pools information together from multiple sources into a usable,
anonymous database of all types of violent deaths so that preven-
tion efforts can be informed and progress monitored.
Opioid Abuse and Overdose Prevention.—The Committee com-
mends CDC for its leadership on combating opioid drug overdoses.
The Committee encourages the Director to continue to implement
these activities based on population-adjusted burden of disease cri-
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teria, including mortality data (age adjusted rate), as significant
criteria when distributing funds for overdose prevention activities.
The Committee recognizes that the substance misuse epidemic is
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85
shifting, with an increase in overdoses resulting from stimulants
and other substances. The Committee urges for CDC to monitor,
prevent, and reduce harms associated with drug use, misuse, and
overdose, including opioids, stimulants, cannabis, and other emerg-
ing risks. The Committee appreciates efforts by CDC to ensure that
funding for opioid abuse and overdose prevention reaches local
communities to advance local understanding of the opioid overdose
epidemic and to scale-up prevention and response activities as in-
tended by Congress.
Public Health Approach to Violence.—The Committee recognizes
all forms of violence as a health crisis that is in desperate need of
increased data collection and funding to support effective preven-
tion and intervention efforts grounded in public health approaches.
There is increasing evidence of the profound negative effects of vio-
lence and the exposure to violence on child development, the long-
term mental and physical health of affected populations, and the
economic development of communities, especially communities of
color. In order to support calls for greater investment in these ap-
proaches, the Committee directs CDC within 180 days of enact-
ment of this Act to submit a comprehensive report detailing the
scope and intersection of all forms of violence in the U.S., the cost
of violence, and identify areas where more data and intervention
are needed.
Rape Prevention.—The Committee includes an increase of
$2,000,000 to amplify funding to States and Territories to support
essential rape prevention and education programs.
Suicide.—The Committee recognizes that suicide is devastating
communities across the U.S., as evidenced by more than 48,000
deaths in 2018, and is the tenth leading cause of death in America.
While depression and other mental health conditions are a signifi-
cant risk factor for suicide, less than half of the people who die by
suicide have a known mental health condition.
NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
Appropriation, fiscal year 2020 ......................................................... $342,800,000
Budget request, fiscal year 2021.. ..................................................... 190,000,000
Committee Recommendation ............................................................. 344,700,000
Change from enacted level ......................................................... +1,900,000
Change from budget request .......................................................... +154,700,000
The National Institute for Occupational Safety and Health
(NIOSH) conducts applied research, develops criteria for occupa-
tional safety and health standards, and provides technical services
to government, labor, and industry, including training for the pre-
vention of work-related diseases and injuries. This appropriation
supports surveillance, health hazard evaluations, intramural and
extramural research, instrument and methods development, dis-
semination, and training grants.
Within the total for NIOSH, the Committee recommends the fol-
lowing amounts:
FY 2021
Budget Activity Committee
National Occupational Research Agenda ....................................................................................................... $117,000,000
Agricultural, Forestry, and Fishing ........................................................................................................ 26,500,000
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Education and Research Centers ................................................................................................................... 30,000,000
Personal Protective Technology ...................................................................................................................... 20,000,000
Mining Research ............................................................................................................................................. 60,500,000
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FY 2021
Budget Activity Committee
National Mesothelioma Registry and Tissue Bank ........................................................................................ 1,600,000
Firefighter Cancer Registry ............................................................................................................................ 2,500,000
Other Occupational Safety and Health Research .......................................................................................... 113,100,000
Agricultural, Forestry, and Fishing.—The Committee includes
funding to support efforts to protect workers in this sector by pro-
viding leadership in applied research, disease and injury surveil-
lance, education and prevention.
Education and Research Centers.—The Committee includes fund-
ing to support efforts to reduce work-related injuries and illnesses
by prevention research, and implementing programs to improve oc-
cupational health and safety.
Mesothelioma.—The Committee recognizes that CDC undertook a
feasibility study for a mesothelioma patient registry in fiscal year
2019 to evaluate case finding methodologies to determine incidence
and prevalence, demographics and risk factors. The Committee in-
cludes an increase of $400,000 to take the next step toward estab-
lishment of a national mesothelioma patient registry through col-
lecting data on individuals suffering from the disease and identify
gaps in treatment in order for researchers to develop new treat-
ments and a cure for this disease, which is among the deadliest
and most painful cancers. The Committee encourages CDC to es-
tablish priorities for successful outcomes; develop and revise stand-
ards of care and treatment best practices; share evidence-based in-
formation between physicians across the country; and implement
benchmarks to improve care for mesothelioma patients.
Total Worker Health.—The Committee includes an increase of
$1,500,000 for the Total Worker Health (TWH) program, which
supports centers of excellence that advance the overall safety,
health, and well-being of U.S. workers. The Committee notes that
millions of American workers and businesses are confronting the
mental health effects of the COVID–19 pandemic; these include iso-
lation, economic insecurity, concerns about physical health and the
challenges of working remotely and reintegrating back into the
workplace. In addition, mental health conditions represent a lead-
ing cause of worker disability, rising medical costs and lost produc-
tivity. Therefore, the Committee directs NIOSH to use the addi-
tional funding to create a new TWH center of excellence for work-
place mental health. This center will support companies across all
sizes and industries in the study and implementation of best prac-
tices to improve workplace mental health and worker well-being
nationwide. NIOSH should award the center to an academic re-
search institution in partnership with a national nonprofit organi-
zation. Priority should be given to applicants with expertise in
mental illness from the worker/workplace perspective, a strong
track record of data collection and analysis, experience in sus-
taining a positive culture/climate in U.S. workplaces, and evalu-
ating workplace policies and practices with employers of varying
sizes. The center should also have the capacity to translate data
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and science into interventions, disseminate best practices across
the country and collect national data on employers and the mental
health and well-being of their workers.
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ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION
PROGRAM
Appropriation, fiscal year 2020 ......................................................... $55,358,000
Budget request, fiscal year 2021 ....................................................... 55,358,000
Committee Recommendation ............................................................. 55,358,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... –––
The Energy Employees Occupational Illness Compensation Pro-
gram (EEOICPA) provides compensation to employees and sur-
vivors of employees of Department of Energy facilities and private
contractors who have been diagnosed with a radiation-related can-
cer, 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 class-
es of workers to the Special Exposure Cohort, and provides admin-
istrative support to the Advisory Board on Radiation and Worker
Health.
GLOBAL HEALTH
Appropriation, fiscal year 2020 ......................................................... $570,843,000
Budget request, fiscal year 2021 ....................................................... 532,222,000
Committee Recommendation ............................................................. 572,843,000
Change from enacted level ......................................................... +2,000,000
Change from budget request ...................................................... +40,621,000
Through its Global Health activities, CDC coordinates, cooper-
ates, participates with, and provides consultation to other nations,
Federal agencies, and international organizations to prevent and
contain diseases and environmental health problems and to develop
and apply health promotion activities. In cooperation with min-
istries of health and other appropriate organizations, CDC tracks
and assesses evolving global health issues and identifies and devel-
ops activities to apply CDC’s technical expertise.
In addition, the Coronavirus Preparedness and Response Supple-
mental Appropriations Act (P.L. 116–123) included $300,000,000
and the CARES Act (P.L. 116–136) included $500,000,000 for glob-
al disease detection and emergency response.
Within the total, the Committee recommends the following
amounts:
FY 2021
Budget Activity Committee
Global AIDS Program ...................................................................................................................................... $128,421,000
Global Tuberculosis ........................................................................................................................................ 9,222,000
Global Immunization Program ........................................................................................................................ 226,000,000
Polio Eradication ................................................................................................................................... 176,000,000
Other Global/Measles ............................................................................................................................ 50,000,000
Parasitic Diseases and Malaria ..................................................................................................................... 26,000,000
Global Public Health Protection ..................................................................................................................... 183,200,000
Global Health Security.—The Committee provided additional,
multi-year funding through coronavirus supplemental appropria-
tions to further CDC’s work to protect global health security
through the Center for Global Health, the National Center for
Emerging and Zoonotic Infectious Diseases, and other programs
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that detect, prevent, and respond to infectious diseases and other
health threats. CDC’s global health security work focuses on the
core foundation for strong public health systems: surveillance, lab-
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oratory, workforce, and emergency operations. As emerging infec-
tious diseases like COVID–19, Ebola and Zika represent profound
challenges for our health system, the Committee supports contin-
ued work supporting the core public health system foundations for
Ministries of Health and enhanced work in research and develop-
ment aimed at creating new tools to respond to health threats at
home and abroad. The Committee urges CDC to ensure that the
importance of research and development to global health security
is appropriately reflected in their international engagements. The
Committee also supports CDC’s core activities in developing and
validating innovative tools for use by U.S. bilateral and multilat-
eral global health programs and laboratory efforts to monitor and
combat drug and insecticide resistance, a function essential to en-
suring that global health programs are responsive, efficient, and
tailored for maximum impact. The Committee notes the urgent
need for new disease detection and diagnostic tools to accurately
measure progress towards the U.S. government’s disease control
and elimination goals and supports CDC’s leadership role in the
development of those tools and in the application of next-generation
approaches to disease sequencing and diagnosis.
Global Public Health Protection.—In addition to the funding pro-
vided in this bill, the Committee provided significant, multi-year
funding in the CARES Act (P.L. 116–136) to support and enhance
CDC’s mission to protect the health of our nation, including by
working across the globe. The Committee supports CDC’s global ef-
forts to detect epidemic threats earlier, respond more effectively,
and prevent avoidable crises, including by providing support of pro-
gram implementation and scientific and technical experts in At-
lanta and in the field with concentrated efforts on countries, popu-
lations, and programs where resources will have the greatest public
health impact.
Global Tuberculosis.—The Committee includes an increase of
$2,000,000 to advance CDC’s global tuberculosis priorities to find,
cure, prevent, and sustain.
Global Water Strategy.—The Committee recognizes CDC’s work
to provide sustainable Water, Sanitation, & Hygiene (WASH) in
healthcare facilities, aligned with the 2017 US Global Water Strat-
egy, and to support WASH efforts to contribute to the elimination
of cholera as a public health threat as outlined by Ending Chol-
era—A Global Roadmap to 2030. The Committee urges CDC to in-
crease its WASH efforts in areas where Neglected Tropical Dis-
eases are endemic.
Malaria.—The Committee is concerned with the exponentially
growing need of severe malaria treatment with no commercially
available options following the withdrawal of the only FDA-ap-
proved drug for severe malaria (quinidine) from the U.S. market.
The severe malaria treatment preferred by the World Health Orga-
nization is IV artesunate which is not FDA-approved due to a lack
of commercial interest. CDC is able to stock its network of Quar-
antine Stations with IV artesunate by relying on imports from
China as well as unused reserves from the Department of Defense.
