House Report 117-403 — Departments of Labor, Health and Human Services, and Education Appropriations
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Report 117-403 of the 117th Congress, 2d Session, dated July 5, 2022, of the Committee on Appropriations on H.R. 8295, the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Bill, 2023, together with minority views. A passage near page 120 on Harmful Algal Blooms (HABs) Human Health Effects Research says blooms are occurring with increasing frequency and severity across the country and that long-term effects of exposure on human health are not known. Surrounding text calls for research on conditions such as infectious disease, injury and trauma, asthma and mental health.
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“House Report 117-403 — Departments of Labor, Health and Human Services, and Education Appropriations.”
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1
117TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
2d Session 117–403
DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS
BILL, 2023
R E P O R T
OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
together with
MINORITY VIEWS
[TO ACCOMPANY H.R. 8295]
JULY 5, 2022.—Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
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117TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
2d Session 117–403
DEPARTMENTS OF LABOR, HEALTH AND
HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS
BILL, 2023
R E P O R T
OF THE
COMMITTEE ON APPROPRIATIONS
HOUSE OF REPRESENTATIVES
together with
MINORITY VIEWS
[TO ACCOMPANY H.R. 8295]
JULY 5, 2022.—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
47–923 WASHINGTON : 2022
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117TH CONGRESS REPORT
" HOUSE OF REPRESENTATIVES !
2d Session 117–403
DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERV-
ICES, AND EDUCATION, AND RELATED AGENCIES AP-
PROPRIATIONS BILL, 2023
JULY 5, 2022.—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. 8295]
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, 2023, and for other purposes.
INDEX TO BILL AND REPORT
Page number
Bill Report
Summary of Estimates and Appropriation .............................................. 1 3
General Summary of the Bill .................................................................... 1 3
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47–423
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Page number
Bill Report
Title I—Department of Labor: 2 11
Employment and Training Administration ....................................... 2 11
Employee Benefits Security Administration ..................................... 22 23
Pension Benefit Guaranty Corporation ............................................. 23 24
Wage and Hour Division .................................................................... 24 24
Office of Labor-Management Standards ........................................... 24 26
Office of Federal Contract Compliance Programs ............................ 25 26
Office of Workers’ Compensation Programs ..................................... 25 27
Occupational Safety and Health Administration ............................. 29 29
Mine Safety and Health Administration ........................................... 30 32
Bureau of Labor Statistics ................................................................. 32 33
Office of Disability Employment Policy ............................................. 32 34
Departmental Management ............................................................... 33 35
General Provisions .............................................................................. 38 41
Title II—Department of Health and Human Services: 48 42
Health Resources and Services Administration ............................... 48 42
Centers for Disease Control and Prevention .................................... 58 70
National Institutes of Health ............................................................. 66 95
Substance Use And Mental Health Services Administration .......... 74 158
Agency for Healthcare Research and Quality ................................... 81 176
Centers for Medicare & Medicaid Services ....................................... 81 178
Administration for Children and Families ........................................ 85 196
Administration for Community Living .............................................. 97 212
Office of the Secretary ........................................................................ 100 218
Public Health and Social Services Emergency Fund ................ 104 235
Advanced Research Projects Agency for Health ........................ 105 242
General Provisions .............................................................................. 106 242
Title III—Department of Education: 145 246
Education for the Disadvantaged ...................................................... 145 246
Impact Aid ........................................................................................... 147 251
School Improvement Programs .......................................................... 148 252
Indian Education ................................................................................. 150 257
Innovation and Improvement ............................................................. 150 258
Safe Schools and Citizenship Education ........................................... 151 265
English Language Acquisition ........................................................... 152 268
Special Education ................................................................................ 152 269
Rehabilitation Services ....................................................................... 158 272
Special Institutions for Persons with Disabilities ............................ 159 274
Career, Technical and Adult Education ............................................ 159 275