Artesunate releases from CDC’s Quarantine Stations have in-
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creased almost 1,100 percent from 2018 to 2019. To address the
need for rapid access, CDC is encouraged to support additional
staff support at Quarantine Stations and headquarters to provide
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technical support, coupled with an expanded distribution model.
Distributing artesunate from Quarantine Stations, select health de-
partments, and positioning at select hospitals is the most effective
and cost-efficient method for preventing morbidity in high burden
areas. This hybrid model would put artesunate within 100 miles of
88 percent of the places that severe cases have historically reported
to. Additional work to promote utilization of malaria prophylaxis
for travelers could help reduce malaria cases.
Parasitic Disease and Malaria.—The Committee recognizes the
important role the Center plays in the fight against malaria and
parasitic disease, and protecting Americans through global health
security through its efforts to detect, prevent, and respond to infec-
tious diseases and other health threats. The Center also provides
crucial monitoring and surveillance of transmission, evaluation of
interventions for effectiveness and impact, development of key
diagnostics, and testing of tools in a real work setting that are crit-
ical to ensuring that our global health investments are smarter,
better, and not wasteful. Therefore, the Committee encourages
CDC to continue to research, monitor, and evaluate efforts for ma-
laria and parasitic disease in collaboration with other divisions and
agencies.
Population-based Surveillance Platforms.—The Committee di-
rects at least $3,000,000 to be used to support existing longitudinal
population-based infectious disease surveillance platforms that en-
able comparative analysis between urban and rural populations in
the developing world.
Soil Transmitted Helminth and Related Diseases of Poverty.—The
Committee includes $1,500,000 to extend the currently funded CDC
projects aimed at surveillance, source remediation and clinical care
to reduce soil transmitted helminth infection.
World Health Organization.—The Committee strongly opposes
the President’s proposed ban on U.S. support and funding for the
World Health Organization (WHO). This action would have a dam-
aging impact on global public health efforts affecting billions of
people across the globe, including the current response to the
COVID–19 pandemic, global health security, emergency prepared-
ness and response, and programs to reduce chronic disease. For ex-
ample, a ban on support for the WHO would have a terrible impact
on the global polio eradication campaign, in which WHO-coordi-
nated surveillance is critical to tracking polio outbreaks, targeting
resources to those outbreaks, and ultimately, certifying regions to
be polio free. The Committee urges CDC to continue to engage with
the WHO to address global health issues, including COVID–19, and
to continue to use its resources to support essential WHO global
health activities.
PUBLIC HEALTH PREPAREDNESS AND RESPONSE
Appropriation, fiscal year 2020 ......................................................... $827,200,000
Budget request, fiscal year 2021 ....................................................... 802,000,000
Committee Recommendation ............................................................. 852,200,000
Change from enacted level ......................................................... +25,000,000
Change from budget request ...................................................... +50,200,000
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The Public Health Preparedness and Response (PHPR) account
supports programs that build and strengthen national prepared-
ness for public health emergencies, both naturally-occurring and in-
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tentional. PHPR supports needs assessments, response planning,
training, epidemiology and surveillance, and upgrades for labora-
tory capacity and communications systems.
In addition, the Coronavirus Preparedness and Response Supple-
mental Appropriations Act (P.L. 116–123) included $950,000,000;
the CARES Act (P.L. 116–136) included $1,500,000,000 for State,
local, Tribal, and Territorial health departments. Moreover, the
Paycheck Protection Program and Health Care Enhancement Act
(P.L. 116–139) included $10,250,000,000 for diagnostic testing of
COVID–19 that was distributed to State, local, and Territorial re-
cipients through the public health emergency preparedness cooper-
ative agreement.
Within the total, the Committee recommends the following
amounts:
FY 2021
Budget Activity Committee
Public Health Emergency Preparedness Cooperative Agreement .................................................................. $700,000,000
Academic Centers for Public Health Preparedness ....................................................................................... 8,200,000
CDC Preparedness and Response .................................................................................................................. 144,000,000
Agricultural Farmworkers and COVID–19.—The Committee rec-
ognizes the risks posed by the COVID–19 pandemic to our nation’s
essential farm workforce as they continue to ensure the availability
of the food supply. The Committee urges the CDC to provide tech-
nical assistance to State and local health departments to ensure
that farmworkers are included in any category of the workforce
that receives priority for COVID–19 diagnostic testing.
Public Health Preparedness Cooperative Agreements.—The Com-
mittee includes an increase of $25,000,000 to enhance support to
State and local health departments in developing and maintaining
capable, flexible, and adaptable public health systems to rapidly re-
spond in an emergency. The Committee encourages CDC to apply
a risk-based approach using population or other risks when allo-
cating funds to PHEP in order to reflect the potential magnitude
of illness and death that may be anticipated. The Committee recog-
nizes the challenges of ensuring adequate response in remote geo-
graphical areas, such as the Pacific territories, during potential
outbreaks and encourages CDC improve laboratory capacity in
such areas. Furthermore, the Committee directs the incorporation
of Limited English Proficient (LEP) Individuals in emergency plan-
ning. The Committee requests a report on the steps taken to en-
sure that recipients are conducting outreach to LEP communities
in the fiscal year 2022 Congressional Justification.
Strategic National Stockpile.—The Committee recognizes the re-
organization of the Strategic National Stockpile (SNS) to the Office
of the Assistant Secretary for Preparedness and Response. The
Committee expects that CDC will continue its significant role in
providing scientific expertise in decision-making related to procure-
ment of countermeasures, and maintaining strong relationships
with State and local public health departments to facilitate effi-
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cient deployment of countermeasures in public health emergencies.
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BUILDINGS AND FACILITIES
Appropriation, fiscal year 2020 ......................................................... $25,000,000
Budget request, fiscal year 2021 ....................................................... 30,000,000
Committee Recommendation ............................................................. 30,000,000
Change from enacted level ......................................................... +5,000,000
Change from budget request ...................................................... –––
The Committee recommendation includes $30,000,000, an in-
crease of $5,000,000, in discretionary budget authority.
This account supports capital projects as well as repairs and im-
provements to restore, maintain, and improve CDC’s assets at fa-
cilities in seven States and San Juan, Puerto Rico.
The Committee continues language to allow CDC to retain unob-
ligated funds in the Individual Learning Accounts from departed
employees to support the replacement of the underground and sur-
face coal mine safety and health research facility.
CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT
Appropriation, fiscal year 2020 ......................................................... $358,570,000
Budget request, fiscal year 2021 ....................................................... 155,000,000
Committee Recommendation ............................................................. 358,570,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... +203,570,000
The Committee recommendation includes $198,570,000 in discre-
tionary funds and $160,000,000 in transfers from the PPH Fund.
This account supports public health leadership and support ac-
tivities at CDC.
Within the total, the Committee recommends the following
amounts:
FY 2021
Budget Activity Committee
Preventive Health and Health Services Block Grant ..................................................................................... $160,000,000
Public Health Leadership and Support .......................................................................................................... 113,570,000
Infectious Diseases Rapid Response Reserve Fund ...................................................................................... 85,000,000
Infectious Diseases Rapid Response Reserve Fund.—The Com-
mittee includes funding within this account for the Infectious Dis-
eases Rapid Response Reserve Fund. This funding is in addition to
the resources provided in the Coronavirus Preparedness and Re-
sponse Supplemental Appropriations Act (P.L. 116–123) and the
CARES Act (P.L. 116–136). As utilized during the initial response
to COVID–19, the Reserve Fund will provide an immediate source
of funding to quickly respond to an imminent infectious disease cri-
sis that endangers American lives. Funds are available until ex-
pended.
Management-Worker Relations.—The Committee urges CDC to
continue a robust program to support the morale and engagement
of staff, including addressing management-worker relations and en-
suring fair, equitable treatment that complies with Federal civil
rights statutes and standards.
Prevention and Public Health Fund.—The Committee encourages
the Prevention and Public Health fund be used for programs it was
intended to assist, such as cardiovascular/stroke prevention
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through Million Hearts.
Preventive Health and Health Services Block Grant.—The Com-
mittee continues to support the Preventive Health and Health
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Services Block grant, of which at least $7,000,000 is to support di-
rect services to victims of sexual assault and to prevent rape.
Undergraduate Public Health Scholars Program.—The Com-
mittee encourages CDC to continue engagement of Historically
Black Colleges and Universities in the CDC Undergraduate Public
Health Scholars (CUPS) Program.
NATIONAL INSTITUTES OF HEALTH
Appropriation, fiscal year 2020 ......................................................... $41,684,000,000
Budget request, fiscal year 2021 ....................................................... 38,371,491,000
Committee Recommendation ............................................................. 46,959,000,000
Change from enacted level ......................................................... +5,275,000,000
Change from budget request ...................................................... +8,587,509,000
The Committee recommendation for the National Institutes of
Health (NIH) program level includes $40,617,687,000 in discre-
tionary appropriations and $1,341,313,000 in Public Health Service
Act section 241 evaluation set-aside transfers. Within the total ap-
propriation, the Committee recommendation includes $404,000,000
in budget authority authorized in the 21st Century Cures Act (P.L.
114–255). The bill includes an increase in discretionary, non-emer-
gency budget authority of 588,000,000 above the fiscal year 2020
enacted level, which is necessary to maintain an overall increase
of $500,000,000 while compensating for a reduction of $88,000,000
in funding made available by the Cures Act.
In addition, Title VI of this Act includes $5,000,000,000 in emer-
gency appropriations to NIH, of which not less than $2,500,000,000
must be transferred to Institutes and Centers in proportion to their
share of appropriations in fiscal year 2020. Each Institute and Cen-
ter will receive an increase of at least 7 percent over the 2020 en-
acted level. The emergency appropriation is further described
under Title VI.
Further, the Coronavirus Preparedness and Response Supple-
mental Appropriations Act included $826,000,000; the CARES Act
included $945,400,000; and the Paycheck Protection Program and
Health Care Enhancement Act included $1,806,000,000 for NIH to
support and conduct research on diagnostics, therapeutics, and vac-
cines for COVID–19.
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 under-
standing towards designing new approaches for preventing, diag-
nosing, and treating disease and disability; and ensure that these
approaches are widely available.
The recommendation includes funding for initiatives established
in the 21st Century Cures Act, including a total of $195,000,000 for
the Cancer Moonshot Initiative; $500,000,000 for the ‘‘All of Us’’
precision medicine initiative (including $109,000,000 from the
Cures Act); and $500,000,000 for the Brain Research through Ap-
plication of Innovative Neurotechnologies (BRAIN) Initiative (in-
cluding $100,000,000 from the Cures Act).
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The Committee includes specific funding allocations for a number
of initiatives and activities detailed in the Institute- and Center-
specific sections below.