Student Financial Assistance ............................................................. 160 277
Federal Direct Student Loan Program Account ............................... 279
Student Aid Administration ............................................................... 161 280
Higher Education ................................................................................ 162 283
Howard University .............................................................................. 163 295
College Housing and Academic Facilities Loans .............................. 163 296
Historically Black College and University Capital Financing Pro-
gram Account ................................................................................... 164 296
Institute of Education Sciences .......................................................... 164 296
Departmental Management ............................................................... 165 300
General Provisions .............................................................................. 166 303
Title IV—Related Agencies: 176 305
Committee for the Purchase from People Who Are Blind or Se-
verely Disabled ................................................................................ 176 305
Corporation for National and Community Service ........................... 177 305
Corporation for Public Broadcasting ................................................. 183 309
Federal Mediation and Conciliation Service ..................................... 184 310
Federal Mine Safety and Health Review Commission ..................... 185 310
Institute of Museum and Library Services ....................................... 186 311
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Medicare Payment Advisory Commission ......................................... 186 312
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Page number
Bill Report
Medicaid and CHIP Payment and Access Commission ................... 186 313
National Council on Disability ........................................................... 186 313
National Labor Relations Board ........................................................ 187 313
National Mediation Board .................................................................. 187 313
Occupational Safety and Health Review Commission ..................... 187 314
Railroad Retirement Board ................................................................ 187 314
Social Security Administration .......................................................... 189 315
Title V—General Provisions: 195 320
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 2023, the budget request
for fiscal year 2023, and the Committee recommendation for fiscal
year 2023 in the accompanying bill.
2023 LABOR, HHS, EDUCATION BILL
[Discretionary funding in thousands of dollars]
Fiscal Year— 2023 Committee compared to—
Budget Activity 2022 2023 2023 2022 2023
Enacted Budget Committee Enacted Budget
Department of Labor ......................... $13,189,218 $14,900,363 $15,030,743 +$1,841,525 +$130,380
Department of Health and Human
Services ......................................... 108,625,224 123,894,211 124,218,951 +15,593,727 +324,740
Department of Education .................. 76,424,255 88,326,976 86,717,384 +10,293,129 ¥1,609,592
Related Agencies ............................... 15,906,903 17,656,312 17,288,922 +1,382,019 ¥367,390
GENERAL SUMMARY OF THE BILL
For fiscal year 2023, the Committee recommends a total of
$224,399,000,000 in current year discretionary funding—the 302(b)
allocation—and $242,105,000,000 in overall programmatic funding,
including offsets and adjustments. The fiscal year 2023 rec-
ommendation is an increase of $28,536,000,000 above the fiscal
year 2022 enacted level.
The Labor-HHS-Education bill supports some of the nation’s
most critical programs that touch individuals and families through-
out their lifespan, from Early Head Start to Social Security.
Through this bill, the Committee continues to build on progress
from the fiscal year 2022 Consolidated Appropriations Act, such as
significant investments in education, including strong funding in-
creases for schools serving students in low-income communities and
students with disabilities, as well as programs to expand access to
post-secondary education.
The fiscal year 2023 Labor-HHS-Education bill continues to build
on investments in public health, including flexible resources for
State and local governments to strengthen core public health infra-
structure and capacity. And the bill continues to build on progress
in biomedical research—following a 50 percent increase in funding
for the National Institutes of Health over the past seven years—
and expands the subcommittee’s investment in the Advanced Re-
search Projects Agency for Health (ARPA–H), which was estab-
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lished in fiscal year 2022, to accelerate the pace of scientific break-
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throughs that have the potential to transform health care and ad-
dress our most complex health challenges.
The bill continues to address our nation’s most urgent health cri-
ses, including maternal health, mental health, gun violence, and
substance misuse, while making strides to reduce persistent and
unacceptable health disparities.
And the Committee invests in workforce training and worker
protection agencies, including significant new investments to re-
build capacity to enforce federal labor laws to protect workers’ pay-
checks, benefits, and ensure the health and safety of our work-
places. The Committee also makes a major commitment to retired
workers by including an increase of $1,100,000,000 for the Social
Security Administration’s operating expenses, which will restore
federal capacity to provide earned benefits and services through So-
cial Security, one of the cornerstones of the federal safety net.
Some of the most notable initiatives in fiscal year 2023 include:
Elementary and Secondary Education
The Committee is committed to increasing investments in core
Federal programs that support high-quality public education oppor-
tunities for all students. Our nation’s public schools serve more
than 50 million children, more than 50 percent of whom come from
low-income families. Research shows that low-income students are
more likely to struggle academically and often attend high-need
schools with fewer resources, less experienced teachers, and more
limited access to advanced coursework. At the same time, there is
overwhelming empirical evidence on education spending and stu-
dent outcomes that finds more funding in schools yields statis-
tically significant positive results for students.
Overall, the Committee recommendation provides
$50,918,030,000 for Federal K–12 education programs, including
the Individuals with Disabilities Education Act (IDEA), an increase
of $8,333,798,000 over the fiscal year 2022 enacted level. The rec-
ommendation is a 20 percent increase over last year.
In particular, the Committee recommends an additional
$3,000,000,000 over the fiscal year 2022 enacted level for Title I
Grants to Local Educational Agencies for a total of
$20,536,802,000. Title I serves an estimated 25 million students in
nearly 90 percent of school districts and nearly 60 percent of all
public schools.
The Committee recommends $1,000,000,000 for the English Lan-
guage Acquisition program, which provides formula grants to
States to serve English Leaners (EL), an increase of $168,600,000
over the fiscal year 2022 enacted level. Federal data shows that
significant achievement gaps exist between ELs and their peers. At
the same time, many States and school districts have experienced
rapid growth in their EL populations. Providing increased re-
sources to improve educational quality for EL students is a top pri-
ority for the Committee.
The Committee recommends $16,259,193,000 for IDEA Part B
Grants to States, which is $2,915,489,000 above the fiscal year
2022 enacted level. The Committee is concerned that the Federal
share of the excess cost of educating students with disabilities has
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declined and notes the critical role this increase will play in help-
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5
ing to reverse this trend and serve as a significant step toward
fully funding IDEA.
Early Childhood Education
The Committee includes nearly $20,000,000,000 for early child-
hood education programs through the Child Care and Development
Block Grant (CCDBG), Head Start, and Preschool Development
Grants—an increase of $2,420,000,000 over the fiscal year 2022 en-
acted level.
The Committee recognizes that child care and early learning in-
vestments are essential for children and working families, and in-
cludes a $1,000,000,000 increase for the CCDBG program. This
funding will provide critical support to families by providing afford-
able, high quality child care to more children, providing opportuni-
ties for more parents to remain in or return to the workforce, and
supporting the child care workforce, which is primarily made up of
women, and particularly women of color.
The bill includes an increase of $1,360,000,000 for Head Start,
including a $596,000,000 cost-of-living adjustment for the Head
Start workforce, $262,000,000 in flexible, quality improvement
funding for program-specific needs, and $500,000,000 to expand
Head Start, Early Head Start, and Early Head Start-Child Care
Partnerships to approximately 30,000 additional infants and tod-
dlers from low-income families.
The Committee further recommends $350,000,000, an increase of
$60,000,000, for Preschool Development Grants to build State and
local capacity to provide early childhood care and education for
children birth through five from low- and moderate-income fami-
lies.
Higher Education
In the aftermath of the COVID–19 pandemic, college afford-
ability and access are vital to our nation’s recovery efforts. There-
fore, the Committee recommendation makes necessary investments
in programs supporting student financial aid, student support serv-
ices, and other programs supporting institutions of higher edu-
cation and their students.
The recommendation includes sufficient funding to support an in-
crease in the maximum Pell Grant by $500 over the fiscal year
2022 enacted level, from $6,895 to $7,395. In addition, the Com-
mittee recommendation provides $1,243,882,000 for Federal Work
Study, an increase of $33,882,000 over the fiscal year 2022 enacted
level. The Committee recommendation also includes $920,000,000
for the Federal Supplemental Educational Opportunity Grants, an
increase of $25,000,000 over the fiscal year 2022 enacted level.