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NATIONAL CANCER INSTITUTE (NCI)
Appropriation, fiscal year 2020 ......................................................... $6,440,442,000
Budget request, fiscal year 2021 ....................................................... 5,881,173,000
Committee Recommendation ............................................................. 6,494,155,000
Change from enacted level ......................................................... +53,713,000
Change from budget request ...................................................... +612,982,000
Committee Recommendation (including Title VI) ........................... 6,908,600,000
Change from enacted level ......................................................... +468,158,000
Change from budget request ...................................................... +1,027,427,000
In addition, the Paycheck Protection Program and Health Care
Enhancement Act included $306,000,000 for NCI to support re-
search related to the COVID–19 pandemic.
Mission.—NCI leads, conducts, and supports cancer research
across the nation to advance scientific knowledge and help all peo-
ple live longer, healthier lives.
Cancer Bioengineering.—The Committee is concerned about the
high cost of new cancer therapies. A major driver for the high cost
is that 95 percent of cancer therapies that begin Phase I clinical
trials fail to secure FDA approval. The Committee is encouraged by
the scientific advances in cancer research generated by the Phys-
ical Sciences Oncology Network (PSON) and the Cancer Systems
Biology Consortium (CSBC) where math, physics, and bio-
engineering approaches have revealed novel strategies that may re-
duce the clinical trial failure rate and lower the cost of new cancer
therapies. The Committee encourages NCI to build upon the suc-
cess of the PSON and CSBC by funding research focused on bio-
engineering and quantitative approaches to basic science and
translational oncology.
Cancer Clinical Trials.—The Committee is concerned that only a
small percent of patients participate in cancer clinical trials, even
though most express an interest in clinical research; and that ulti-
mately, about one in five cancer clinical trials fail because of lack
of patient enrollment. Groups that are generally underrepresented
in clinical trials include racial and ethnic minorities and older and
lower-income individuals as well as those from rural communities.
As such, the Committee directs the GAO to conduct a review of
what actions Federal agencies have taken to help to address bar-
riers to participate in Federally-funded cancer clinical trials by
populations that have been traditionally underrepresented in such
trials, and identify challenges, if any, in implementing such ac-
tions. In addition, this GAO review should identify additional ac-
tions that can be taken by Federal agencies to address barriers to
participation in Federally-funded cancer clinical trials by popu-
lations that have been traditionally underrepresented in such trials
and make recommendations on potential changes in practices and
policies to improve participation in such trials by such populations.
Cancer Immunotherapy.—The Committee recognizes that cancer
immunotherapies hold enormous promise to cure a number of can-
cers. Patients with certain hematologic malignancies have already
benefited from the development of chimeric antigen receptor T-cell
(CAR–T), an immunotherapy. Additional innovative and life-saving
therapies for different types of cancers, some with few treatment
options, will only be available from additional research in this field.
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The Committee is encouraged by the research NCI has already
supported in this field, but urges the Institute to continue to
prioritize research on new immunotherapies. The Committee re-
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94
quests that NCI provide an update in the fiscal year 2022 Congres-
sional Justification on progress being made in this area and the
gaps in research that remain.
Cancer Moonshot.—The Committee directs NIH to transfer
$195,000,000 from the NIH Innovation Account to NCI to support
the Cancer Moonshot initiative. These funds were authorized in the
21st Century Cures Act (P.L. 114–255).
Childhood Cancer Data Initiative (CCDI).—The Committee in-
cludes $50,000,000 for the second year of the CCDI, as proposed in
the fiscal year 2021 budget request. The development of new thera-
pies is important to finding a cure for childhood cancers, many of
which have not seen new therapies in decades.
Childhood Cancer Survival Metrics.—A recent study determined
that childhood cancer diagnoses are on the rise by approximately
0.8 percent per year. Worldwide, there are 400,000 new childhood
cancer diagnoses annually. However, childhood cancer death rates
are described as being on the decline. The Committee is concerned
that the current metric used to determine mortality and survival
statistics for childhood cancer does not fully capture the long-term
morbidity and mortality of these diseases. Currently, a child or
adult that lives five years from the date of diagnosis is considered
a survivor. Yet, children are not small adults and their potential
life span after diagnosis is much longer than an adult. Using the
five-year survival metric does not capture children who die pre-
maturely as a result of their cancer or its treatment when they are
past the five-year point. The Committee directs NCI to establish a
task force composed of childhood cancer researchers and advocates
to determine the most appropriate survivorship metric for child-
hood cancer. In addition, the Committee recognizes a critical goal
of the CCDI is to collect comprehensive data about every child di-
agnosed with cancer in the U.S., including data on survival and
mortality, such as death due to late effects of cancer and its treat-
ment. The Committee requests an update from NCI in the fiscal
year 2022 Congressional Justification focusing on how CCDI efforts
will address this need to more accurately capture childhood cancer
mortality beyond the current five-year survival metric.
Deadliest Cancers.—The Committee looks forward to seeing
NCI’s update on developing scientific frameworks for stomach and
esophageal cancers as well as ways in which it is supporting re-
search into all recalcitrant cancers, as directed in House Report
116–62. Further, the Committee notes that the Recalcitrant Cancer
Research Act of 2012 directed NCI to develop a scientific frame-
work for at least two cancer types that meet the definition of recal-
citrant cancers as defined in the Act. The Committee directs NCI
to outline other specific steps the NCI is taking to support research
that aims to reduce the burden of disease from pancreatic, non-
small cell lung, stomach, and esophageal cancers in the fiscal year
2022 Congressional Justification.
Endometrial Cancer.—The Committee is concerned that both the
incidence and mortality rates for endometrial cancer are rising,
with a survival disparity for Black women. The Committee believes
that a renewed emphasis by NCI on endometrial cancer research
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is needed to facilitate early detection and optimal treatments and
outcomes for all women, including minority populations. The Com-
mittee urges NCI to study endometrial cancer disparities, including
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biologic differences in tumor type, molecular mechanisms, patho-
genesis, and tumor microenvironment, and to conduct clinical trials
to better define appropriate therapy for a precision medicine ap-
proach to endometrial cancer. The Committee requests an update
on NCI’s activities regarding endometrial cancer in the fiscal year
2022 Congressional Justification, including progress made in inci-
dence and survival rates by ethnicity.
Glioblastoma (GBM).—The Committee recognizes that GBM is
the most common, most deadly, and most difficult form of brain
cancer to treat in adults. For the thousands of Americans facing
this disease, the lack of progress is a devastating reality that trails
behind the impressive progress made in research of other forms of
cancer. The Committee strongly encourages NIH to support addi-
tional research on glioblastoma treatment.
HPV Associated Cancers.—The Committee encourages NCI to ex-
pand research related to HPV-associated cancers.
Kidney Cancer.—The Committee is concerned with the growing
number of kidney cancer diagnoses and lack of early detection of
the disease. The Committee encourages NCI to continue to
prioritize meritorious research that could assist in developing diag-
nostic tests and early detection techniques.
Liver Cancer.—The Committee notes that liver cancer is a dev-
astating disease, with a five-year survival rate of only 20 percent.
The Committee commends NCI for the creation of a Specialized
Center of Research Excellence (SPORE) focused on liver cancer and
encourages other new program projects, research, and contract op-
portunities for investigators that focus on a better understanding
of the biology of liver cancer and new therapeutic targets. In addi-
tion, the Committee commends NCI for its support of the inter-in-
stitute effort to develop the NIH Strategic Plan to Cure Hepatitis
B and encourages continued close collaboration with the National
Institute of Allergy and Infectious Diseases (NIAID) and the Na-
tional Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK) and active participation in the Director’s Trans-NIH Hep-
atitis B Working Group. The Committee requests an update on
NCI’s activities in these areas in the fiscal year 2022 Congressional
Justification.
Melanoma.—The Committee encourages NCI to continue its sup-
port of research on melanoma, including the development of experi-
mental models to identify mechanisms and associated biomarkers,
new technologies such as artificial intelligence systems for detec-
tion and classification, and clinical trials that provide population-
based evidence for public health guidelines for screening and sun
protection practices. In addition, the Committee encourages re-
search on therapies for metastatic melanoma, including CNS,
LMD, uveal, mucosal and pediatric melanomas; neoadjuvant thera-
pies in trials designed to test for clinical benefit; and risk factors
for recurrence. The Committee also urges NCI to continue to evalu-
ate clinical trial eligibility criteria so that patients with brain me-
tastases can also be included in trials whenever clinically appro-
priate and urges inclusion of melanoma in enhancements to the
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SEER registry. Finally, in the U.S., there are now more than 1.3
million survivors of melanoma. The Committee encourages further
research into survivorship care for melanoma patients. The Com-
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96
mittee requests an update on these requests in the fiscal year 2022
Congressional Justification.
Pancreatic Cancer.—The Committee appreciates NCI’s recent
submissions of the five-year review and update reports required by
the Recalcitrant Cancer Research Act of 2012. This year, the Com-
mittee looks forward to the report on the effectiveness of the frame-
work, including an update on research efforts in pancreatic cancer
prevention, detection, diagnosis, and treatment. While progress has
been made, the Committee encourages NCI to continue to support
research efforts to advance discoveries and improve treatment op-
tions for patients diagnosed with pancreatic cancer.
Partnerships to Advance Cancer Health Equity (PACHE) Pro-
gram.—The Committee encourages NCI to expand support for the
PACHE program, which aims to create stable, comprehensive, and
long-term partnerships between institutions serving underserved
health disparity populations and underrepresented students
(ISUPS) and NCI-designated Cancer Centers (CCs) in the areas of
cancer research, cancer research education, and cancer outreach.
The Committee encourages NCI to prioritize funding to States and
territories in the Pacific Region, where, according to the National
Center for Biotechnology Information, sociocultural, geographic,
and biologic factors contribute to cancer health disparities in indig-
enous Pacific peoples (IPPs) in Guam, Hawaii, and the U.S. Associ-
ated Pacific Islands (USAPI), and IPPs experience a greater burden
of cancer health disparities that are associated with late-stage di-
agnosis and poor survival outcomes compared with majority popu-
lations in the U.S.
Pediatric Brain Cancer.—The Committee recognizes that brain
cancer remains the most fatal of all pediatric cancers. Despite
progress in other diseases, pediatric brain cancer survival rates
have not improved for decades and have lagged behind the strides
made in other cancers. The majority of children who survive may
experience lifelong impairments and disabilities that result from
high levels of toxicity associated with treatment. The Committee
strongly encourages NIH to expand funding on research on pedi-
atric brain cancer, including but not limited to drug delivery meth-
ods and new therapies with reduced levels of toxicity and long-term
complications.
Prostate Cancer.—The Committee remains concerned that pros-
tate cancer lacks treatments for men with advanced disease as well
as adequate diagnostic and imaging methodologies. To ensure Fed-
eral resources are leveraged to the greatest extent possible, the
Committee encourages NCI to coordinate, when appropriate, its re-
search efforts with other Federal agencies, including the Depart-
ment of Defense, as well as private research foundations and advo-
cacy groups.