The Committee recommendation includes $1,297,761,000 for the
TRIO programs, an increase of $160,761,000 over the fiscal year
2022 enacted level. The recommendation also includes
$408,000,000 for the Gaining Early Awareness and Readiness for
Undergraduate Programs, which is $30,000,000 more than the fis-
cal year 2022 enacted level.
In an effort to assist postsecondary institutions in addressing
barriers in completion and attainment, the Committee rec-
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ommendation includes a total of $1,110,117,000 for programs that
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serve high proportions of students of color (Historically Black Col-
leges and Universities, Hispanic-Serving Institutions, Tribal Col-
leges and Universities, and other Minority Serving Institutions), an
increase of $225,000,001 over the fiscal year 2022 enacted level.
The Committee also includes robust funding to support teacher
preparation. The recommendation includes $30,000,000 in funding
for the Augustus F. Hawkins Centers of Excellence program, an in-
crease of $22,000,000 over the fiscal year 2022 enacted level, and
the recommendation includes $132,092,000 for the Teacher Quality
Partnerships program, an increase of $73,000,000 over the fiscal
year 2022 enacted level.
Public Health
Public health can no longer only get attention during a crisis.
The Committee recognizes that State, local, territorial, and Federal
public health partners need a long-term strategy and long-term in-
vestments, beginning at CDC. The bill includes approximately
$10,500,000,000 for CDC, an increase of more than $2,000,000,000.
Half of the increase included in the bill is directed to core capac-
ities, as CDC’s budget must be rebalanced between disease- or con-
dition-specific activities and fundamental activities that support
the nation’s public health ecosystem. Building on funding initially
provided in fiscal year 2022, the bill includes an increase of
$550,000,000 for public health infrastructure to turn the tide on
the nation’s public health capacity by providing a stable source of
disease-agnostic funding so the nation’s State, local, territorial, and
Federal public health agencies will be better equipped to coordinate
together to save lives.
This bill also includes core capacity increases of: $45,000,000 for
Public Health Workforce and Career Development to invest in es-
sential public health workers who protect our communities and are
empowered by science; $150,000,000 for Public Health Data Mod-
ernization to advance the transformation of the collection and utili-
zation of public health data from retrospective reporting to driving
action in real time; $10,000,000 to advance laboratory science and
safety so CDC is capable of meeting evolving health threats and
maintaining the highest standards; $10,000,000 for the National
Center for Health Statistics to initiate investments in the next gen-
eration of surveys; $100,000,000 for Global Public Health Protec-
tion to modernize and expand disease surveillance and response ca-
pabilities to strengthen global health security; and $50,000,000 for
the Center for Forecasting and Outbreak Analytics to improve pre-
paredness and response.
Biomedical Research through NIH and ARPA–H
The Committee has increased NIH funding by nearly
$15,000,000,000, or 49 percent, over the past seven years, under
both Democratic and Republican leadership. The Committee con-
tinues and accelerates this investment by providing
$47,459,000,000, an increase of $2,500,000,000 above the fiscal
year 2022 enacted level for NIH research and activities.
The Committee continues its ongoing support for key NIH initia-
tives, such as the Cancer Moonshot, BRAIN Initiative, and the All
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of Us Precision Medicine Initiative. The bill also includes sufficient
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funding to provide an across-the-board increase of at least 3.2 per-
cent for NIH Institutes and Centers. The Committee remains con-
cerned that targeted funding for specific research initiatives in re-
cent years has slowed the growth in other areas of basic research
that may lead to unforeseeable scientific breakthroughs.
The Committee also established the Advanced Projects Research
Agency for Health (ARPA–H) in fiscal year 2022. Modeled after the
Defense Advanced Research Project Agency (DARPA), ARPA–H
will invest in large high-risk, high-reward research projects that
have the potential to achieve breakthroughs in the treatment of
diseases such as cancer, Alzheimer’s disease, diabetes, amyotrophic
lateral sclerosis (ALS), and others that impact the lives of millions
of Americans and exacerbate existing health disparities. The Com-
mittee provides $2,750,000,000 for ARPA–H in fiscal year 2023, an
increase of $1,750,000,000 above the fiscal year 2022 enacted level,
to accelerate these critical research projects.
Mental and Behavioral Health
The COVID–19 pandemic exacerbated existing mental health
and substance use disorder crises, with more people reporting in-
creased levels of anxiety, depression, suicidal ideation, and sub-
stance use. In particular, more than a third of high school students
reported experiencing poor mental health during the COVID–19
pandemic. Suicide continues to be a leading cause of death, taking
more than 45,000 lives in 2020, and is the second leading cause of
death among youth between the ages of 10 and 14. Drug overdose
deaths have also continued to increase with CDC estimating more
than 107,000 drug overdose deaths in the United States during
2021, an increase of nearly 15 percent from 2020, according to pro-
visional data.
The Committee recommendation includes $9,170,380,000 for the
Substance Use And Mental Health Services Administration
(SAMHSA), making a range of investments across the behavioral
health continuum to support prevention, screening, treatment, and
other services. The Committee includes a total increase of
$1,726,062,000 for mental health activities. This includes an in-
crease of $500,000,000 for the Mental Health Block Grant and an
increase of $85,000,000 for Certified Community Behavioral Health
Clinics. In addition, the Committee includes a significant increase
of $640,280,000 for the new three-digit 988 program, including the
National Suicide Prevention Lifeline and behavioral health crisis
response infrastructure, which is scheduled for rollout in July 2022.
The bill also increases the mental health crisis set-aside to ten per-
cent and creates a new set-aside for prevention and early interven-
tion.
The Committee includes $60,000,000, an increase of $50,000,000
over the fiscal year 2022 enacted level, for the second year of the
Mental Health Crisis Response Grant program, to help commu-
nities continue to create mobile crisis response teams that divert
the response for mental health crises from law enforcement to be-
havioral health teams.
The bill supports children’s mental health with a $68,113,000 in-
crease to the National Child Traumatic Stress Initiative, a
$20,000,000 increase for Infant and Early Childhood Mental
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Health, and an additional $100,000,000 for Children’s Mental
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Health services, including a new pilot program to address the im-
pact of violence in communities of color.
The Committee includes a total increase of $871,452,000 for sub-
stance use treatment activities. This includes an increase of
$500,000,000 for the Substance Use Prevention and Treatment
Block Grant and an increase of $250,000,000 for State Opioid Re-
sponse Grants. The bill creates a new set-aside within the block
grant to support recovery services. The Committee recommendation
also includes an increase of $30,215,000 for substance use preven-
tion services and activities.
The bill also includes a significant investment in recruiting and
training mental and behavioral health professionals to expand ac-
cess to quality mental health and substance use disorder treatment
services to areas and populations most in need, including an in-
crease of $62,000,000 for HRSA’s Behavioral Health Workforce
Education and Training activities.
Maternal Health
To help eliminate race-based disparities and drive down the rate
of maternal mortality, the bill provides an increase of $60,000,000
for CDC’s Safe Motherhood and Infant Health programs. This fund-
ing allows for the expansion of Maternal Mortality Review Commit-
tees and Perinatal Quality Collaboratives, and for increased sup-
port to current States and territories, as well as increased support
for other programs including Sudden Unexplained Infant Death.
The bill provides an increase of $120,000,000 for HRSA’s Maternal
and Child Health Services Block Grant, which includes invest-
ments in projects such as an increase of $10,000,000 for State Ma-
ternal Health Innovation Grants, an increase of $3,300,000 to ex-
pand the Alliance for Innovation in Maternal Health Safety Bun-
dles to more States, and an increase of $3,000,000 to support and
expand availability of the Maternal Mental Health Hotline. The bill
also provides $30,000,000 to recruit and train midwives and doulas
and an increase of $5,000,000 for Screening and Treatment for Ma-
ternal Depression and Related Disorders.