Rare Cancers Therapeutics Research and Development.— Rare
cancers, defined at those cancers that have fewer than six new
cases per 100,000 Americans per year, represent over 30 percent of
all cancers. Rare cancers present a unique research challenges for
many reasons, including the difficulty in accruing enough patients
to participate in clinical trials, the lack of industry focus on these
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cancers due to the relatively small number of patients diagnosed
with each cancer, the lack of rare cancer tumor models and cell
lines, and the difficulty of patients receiving accurate and precise
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diagnoses due in part to the lack of clinician familiarity with rare
cancers. The Committee commends NCI’s investment in the Rare
Tumor Patient Engagement Networks, including NCI CONNECT
and MyPART, and in particular the NCI Experimental Thera-
peutics Program, with a focus on supporting the most promising
new drug discovery and development projects. The Committee en-
courages NCI to expand these initiatives to include additional rare
cancers not covered in prior and existing efforts and to issue a re-
port on this progress and an update on the DART study in the fis-
cal year 2022 Congressional Justification.
Reducing Native American Cancer Disparities.—The Committee
encourages NCI to expand research efforts to reduce Native Amer-
ican cancer disparities, including through NCI’s continued partici-
pation in the trans-NIH Intervention Research to Improve Native
American Health (IRINAH) program. The Committee notes that
the Native American population experiences an overall cancer inci-
dence and mortality rates which are much higher than non-Native
populations. The goal of intensifying research in this area is to de-
velop durable capacity for tribally-engaged cancer disparities re-
search through an integrated program of research, education, out-
reach, and clinical access.
Surveillance, Epidemiology, and End Results (SEER) Program
Registry.— The SEER Program is an authoritative source of infor-
mation on cancer incidence and survival in the U.S. SEER cur-
rently collects and publishes cancer incidence and survival data
from population-based cancer registries covering approximately
34.6 percent of the U.S. population. The Committee encourages
NCI to continue to advance efforts to modernize the SEER Registry
and better capture key data points, such as metastatic recurrence
and cancer migration. The Committee requests an update on plans
to cover more of the U.S. population in the fiscal year 2022 Con-
gressional Justification.
Specialized Programs of Research Excellence (SPOREs).—The
SPORE program is a key component of NCI’s efforts to translate
basic research into the prevention, early detection, diagnosis, and
treatment of cancer. The Committee commends NCI for its recent
funding opportunity announcement regarding the development of
SPOREs that are focused on cancer health disparities, and it en-
courages additional research in this area. The Committee urges
NCI to prioritize the use of multi-center SPOREs, which allow
greater opportunities for collaborative, interdisciplinary research.
STAR Act.—The Committee includes no less than $25,000,000,
the same as the fiscal year 2020 enacted level, for continued imple-
mentation of sections of the Childhood Cancer Survivorship, Treat-
ment, Access, and Research (STAR) Act to expand existing bio-
repositories for childhood cancer patients enrolled in NCI-spon-
sored clinical trials to collect and maintain relevant clinical, bio-
logical, and demographic information on children, adolescents, and
young adults, with an emphasis on selected cancer subtypes (and
their recurrences) for which current treatments are least effective.
Funding provided this year will allow NCI to continue to conduct
and support childhood cancer survivorship research as authorized
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in the STAR Act.
Women and Lung Cancer.—The Committee notes that lung can-
cer has a disparate impact on women, particularly younger women
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who have never smoked. Additional research strategies are needed
to explore the differences in women with respect to lung cancer risk
factors, incidence, and histology. The Committee urges NCI to ac-
celerate research into treatments and implementation of lung can-
cer preventive services for women. The Committee requests an up-
date on these activities in fiscal year 2022 Congressional Justifica-
tion.
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)
Appropriation, fiscal year 2020 ......................................................... $3,624,258,000
Budget request, fiscal year 2021 ....................................................... 3,298,004,000
Committee Recommendation ............................................................. 3,655,428,000
Change from enacted level ......................................................... +31,170,000
Change from budget request ...................................................... +357,424,000
Committee Recommendation (including Title VI) ........................... 3,888,652,000
Change from enacted level ......................................................... +264,394,000
Change from budget request ...................................................... +590,648,000
In addition, the CARES Act included $103,400,000 for NHLBI to
support and conduct research related to the COVID–19 pandemic.
Mission.—NHLBI provides global leadership for a research,
training, and education program to promote the prevention and
treatment of heart, lung, and blood disorders and enhance the
health of all individuals so that they can live longer and more ful-
filling lives.
Blood Donor Questionnaire Education Materials.—The Com-
mittee is concerned that certain FDA guidance in the educational
materials provided in the blood donor questionnaire is inappro-
priate and misguided. The recommendations for deferral should not
mention someone’s sexual orientation, and rather should focus on
risk factors that might expose a potential donor to blood-borne ill-
ness. The Committee strongly recommends that NHLBI work with
the FDA and remove or replace the recommended deferment of
blood for men who have had sex with men in the last 12 months.
Cardiovascular Disease.—The Committee remains concerned
about the prevalence of cardiovascular disease among Americans
and encourages ongoing support for basic research programs to
evaluate the damaging effects of smoking. Such research could help
mitigate the risk of heart attack and stroke related to smoking and
should also include better infrastructure to gather data on dam-
aged endothelial cells in order to identify abnormalities caused by
smoking, biomarkers of early disease, and personalized therapies to
promote blood vessel healing. The Committee encourages NIH to
support research to be conducted across the disciplines of medicine,
immunology, imaging, chemistry, biomedical engineering, physics,
statistics, mathematics, and entrepreneurship to design new thera-
pies and therapy delivery systems and strategies that are safer and
more effective and improve patient compliance, while seeking to
move technologies from bench to bedside with private partners and
local health care and community organizations.
Familial Hypercholesterolemia (FH).—The Committee recognizes
the value that well-characterized, longitudinal, population-based
cohort studies provide in bringing to light more information about
cardiovascular disease progression in FH. By studying participants
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over time, much can be learned about the development of cardio-
vascular disease that will help scientists understand the role of en-
vironmental and genetic factors in disease development and pro-
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gression. The Committee urges NHLBI to fund efforts to continue
the study into the development and progression of cardiovascular
disease caused by FH, the effect of treatment on patient outcomes,
and effective ways to identify individuals with FH and their af-
fected family members early in life.
G Protein-Coupled Receptors (GPCRs).—The Committee recog-
nizes that recent developments in multiple basic sciences (struc-
tural biology, molecular modeling, receptor biology, and pharma-
cology) have greatly accelerated the rate of discovery of drugs that
GPCRs, the largest and most readily and frequently targeted pro-
tein family in the human genome. The rate of discovery now
strains the ability of academic laboratories to test, in a timely man-
ner, the efficacy of these drugs in physiologically and disease-rel-
evant systems. Cardiovascular, lung, and blood diseases remain
among the most important and costly diseases that would benefit
from a new generation of drugs. The Committee encourages NHLBI
to develop additional funding mechanisms enabling academic lab-
oratories, as both singular and networked or collaborative entities,
to accelerate the pace of pre-clinical development of GPCR-tar-
geting drugs.
Heart Disease.—Heart disease continues to be the leading cause
of death in the U.S., claiming hundreds of thousands of lives and
costing billions of dollars every year. The Committee is concerned
that this largely preventable disease disproportionately affects ra-
cial and ethnic minorities and those living in rural communities
and supports ongoing population studies that seek to address these
disparities. The Committee is concerned that heart disease is the
leading cause of death of pregnant women and that one in five
American women experience some type of cardiovascular complica-
tion during pregnancy. The Committee supports the NHLBI’s Stra-
tegic Vision Objective to address maternal health and reduce the
risk of cardiovascular disease for women before, during, and after
pregnancy. The Committee also supports continued research ad-
dressing congenital heart disease, the acceleration of research in
regenerative medicine, further investments in data science that
will help facilitate precision medicine, and continued genetic re-
search related to heart disease, including heart failure and atrial
fibrillation (AFib). The Committee also commends the Institute for
initiating research that seeks to address the health-related effects
of e-cigarette use and vaping.
Lymphedema (LE).—LE is a chronic, debilitating, and incurable
swelling that can be a result of damage to the lymphatic system
due to surgery, cancer treatment, or injury, and that can also be
inherited. An estimated 10 million Americans suffer from
lymphedema. Additional research is necessary to improve our un-
derstanding of this condition and expand the treatment options
available. The Committee strongly encourages NHLBI to expand
support for research on LE and requests a report within 120 days
of enactment of this Act describing NHLBI’s current and planned
research related to LE.
National Center on Sleep Disorders Research (NCSDR).—The
Committee commends the ongoing work of NCSDR to reinvigorate
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sleep, circadian, and sleep disorders research activities across the
government, and notes impactful new projects through the HEAL
Initiative and studying the relationship between sleep and stroke.
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The Committee encourages NCSDR to continue to build meaningful
partnerships across Federal agencies and further coordinate re-
search in this area.
National Chronic Obstructive Pulmonary Disease (COPD) Action
Plan.—The Committee notes NHLBI’s role in crafting the National
COPD Action Plan and encourages NHLBI to continue this impor-
tant work by supporting additional research activities and collabo-
rating with other Public Health Service agencies to facilitate imple-
mentation of the plan’s recommendations.
Postural Orthostatic Tachycardia Syndrome (POTS).—The Com-
mittee is disappointed in NIH’s disregard for Congressional direc-
tion in the recent NIH report Postural Orthostatic Tachycardia
Syndrome (POTS): State of the Science, Clinical Care, and Re-
search, which was requested in Senate Report 115–289 and sub-
mitted to the Committee on January 31, 2020. NIH appears to
have ignored the symposium participants’ recommendations and
failed to provide the requested estimate of the level of funding
needed annually to achieve the objectives specified in Senate Re-
port 115–289. The Committee directs NIH to: (1) update the Janu-
ary 31, 2020 report with recommendations from the POTS experts
and submit a revised report to the Committee within 30 days of en-
actment of this Act, (2) implement the research priorities described
in the January 31, 2020 report supplemented with recommenda-
tions from the POTS experts, including a funding estimate, and (3)
provide a progress update to the Committee within 90 days of en-
actment of this Act documenting progress towards identifying pri-
ority areas of focus for future POTS research.
Pulmonary Fibrosis (PF).—The Committee recognizes that PF is
a family of more than 200 different lung diseases that all look very
much alike despite having a variety of causes. This heterogeneity
presents significant challenges for diagnosis and treatment. The
Committee commends NHLBI for its recent efforts to apply the
principles of precision medicine to PF research, especially by fund-
ing a major new study that will evaluate a promising treatment for
a subset of patients with a particular gene variant. This study,
known as PRECISIONS, also aims to identify genetic variants that
play a role in certain forms of PF. The Committee urges NHLBI
to prioritize basic research on PF, particularly to better understand
the causes and process of scarring and the varying impacts on pa-
tients.
Sickle Cell Disease (SCD).—The Committee commends NIH for
its ongoing support of clinical research for SCD, which imposes
major morbidity on an estimated 90,000 to 100,000 individuals in
the U.S., with three million Americans carrying the sickle cell trait.
The Committee encourages NIH to support clinical trials for pre-
natal and postnatal treatment of SCD, which includes multiple
promising approaches to eradicate this disease, save lives, and dra-
matically reduce the substantial health care costs associated with
SCD for children and adults. The Committee encourages NIH to
consider programs both domestically and globally to evaluate the
effectiveness of screening technologies for infants and children with
the sickle cell trait and disease. Further, while the Committee is
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aware that NHLBI is funding very promising areas of innovation
related to curative gene therapies, the Committee strongly encour-
ages NHLBI to increase its focus as well on disease-modifying
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therapies that could improve day-to-day care for the vast majority
of patients and address issues such as organ damage and pain
management. Lastly, the Committee encourages NHLBI to fund
the training of more sickle cell disease clinicians and researchers
in order to maintain this essential workforce pipeline and to make
advances on the transition from childhood medical care to adult.
Thalassemia.—Recent studies have shown that the length of time
between when blood is donated and transfused does not impact out-
comes for patients in need of an emergency blood transfusion. How-
ever, these studies do not determine the impact on chronically-
transfused patients, such as those with thalassemia, in which an
administration of older red cells may exacerbate iron loading and
contribute to worse outcomes. The Committee urges NHLBI to re-
view the scientific literature on this issue and provide an update
in the fiscal year 2022 Congressional Justification on the best way
to address this public health issue.
The Heart Truth Program.—For over a decade, The Heart Truth
program has worked to raise awareness about women’s risk of
heart disease. The program’s goals are to increase awareness that
heart disease is the leading cause of death among women and to
increase the conversations between women and their healthcare
providers. The Committee encourages NHLBI to continue robust
support for The Heart Truth program.
NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH
(NIDCR)
Appropriation, fiscal year 2020 ......................................................... $477,429,000
Budget request, fiscal year 2021 ....................................................... 434,559,000
Committee Recommendation ............................................................. 481,535,000
Change from enacted level ......................................................... +4,106,000
Change from budget request ...................................................... +46,976,000
Committee Recommendation (including Title VI) ........................... 512,258,000
Change from enacted level ......................................................... +34,829,000
Change from budget request ...................................................... +77,699,000
Mission.—The mission of NIDCR is to improve dental, oral, and
craniofacial health through research, research training, and the
dissemination of health information.
Oral Microbiome.—The Committee appreciates NIDCR’s leader-
ship in microbiome research, including its support of the Human
Oral Microbiome Database. The Committee encourages NIDCR to
build upon its microbiome research to discover and better under-
stand the microbiome’s connection to overall health, including its
influence on preventing and treating illness and disease.
Regenerative Medicine.—The Committee appreciates NIDCR’s
contributions to the field of regenerative medicine and recognizes
the promise this field holds for people across the country, including
but not limited to members of the military. The Committee urges
NIDCR to continue supporting its already robust regenerative med-
icine research portfolio and dedicate resources into promising re-
search in this space, including autotherapies research.
Surgeon General’s Report on Oral Health.—The Committee great-
ly appreciates NIDCR’s contributions to the U.S. Surgeon General’s
2020 Report on Oral Health. The Committee encourages NIDCR to
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utilize the findings of the 2020 Report to identify research gaps
across dental, oral, and craniofacial research and pursue research
opportunities to fill those gaps.
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NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY
DISEASES (NIDDK)
Appropriation, fiscal year 2020 ......................................................... $2,114,314,000
Budget request, fiscal year 2021 ....................................................... 1,924,211,000
Committee Recommendation ............................................................. 2,132,498,000
Change from enacted level ......................................................... +18,184,000
Change from budget request ...................................................... +208,287,000
Committee Recommendation (including Title VI) ........................... 2,268,556,000
Change from enacted level ......................................................... +154,242,000
Change from budget request ...................................................... +344,345,000
Mission.—The NIDDK mission is to conduct and support medical
research and research training and disseminate science-based in-
formation on diabetes and other endocrine and metabolic diseases;
digestive diseases, nutritional disorders, and obesity; and kidney,
urologic, and hematologic diseases, to improve people’s health and
quality of life.
End-Stage Renal Disease (ESRD).—The Committee notes the
work in supporting critical kidney research that NIDDK has ac-
complished, including research on ESRD. This research has led to
new developments for possible treatments and the Committee con-
tinues to encourage NIDDK to work with stakeholders to facilitate
new opportunities for research.
Functional Gastrointestinal Disorders.—The Committee encour-
ages NIH to continue to invest in research on functional gastro-
intestinal disorders, including to expand, intensify, and coordinate
the activities of NIH with respect to functional gastrointestinal and
motility disorders in line with the recommendations of the National
Commission on Digestive Diseases relating to functional gastro-
intestinal and motility disorders (FGIMDs). Further, the Com-
mittee urges NIH to enhance innovative basic, translational, and
clinical research focused on FGIMDs.
Gastroesophageal Reflux Disease (GERD).—The Committee recog-
nizes that GERD is the most common gastrointestinal (GI) diag-
nosis and can lead to a variety of other GI diseases. The Committee
is concerned about risks associated with pharmacological treat-
ments of GERD while surgical approaches remain too invasive to
most patients. The Committee directs NIDDK to submit a report
to the Committee within 120 days of enactment of this Act on the
current research done on non-pharmacological, non-surgical treat-
ments for GERD, such as injectable bulking agents. The Committee
encourages NIDDK to prioritize the bulking agents that were FDA-
approved for non-GI indications and show promise in the treatment
of GERD.
Glomerular Diseases.—The Committee continues to support the
important work that the Cure Glomeruloneuropathy (CureGN) ini-
tiative has accomplished that has led to breakthroughs for critical
clinical trials. The Committee encourages NIDDK to continue sup-
porting research that has proven to lead to new therapies.
Inflammatory Bowel Diseases (IBD).—The Committee recognizes
NIDDK’s leadership in supporting research into Crohn’s disease
and ulcerative colitis. The Committee also recognizes the impor-
tance of patient-centered, bedside-to-bench approaches to under-
stand complex, chronic diseases such as IBD, and the need to bet-
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ter understand the impact of diet on IBD. The Committee directs
NIDDK to pursue research on the interactions among food, the gut,
and the brain/nervous system in people with IBD and other chronic
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gastrointestinal diseases. The Committee notes that this bedside-
to-bench approach has been successful in other disease areas, in-
cluding type 2 diabetes and oncology, and we encourage NIDDK to
use a similar approach focused on IBD.
Pediatric Nephrology.—The Committee recognizes the importance
of research funded by NIDDK to develop the infrastructure re-
quired to enhance biomedical research focused on advancing inno-
vations in kidney care, including research on pediatric kidney in-
jury and disease. The Committee has raised concerns about the
lack of clinical trials in pediatric nephrology. One way to address
this problem is to ensure there is a robust training pipeline for the
pediatric nephrology biomedical research workforce. The Com-
mittee encourages NIDDK to prioritize mechanisms to incentivize
researchers to enter this field. The Committee requests that
NIDDK report back in the fiscal year 2022 Congressional Justifica-
tion on the progress made to bolster this biomedical workforce, in-
cluding opportunities so that young investigators may be further
encouraged to explore research in this space.
Polycystic Kidney Disease.—The Committee commends NIDDK
for its continued commitment to Polycystic Kidney Disease Re-
search and Translation Centers and the Pediatric Centers of Excel-
lence in Nephrology, which improve our understanding of the
causes of autosomal dominant polycystic kidney disease and
autosomal recessive polycystic kidney disease. The Committee con-
tinues to encourage NIDDK to work with stakeholders to facilitate
new opportunities for research and promote the development of
new therapeutic strategies.
NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
(NINDS)
Appropriation, fiscal year 2020 ......................................................... $2,444,687,000
Budget request, fiscal year 2021 ....................................................... 2,245,110,000
Committee Recommendation ............................................................. 2,465,110,000
Change from enacted level ......................................................... +40,423,000
Change from budget request ...................................................... +220,000,000
Committee Recommendation (including Title VI) ........................... 2,622,427,000
Change from enacted level ......................................................... +177,740,000
Change from budget request ...................................................... +377,317,000
Mission.—The NINDS mission is to seek fundamental knowledge
about the brain and nervous system and use that knowledge to re-
duce the burden of neurological disease.
Amyotrophic Lateral Sclerosis (ALS).—To leverage the work done
thus far in a meaningful way and make measurable progress to-
wards a cure for ALS patients, the Committee encourages NIH to
bring together researchers to capitalize on recent advancements,
augment existing efforts by bringing into the fight against ALS
leading researchers from other, more developed disciplines, and ex-
pedite the drive towards a cure for ALS. The Committee encour-
ages NIH to incentivize the continued exploration of novel thera-
peutic pathways and support additional clinical trials, increasing
the likelihood that the progress of the last decade can germinate
into cures with the next decade.
Brain Aneurysm.—The Committee continues to be concerned that
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an estimated one out of 50 individuals in the U.S. has a brain an-
eurysm, and an estimated 30,000 Americans suffer from a brain
aneurysm rupture each year. The Committee is concerned that not
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enough research is focused on prevention of brain aneurysm rup-
tures and urges NINDS to increase research on preventing brain
aneurysm ruptures.
BRAIN Initiative.—The Committee directs NIH to transfer
$50,000,000 from the NIH Innovation Account to NINDS to support
the BRAIN Initiative. These funds were authorized in the 21st
Century Cures Act (P.L. 114–255). This collaborative effort is revo-
lutionizing the understanding of how neural components and their
dynamic interactions result in complex behaviors, cognition, and
disease, while accelerating the development of transformative tools
to explore the brain in unprecedented ways, making information
previously beyond reach accessible. To achieve this goal, two spe-
cific projects outlined in a recent BRAIN 2.0 Initiative Advisory
Committee report stand out for their importance to human health
and technical viability: the Human Brain Cell Atlas and the
Human Brain Projectome. Both projects are separate trans-
formative projects that will culminate in a body of data that will
provide the clearest view possible of the human brain. To be suc-
cessful, these projects will require a focused, large-scale effort with
multidisciplinary teams with open platforms for dissemination of
the tools and knowledge realized. The Committee requests an up-
date on this effort in the fiscal year 2022 Congressional Justifica-
tion.
Chronic Fatigue Syndrome (ME/CFS).—The Committee com-
mends NIH on its ongoing ME/CFS efforts, including the unani-
mous adoption of the National Advisory Neurological Disorders and
Stroke (NANDS) Council Working Group by the full NANDS Coun-
cil, the Thinking the Future: A Workshop for Young/Early Career
ME/CFS Investigators workshop, and the continued investment in
the Collaborative Research Centers (CRC) Consortium. The Com-
mittee remains concerned that these initiatives are not making
progress fast enough to meet the urgent needs of millions of Amer-
ican adults and children suffering with ME/CFS today. The Com-
mittee encourages NIH to accelerate and expand efforts for ME/
CFS; such as: (1) accelerating the progress of the NIH ME/CFS In-
tramural Study by publishing and sharing data, (2) issuing new
ME/CFS disease specific funding announcements, (3) coordinating
an initiative to develop an interagency consensus on the selection
criteria for study participants involved in ME/CFS research, and
(4) implementing mechanisms to incentivize new and early career
researchers to enter and contribute data to the ME/CFS scientific
field.
Duchenne Muscular Dystrophy.—Duchenne muscular dystrophy
is a severe type of muscular dystrophy for which there is no cure
and for which the average life expectancy is in the second decade.
The Committee strongly encourages NIH to significantly expand its
support for research on Duchenne muscular dystrophy, particularly
accelerating and optimizing the clinical trial process through novel
and innovative trial designs, such as platform trials, which might
serve as a model for other rare diseases communities. The Com-
mittee also urges NIH to support methodological research on chal-
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lenges, such as redosing, manufacturing supply, and potential im-
mune response, associated with the advent of gene therapies for
rare diseases such as Duchenne.
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Dystonia.—The Committee notes the recommendations from the
conference on dystonia held by NINDS to revitalize the dystonia re-
search portfolio were recently released. The Committee requests an
update in the fiscal year 2022 Congressional Justification on the
release of the recommendations and new research and therapeutic
needs that the conference identified. The Committee encourages
NINDS to work with other dystonia research related Institutes
such as the National Institute on Deafness and Other Communica-
tion Disorders (NIDCD) and the National Eye Institute (NEI) on
research that will lead to a better understanding of dystonia eti-
ology and evaluation of the current status of translational research
that may lead to more treatment options for those affected by
dystonia.
Expanded Access for ALS Treatment.—The Committee supports
efforts to expand access for neurodegenerative diseases with no dis-
ease modifying treatments. The Committee encourages NINDS to
collaborate with stakeholders to expand access for patients through
clinical trials.
Headache Disorders.—The Committee strongly urges NINDS to
consider funding applications on fundamental, translational, and
clinical research on headache disorders, including migraine, post-
traumatic headache, the trigeminal autonomic cephalalgias, and
intracranial hypo/hypertension, that align with the HEAL Initia-
tive’s goal to achieve rapid and long-lasting solutions to the opioid
crisis.
Multiple Sclerosis (MS).—The Committee encourages NINDS to
prioritize studies that develop the medical understanding of the
progression of MS and advance research on prevention strategies,
treatments, and cures for MS.
Muscular Dystrophy.—The Committee is aware of the Eunice
Kennedy Shriver National Institute of Child Health and Human
Development’s (NICHD’s) Data and Specimen Hub (DASH) project
to create a centralized resource to store and access de-identified
data from NICHD-supported studies. The Committee encourages
NINDS to work with NICHD to explore utilizing the DASH site for
NINDS studies.
Myotonic Dystrophy.—The Committee recognizes there are sig-
nificant opportunities to advance the science regarding the causes
of myotonic dystrophy, a serious degenerative genetic condition,
and support current efforts to develop the first ever FDA-approved
treatment for this inherited genetic disorder. The Committee di-
rects NIH to prioritize the recruitment of young researchers to this
field to grow the number of high-quality research proposals sub-
mitted for peer review as these efforts hold significant promise for
major advances across many neurodegenerative diseases, particu-
larly other triplet repeat expansion diseases. The Committee re-
quests an update on these activities in the fiscal year 2022 Con-
gressional Justification.
Opioids.—The Committee continues to support the HEAL (Help-
ing to End Addiction Long-Term) Initiative, a trans-NIH effort to
speed scientific solutions to stem the national opioid public health
crisis. This initiative builds on extensive, well-established NIH re-
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search, including basic science of the complex neurological path-
ways involved in pain and addiction, implementation of science to
develop and test treatment models, and research to integrate be-
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havioral interventions with medication-assisted treatment for
opioid use disorder. The Committee includes no less than the fiscal
year 2020 enacted level of $266,300,000 within NINDS for this re-
search.
Peripheral Neuropathies.—The Committee notes the continued
progress of ongoing research into Guillain-Barre syndrome (GBS),
chronic inflammatory demyelinating polyneuropathy (CIDP), and
related conditions. The Committee encourages NINDS to continue
its work with NIAID and stakeholders on a state of the science con-
ference on evolving research and scientific mechanisms.
Sleep Disorders.—The Committee notes the leadership of NINDS
in advancing research into under-represented sleep disorders, such
as narcolepsy and restless leg syndrome, and encourages NINDS to
bolster these activities and pursue initiatives that advance sci-
entific understanding of specific sleep disorders impacting patients.
Stroke.—Despite remarkable progress to reduce the stroke mor-
tality rate, it is still the most common cause of severe long-term
disability. The Committee supports continued research to improve
the scientific understanding of stroke and clinical trials that are
developing new treatments and improved approaches to stroke re-
covery and rehabilitation through the NIH-funded clinical trials
network StrokeNet. The Committee supports continued stroke-re-
lated research conducted through the BRAIN Initiative that seeks
to discover how brain circuits rewire themselves to repair damage
that occurs during a stroke and that may lead to effective treat-
ments to mitigate this damage in the future. Understanding that
stroke is a largely preventable disorder, the Committee supports
ongoing population studies that seek to reveal the reasons for
stroke disparities found in communities, especially in rural States
in the stroke belt. The Committee further supports additional re-
search exploring how, and the extent to which, the accumulation of
white matter lesions in the brain are related to stroke and demen-
tia and urges continued collaborative research among NIH Insti-
tutes related to vascular dementia.
Traumatic Brain Injury (TBI) Mitigation.—The Committee un-
derstands that research on regenerative medicine and
neuroplasticity, including the use of adult stem cells and
neuroplasticity, may play an important role in developing treat-
ments and identifying therapeutic targets for neuroprotection pre/
post TBI. The Committee urges NINDS to work with all relevant
Institutes and Centers, including NIA, to support a robust and co-
ordinated portfolio of TBI research that explores all promising ave-
nues to facilitate functional repair of damaged circuitry in TBI.
Such analysis should include research on regenerative medicine
and neuroplasticity, inclusive to preventative approaches in reduc-
ing risk or to eliminate vulnerabilities from a TBI. A potential miti-
gation approach is to develop interventions that protect from the
delayed effects of TBI and associated pathology before they occur.
The Committee directs NINDS to provide an update regarding
these specific areas of TBI research in the fiscal year 2022 Con-
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gressional Justification.
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NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)
Appropriation, fiscal year 2020 ......................................................... $5,885,470,000
Budget request, fiscal year 2021 ....................................................... 5,445,886,000
Committee Recommendation ............................................................. 6,013,087,000
Change from enacted level ......................................................... +127,617,000
Change from budget request ...................................................... +567,201,000
Committee Recommendation (including Title VI) ........................... 6,391,821,000
Change from enacted level ......................................................... +506,351,000
Change from budget request ...................................................... +945,935,000
In addition, the Coronavirus Preparedness and Response Supple-
mental Appropriations Act included $826,000,000 and the CARES
Act included $706,000,000 for NIAID to conduct and support re-
search to develop diagnostics, therapeutics, and vaccines for
COVID–19.
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.
Autoimmune Neuropathies.—The Committee is pleased at the
progress between NIAID and NINDS on a state-of-the-science con-
ference on autoimmune neuropathies research into conditions like
Guillain-Barre syndrome and chronic inflammatory demyelinating
polyneuropathy. The Committee continues to encourage both Insti-
tutes to continue their work with patient stakeholders on this im-
portant conference.
Biodefense and Emerging Infectious Diseases.—The Committee
recognizes the threat of emerging infectious diseases from bats and
urges NIAID to fund research into the immunological basis for per-
sistence and clearance of emerging infections; defining common fea-
tures that underlie emerging infectious disease syndromes, such as
viral hemorrhagic fever and severe acute respiratory distress; and
clarifying mechanisms that facilitate transmission of zoonotic
pathogens from reservoir hosts (e.g. bats) to humans. The Com-
mittee supports the ongoing work of the National Biocontainment
Laboratories (NBLs) as a national resource. Given the ongoing
threat of emerging infectious diseases, such as the 2019 novel
coronavirus that causes the disease COVID–19, the Committee en-
courages NIAID to expand its research infrastructure and facilities
to include additional existing BSL 4 labs to conduct research that
will facilitate the development of next generation therapeutics,
diagnostics and vaccines for infectious diseases.
Celiac Disease.—The Committee supports NIH research on celiac
disease, including the autoimmune causation underpinning the af-
fliction. Today, the only known treatment for this disease is a glu-
ten-free diet, but recent research reveals that this strategy is insuf-
ficient for many who suffer from celiac disease. The Committee
urges NIAID to support new research and to better coordinate ex-
isting research with NIDDK and the other Institutes and Centers.
The Committee requests that NIAID report back in the fiscal year
2022 Congressional Justification on the progress made towards
promoting, recruiting, and supporting additional celiac-focused re-
search.
Centers for AIDS Research.—As part of the Ending the HIV Epi-
demic initiative, the Committee includes $61,000,000 for the Cen-
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ters for AIDS Research, an increase of $10,000,000 above the esti-
mated fiscal year 2020 enacted level and the same as the fiscal
year 2021 budget request. These Centers offer evidence-based prac-
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tices on prevention and treatment to initiative partners and sup-
port for evaluating the initiative.
Combating Antibiotic-Resistant Bacteria.—The Committee main-
tains funding for NIAID research related to combating antibiotic-
resistant bacteria. These funds enable NIAID to support research
on antimicrobial (drug) resistance, including basic research on how
microbes develop resistance, new and faster diagnostics, and clin-
ical trials designed to find new vaccines and treatments effective
against drug-resistant microbes.
Food Allergies.—The Committee recognizes the serious issue of
food allergies which affect approximately eight percent of children
and ten percent of adults in the U.S. The Committee commends the
ongoing work of NIAID in supporting a total of 17 clinical sites for
this critical research, including seven sites as part of the Consor-
tium of Food Allergy Research (CoFAR). The Committee strongly
encourages NIAID to expand support for the CoFAR.
Gonorrhea.—The Committee continues to be concerned about the
prevalence of gonorrhea, the 75 percent increase in the incidence
of this disease over the past eleven years, and the drug resistance
to multiple classes of antibiotics. The Committee commends NIAID
for its efforts in developing new antibiotics to combat the bacterium
that causes this disease and encourages NIAID to continue its
work toward better diagnosis, treatments, and cures for this STI.
Hepatitis B (HBV).—The Committee commends NIAID for its
leadership to develop the Trans-NIH Strategic Plan to Cure Hepa-
titis B and urges NIAID to issue targeted calls for research to im-
plement and fund the Strategic Plan. The Committee notes that in-
fection with HBV is a serious public health threat. One in 20
Americans have been infected with HBV, and more than two mil-
lion Americans are chronically infected, increasing by 70,000 a
year. In addition, HBV results in over 780,000 worldwide deaths
each year. To implement the Strategic Plan, the Committee encour-
ages NIAID to use contracts, program announcements, and re-
search resources initiatives to stimulate new research applications
and facilitate ongoing work. The Committee requests that NIAID
submit, within 90 days of enactment of this Act, an update to the
HBV Strategic plan focused on a cure for HBV in coordination with
the Trans-NIH Hepatitis B Working Group.
Hereditary Angioedema (HAE).—The Committee notes NIAID’s
meaningful progress in advancing research and diagnosis for pa-
tients who suffer from HAE caused by C1 inhibitor deficiency and
encourages NIAID to facilitate basic and clinical genetic and bio-
chemical research focused on understanding swelling in patients
with normal C1 inhibitor.
Inflammatory Disorders.—The Committee supports expanded re-
search into the treatment of inflammation. Inflammation is one of
the body’s major defense mechanisms in response to infection or in-
jury, but when it is uncontrolled, it causes inflammatory diseases
such as COPD, asthma, rheumatoid arthritis, inflammatory bowel
disease, otitis media, and cancer.
Lyme Disease Vaccine Development.—With an estimated 300,000
new cases of Lyme disease reported each year, the Committee en-
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courages NIAID to expand its research on tick-borne disease, in-
cluding prevention, diagnosis, and treatment. The Committee com-
mends the NIAID’s strategic plan for combating tick-borne illnesses
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to include vaccine development and encourages NIAID to focus its
attention on supporting the most promising Lyme disease vaccine
candidate clinical trials.
Microbicides.—The Committee recognizes that with NIH and
USAID leadership, research has shown the potential for
antiretroviral (ARV) drugs to prevent HIV infection in women. The
Committee encourages NIAID to continue coordination with
USAID, the State Department, and others to advance ARV-based
microbicide development efforts with the goal of enabling regu-
latory approval of the first safe and effective microbicide for women
and supporting an active ARV-based microbicide pipeline to
produce additional solutions to prevent HIV and help end the epi-
demic.
Pandemic Influenza.—T cell-mediated immunity plays a central
role in controlling viral infections. To create a universal influenza
vaccine, the Committee encourages NIAID to prioritize research to
facilitate the application of vaccines that induce strong cross-reac-
tive T cell responses as a complementary or alternative approach
to vaccines primarily designed to elicit an antibody response.
Syphilis.—The Committee continues to be concerned about the
increased cases of syphilis, the rise in congenital syphilis, and the
link between syphilis and transmitting HIV. The Committee com-
mends the NIAID for their work in this area and encourages accel-
eration in the development of screening tests, vaccines for preven-
tion, and new treatment options, for both adults and newborns, to
provide a fasts and efficient way to diagnose and define the stages
of this infection.
Tuberculosis.—The Committee encourages NIAID to continue to
support research on tuberculosis.
Universal Influenza Vaccine.—The Committee directs NIAID to
allocate at least $240,000,000, an increase of $40,000,000 over the
fiscal year 2020 level, to support basic, translational, and clinical
research to develop a universal influenza vaccine that provides ro-
bust, long-lasting protection against multiple subtypes of flu, rath-
er than a select few. Such a vaccine would eliminate the need to
update and administer the seasonal flu vaccine each year and could
provide protection against newly emerging flu strains, potentially
including those that could cause a flu pandemic. The Committee di-
rects NIAID to allocate the increase in funding to clinical research.
The Committee requests an update on these efforts within 60 days
of enactment of this Act.
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)
Appropriation, fiscal year 2020 ......................................................... $2,937,218,000
Budget request, fiscal year 2021 ....................................................... 2,672,074,000
Committee Recommendation ............................................................. 2,972,479,000
Change from enacted level ......................................................... +35,261,000
Change from budget request ...................................................... +300,405,000
Committee Recommendation (including Title VI) ........................... 3,161,491,000
Change from enacted level ......................................................... +224,273,000
Change from budget request ...................................................... +489,417,000
Mission.—NIGMS supports basic research that increases our un-
derstanding of biological processes and lays the foundation for ad-
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vances in disease diagnosis, treatment, and prevention.
Forecasting and Modeling Partnerships for Countering Infectious
Diseases.—The Committee believes that emerging viral threats
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such as COVID–19 highlight the need for innovative and real-time
forecasting and modeling techniques to ensure the U.S. is best posi-
tioned to respond to emerging public health threats. The Com-
mittee encourages NIGMS and the Fogarty International Center
(FIC) to continue to support emerging infectious disease forecasting
and modeling methods and monitoring data developed by univer-
sity and private partners. The Committee encourages NIGMS and
FIC to prioritize funding and explore partnerships to improve our
ability to respond to public health and national security threats
through emerging infectious disease modeling and forecasting.
Institutional Development Awards (IDeA).—The Committee pro-
vides $396,573,000 for IDeA, $10,000,000 above the fiscal year
2020 enacted level. IDeA supports high-quality research and inves-
tigators throughout the country in States in which the success rate
for NIH grants has been historically low.
Minority Access to Research Careers (MARC).—The Committee
includes continued support for the MARC Program, which provides
research training opportunities for underrepresented minority stu-
dents and faculty in biomedical and behavioral sciences relevant to
biomedicine, including mathematics and engineering.
Science Education Partnership Awards (SEPA).—The Committee
continues to support the SEPA program, which supports edu-
cational activities and workforce training for teachers to expand op-
portunities for students from underserved communities to consider
careers in basic or clinical research.
Small Business Technology Transfer (STTR) Regional Accelerator
Hubs.—The Committee remains concerned with the lower levels of
STTR funding in IDeA States compared to non-IDeA States. In re-
sponse to this discrepancy, NIGMS funded four STTR Regional Ac-
celerator Hubs to help build entrepreneurial cultures in IDeA
States through developing technology transfer networks, providing
entrepreneurial training, and leveraging resources. The Committee
continues to support this program and encourages NIGMS to pro-
vided funding at a lever sufficient for initial awards to be renewed.
EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH
AND HUMAN DEVELOPMENT (NICHD)
Appropriation, fiscal year 2020 ......................................................... $1,556,879,000
Budget request, fiscal year 2021 ....................................................... 1,416,366,000
Committee Recommendation ............................................................. 1,570,269,000
Change from enacted level ......................................................... +13,390,000
Change from budget request ...................................................... +153,903,000
Committee Recommendation (including Title VI) ........................... 1,670,455,000
Change from enacted level ......................................................... +113,576,000
Change from budget request ...................................................... +254,089,000
Mission.—NICHD investigates human development throughout
the entire life process, with a focus on understanding disabilities
and important events that occur during pregnancy.
Addressing Maternal Mortality Disparities.—The Committee en-
courages NICHD to continue its support of research into the lead-
ing causes of maternal morbidity and mortality. As Black women
experience maternal mortality at nearly four times the rate of
white women, the Committee strongly urges NICHD to support re-
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search that investigates factors contributing to this disparity, and
test evidence-based interventions to address this disparity. The
Committee also encourages NICHD to collaborate with the Na-
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tional Institute for Minority Health and Health Disparities
(NIMHD) as appropriate to develop targeted funding opportunities.
Congenital Syphilis (CS).—The Committee continues to be con-
cerned about the rise of congenital syphilis and the lifelong health
effects the disease can have on children. The Committee encour-
ages NICHD to prioritize research in this area and to work with
NIAID on new testing, diagnosis, and treatment efforts.
Endometriosis.—Endometriosis affects one in ten women, can
cause intense pain, and is a leading cause of infertility. Despite its
prevalence and health impact, there has been little investment in
research to better understand this condition. Such research could
lead to better health outcomes for millions of women. The Com-
mittee strongly encourages NICHD to significantly increase fund-
ing to expand basic, clinical, and translational research into the
mechanics of endometriosis, identify early diagnostic markers, and
develop new treatment methods.
Human Microbiome.—The Committee appreciates the NICHD
2020 strategic plan’s key research themes, including: (1) promoting
gynecologic, andrologic, and reproductive health, and (2) setting the
foundation for healthy pregnancies and lifelong wellness. The Com-
mittee commends NICHD’s partnership with the Office of the Di-
rector on the Human Microbiome Project, which has led to valuable
scientific discoveries related to women’s reproductive health and
pregnancy. The Committee urges continued focus on the human
microbiome and expanded investigation into the impact of the
microbiome of the female reproductive tract on women’s health and
pregnancy outcomes, including larger collaborative and inter-
disciplinary multi-omic projects cognizant of health disparities
among racial and ethnic populations.
Human Milk Research.—The Committee encourages NICHD to
expand its research on human milk, including by expanding the re-
search pipeline by supporting graduate and postdoctoral fellow-
ships in this area. In addition, the Committee encourages NICHD
to establish a research center network for human milk research to
facilitate support for shared resources and infrastructure for
human milk research.
Learning Disabilities Research.—The Committee is concerned
with the decline in achievement for students with disabilities and
recognizes the need for continued research and improved interven-
tions. The Committee recognizes the importance of NICHD’s fund-
ing of Learning Disabilities Research Centers and Learning Dis-
abilities Innovation Hubs, which are the only source of Federal
funding available to researchers interested in exploring child devel-
opment and learning disabilities to conduct randomized control
trials and explore the relationships between different variables at
work. While learning disabilities affect an individual’s education
and academic achievement, these disorders are brain-based, and
clinical research using the latest technology and advances in neuro-
science is essential. The Committee encourages NICHD to continue
its robust research into language, reading development, learning
disabilities, and disorders that adversely affect the development of
listening, speaking, reading, writing, and mathematics abilities.
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The Committee also encourages NICHD to increase its investment
in its Learning Disabilities Research Centers and Learning Disabil-
ities Innovation Hubs.
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Male Reproductive Health.—The Committee urges NICHD to
support research on male mechanisms of infertility. In fiscal year
2020, the Committee encouraged NICHD to support research on
male infertility and requests a report on progress in this area in
the fiscal year 2022 Congressional Justification. Due to the gap in
knowledge of how to diagnose and treat male infertility and abnor-
mal embryo development, the Committee reiterates its priority in-
terest. The Committee requests a report within 90 days of enact-
ment of this Act detailing NICHD’s existing collaborations and re-
search to identify new proteins and sperm structures that are nec-
essary for normal sperm foundation and, consequently, for fertility
and embryo development.
Maternal-Fetal Medicine Units (MFMU) Network.—The Com-
mittee supports the critical work of the MFMU Network in improv-
ing health outcomes for pregnant women and their babies.
Leveraging existing infrastructure to address maternal mortality
and severe maternal morbidity in the U.S. is critical. The Com-
mittee understands that NICHD is considering several models of
infrastructure for its networks and encourages NICHD to maintain
the features that made the MFMU Network successful and cost-ef-
fective, including the renewal process that maximizes efficiency
and ability to conduct multiple large trials with long term follow
up over many years. Such an infrastructure is essential for main-
taining a collective repository of knowledge and skills as well as a
stable foundation for data sharing and workforce development. The
Committee looks forward to reports about the process for restruc-
turing and final outcomes once a final decision has been made with
respect to the new infrastructure.
Maternal-Fetal Transmission of Lyme Disease.—The HHS Tick-
Borne Disease Working Group’s Clinical Aspects of Lyme Disease
Subcommittee January 2020 report includes ‘‘further evaluate po-
tential maternal-fetal transmission of Lyme disease and of con-
genital Lyme disease’’ as a recommended priority. The Committee
urges NIH to evaluate potential maternal-fetal transmission of
Lyme disease and congenital Lyme disease and issue requests for
proposals and funding opportunity announcements to stimulate re-
searcher interest in these areas. Within 180 days of enactment of
this Act, the Committee requests a report on NIH plans to address
the need for research on maternal-fetal transmission of B.
burgdorferi, congenital Lyme disease, and adverse outcomes in in-
fants and children from maternal transmission.
Maternal Mortality Research.—The Committee supports NIH ef-
forts to establish the Implementing a Maternal Health and Preg-
nancy Outcomes Vision for Everyone (IMPROVE) Initiative. The
initiative will use an integrated approach to understand biological,
behavioral, sociocultural, and structural factors that affect severe
maternal mortality and maternal mortality (SMM/MM) by building
an evidence base for improved care and outcomes in specific regions
of the country. IMPROVE will target health disparities associated
with SMM/MM by (1) implementing and evaluating community-
based interventions for disproportionately affected women (e.g., Af-
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rican American, American Indian/Alaska Native, advanced mater-
nal age, low socioeconomic status, and rural populations), and (2)
identifying risk factors and the underlying biological mechanisms
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associated with leading causes of SMM/MM, including cardio-
vascular disease, infection and immunity, and mental health.
Participation of Pregnant and Lactating Individuals in COVID–
19 Research.—The Committee directs NICHD, within 90 days of
enactment of this Act, to submit a report to the Committee describ-
ing the specific steps being taken to ensure racially, ethnically, and
geographically diverse participation in studies conducted to under-
stand the effects of COVID–19 on pregnant and lactating individ-
uals.
Polycystic Ovary Syndrome (PCOS).—PCOS affects up to 15 per-
cent of women and has metabolic, reproductive, mental, and mater-
nal/child health manifestations. PCOS is the most common endo-
crine disorder in women and is a significant risk factor for high
blood pressure, sleep disorders, heart disease, pregnancy-induced
hypertension, preeclampsia, cholesterol disorders, and other dis-
orders that impact cardiovascular and metabolic health. The Com-
mittee encourages NICHD to partner with NHLBI to promote re-
search in PCOS, particularly with a focus on comorbidities associ-
ated with PCOS that impact heart, blood, lung, sleep, and mater-
nal/fetal health as they contribute to negative health outcomes. The
Committee also encourages NHLBI to report on research that has
been conducted on PCOS and its impact on cardiovascular health
to date in the fiscal year 2022 Congressional Justification.
Population Research.—The Committee recognizes NICHD for
supporting innovative population research and research training
programs, longitudinal surveys, and research on the social deter-
minants of health and on the development of low-cost data
archiving, data curation, and data sharing strategies that both pro-
tect survey participants and provide unparalleled access for re-
searchers. The Committee encourages NICHD to highlight these
strategies as it works with NIH leadership to implement its data
sharing and management policy. Further, the Committee urges
NICHD to continue supporting large-scale data collection activities,
especially prospective, population-representative longitudinal stud-
ies, and to continue its leadership in supporting research on the so-
cial determinants of health, morbidity, and mortality across the
lifespan, including maternal and infant health.
Premature Birth Research.—The Committee supports NIH’s ef-
forts to expand neonatal research to improve the treatment and
health outcomes of premature babies and explore ways to support
multi-site clinical trials in pregnancy and lactation, which will lay
the foundation for optimal clinical care for these infants.
Research in Pregnant and Lactating Women.—The Committee is
pleased with the progress being made by the Task Force on Re-
search Specific to Pregnant Women and Lactating Women in iden-
tifying and developing strategies to address gaps in knowledge and
research on safe and effective therapies for pregnant and lactating
women to carry out the recommendations in its 2018 report. The
Committee directs NICHD to provide the Task Force’s rec-
ommendations to the Committee within 60 days of enactment of
this Act. The Committee also directs NICHD, along with other rel-
evant NIH Institutes and Centers, CDC, FDA, and other relevant
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agencies, to prepare to implement these recommendations to the
extent appropriate and feasible under the legal authorities avail-
able to the Secretary. Finally, the Committee directs NICHD, in
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conjunction with the Secretary, to report back to the Committee on
the feasibility of implementing these policies and any additional
authorizations or appropriations required in the fiscal year 2022
Congressional Justification.
Strategic Plan.—The Committee has reviewed NICHD’s 2020
Strategic Plan and believes that there is insufficient focus on be-
havioral health, cognition, development of young children, lan-
guage, learning differences, and school readiness. NICHD has long
history of funding critical and meritorious work in these areas. The
Committee encourages NICHD to consider otherwise qualified
grants in these areas on the same basis as any other areas of focus
as it works to implement its strategic plan.
NATIONAL EYE INSTITUTE (NEI)
Appropriation, fiscal year 2020 ......................................................... $824,090,000
Budget request, fiscal year 2021 ....................................................... 749,003,000
Committee Recommendation ............................................................. 831,177,000
Change from enacted level ......................................................... +7,087,000
Change from budget request ...................................................... +82,174,000
Committee Recommendation (including Title VI) ........................... 884,208,000
Change from enacted level ......................................................... +60,118,000
Change from budget request ...................................................... +135,205,000
Mission.—NEI conducts and supports basic and clinical research,
research training, and other programs with respect to blinding eye
diseases, visual disorders, and mechanisms of visual function, pres-
ervation of sight, and the special health problems and needs of in-
dividuals who are visually-impaired or blind.
Academic and Non-Profit Institutional Research Using Human
Ocular Tissue from Not-for-Profit Eye Banks.—Macular degenera-
tion is the leading cause of blindness and impacts some 15 million
people in the U.S., with an estimated 200,000 new cases annually.
The Committee is aware that, due to the high cost of human ocular
tissue, many academic researchers resort to using animal tissue
when studying diseases and conditions of the eye. This is problem-
atic as animal tissue is not a perfect equivalent to human tissue,
and certain diseases, such as macular degeneration, are not
present in animal tissue. The Committee encourages NEI to con-
sider establishing an ocular tissue program to achieve cost savings
and facilitate critical ocular research utilizing tissue provided by
non-profit organizations to academic and other not-for-profit re-
search entities. Such a program could facilitate critical research to
eradicate the debilitating impact of macular degeneration and
other ocular disorders.
Blepharospasm.—The Committee continues to encourage NEI to
pursue collaboration with stakeholders on cross-cutting research
opportunities that affect all forms of dystonia, including
blepharospasm. The Committee notes the opportunity to collabo-
rate with NINDS and NIDCD from the 2018 dystonia conference
and encourages all three Institutes to work together to advance
critical research.
Eye Bonds.—The Committee recognizes the monumental strides
being made in medical research, but is also concerned about the
growing need to fund translational research in what is known as
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the valley of death, that area between basic science and the devel-
opment of a patient-ready product. Eye disease in America is one
such challenge with significant human and economic consequences.
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In America, 4.24 million adults are blind or have vision impair-
ment, and among working-age blind adults, 70.5 percent are not
employed full-time. The economic burden of eye diseases is esti-
mated to be $138 billion a year. The Committee encourages NEI to
work with other Institutes and Centers, other agencies within
HHS, and stakeholder organizations to examine novel methods to
fund translational research and bridge the valley of death.
Macular Degeneration.—The Committee is concerned with ad-
vanced age-related macular degeneration as the leading cause of ir-
reversible blindness and vision impairment globally. At least 11
million people in the U.S. have some form of macular degeneration
and that number is expected to double to 22 million by 2050. The
Committee encourages NIH to fund research that will stem the
growth of macular degeneration and requests an update on current
research and future initiatives in the fiscal year 2022 Congres-
sional Justification.
Vision Research.—The number of Americans with visual impair-
ment or blindness is expected to double to more than 8 million by
2050. The Committee recognizes NEI’s research to advance the un-
derstanding of the causes of these afflictions and potential treat-
ments and encourages NEI to expand these research activities.
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)
Appropriation, fiscal year 2020 ......................................................... $802,598,000
Budget request, fiscal year 2021 ....................................................... 730,147,000
Committee Recommendation ............................................................. 809,501,000
Change from enacted level ......................................................... +6,903,000
Change from budget request ...................................................... +79,354,000
Committee Recommendation (including Title VI) ........................... 861,149,000
Change from enacted level ......................................................... +58,551,000
Change from budget request ...................................................... +131,002,000
Mission.—NIEHS’s mission is to discover how the environment
affects people in order to promote healthier lives.
Air Pollution and Asthma.—The Committee notes with concern
the evidence suggesting a causal link between air pollution and the
development of asthma. The Committee urges NIEHS to explore
this potential causal link and any interventions necessary to pre-
vent the development of asthma.
Harmful Algal Blooms Human Health Effects Research.—The
Committee recognizes the value of the NIEHS mission and the
NIEHS–NSF jointly-funded Oceans and Human Health Program as
a means to increase scientific knowledge about short-term and
long-term human health effects associated with acute and chronic
exposures to toxins produced by harmful algal blooms (HABs). The
Committee recognizes the increasing relevance of this scientific re-
search to communities directly affected by HABs, including in Flor-
ida, where one of the longest documented HABs in the State’s his-
tory occurred from late 2017 through early 2019. The Committee
encourages NIEHS to continue investing in this research area
using its competitive, peer-reviewed grantmaking processes. In par-
ticular, the Committee notes growing scientific interest in further
investigating respiratory irritation and illness associated with in-
halation of aerosolized HAB toxins and neurotoxic shellfish poi-
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soning arising from ingestion of contaminated seafood. The Com-
mittee commends NIEHS for its collaborations with other agencies,
including the National Science Foundation (NSF), National Oceanic
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