HIV Initiative
Advances in medications for the prevention and treatment of
HIV, improved diagnostic tests, and new outbreak detection tech-
nology provide a unique opportunity to alter the trajectory of HIV
infection rates in the U.S. with a goal of eliminating new HIV in-
fections. This bill provides a total of $738,000,000, which is an in-
crease of $225,000,000 for the fourth year of the Ending the HIV
Epidemic Initiative, which began a new era of moving the U.S.
from HIV prevention to HIV epidemic control.
Firearm Injury and Mortality Prevention Research
Firearm injury and mortality is among the leading causes of
death for people aged 1–64 in the U.S. In 2019, there were nearly
40,000 firearm-related deaths in the U.S. Addressing the gaps in
knowledge around this issue and identifying effective prevention
strategies are needed steps toward keeping people, families,
schools, and communities safe from firearm injury. In fiscal year
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2020, the Committee provided the first funding in more than two
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9
decades to address the public health emergency of firearm violence
with a total of $25,000,000 to CDC and NIH. This bill more than
doubles the total funding to $60,000,000 to support research to
identify the most effective ways to prevent firearm related injuries
and deaths, and to broaden firearm injury data collection. Building
on these efforts to address firearm injury and death, this bill also
includes $100,000,000 for a new evidence-based community vio-
lence intervention initiative at CDC, which aims to prevent inten-
tional violence, such as mass casualty violence or gang violence.
Employment and Training
The economy and the labor market have seen significant gains
since the economic recession resulting from the COVID–19 pan-
demic. The U.S. economy has added 6.5 million jobs over the past
year and the unemployment rate, which peaked at 14.7 percent two
years ago, is now down to 3.6 percent. Despite the strong labor
market, however, economic opportunity remains hard to reach for
millions in communities around the country. The unemployment
rate for Black and Hispanic workers remains considerably higher
than that of the overall population, and far too many women have
been pushed out of the workforce or forced to consider new employ-
ment over the last two years. We must prioritize our workers and
their wages as the nation emerges from the COVID–19 pandemic.
As such, the Committee recommendation includes needed invest-
ments in workforce and training systems. Specifically, the rec-
ommendation includes $3,135,332,000 for Workforce Innovation
and Opportunity Act Grants to States, an increase of $256,000,000
above the fiscal year 2022 enacted level and $116,230,000 above
the fiscal year 2023 budget request. In addition, the recommenda-
tion includes $303,000,000 for registered apprenticeships, an in-
crease of $68,000,000 above the fiscal year 2022 enacted level and
the same as the fiscal year 2023 budget request.
The recommendation also includes $100,000,000 for the
Strengthening Community Colleges Training Grant program, an in-
crease of $50,000,000 above the fiscal year 2022 enacted level and
equal to the fiscal year 2023 budget request. This program helps
community colleges build capacity for training workers. The rec-
ommendation includes $50,000,000 for a new grant program to sup-
port communities suffering dislocations related to changes in fossil
fuel and other energy industries.
The recommendation also includes $3,184,635,000 for Unemploy-
ment Compensation State Operations, an increase of $333,819,000
over the fiscal year 2022 enacted level and the same as the fiscal
year 2023 budget request. This funding will help support States in
overcoming challenges associated with administering unemploy-
ment insurance programs. Altogether, these investments will con-
tinue to support families with the economic consequences of
COVID–19 and prepare workers for new employment opportunities.
Worker Protection Agencies
The Committee recommends $2,179,524,000 for Department of
Labor agencies responsible for worker protection and worker rights.
This is an increase of $346,589,000 over the fiscal year 2022 en-
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acted level.
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The Wage and Hour Division employs fewer investigators today
than it did 75 years ago, despite the workforce having grown sig-
nificantly in that time. To help make up for this lost ground, hold
bad-acting employers accountable, and defend working people so
they receive the pay they earned and are legally entitled to, the
Committee recommendation includes $312,678,000, an increase of
$61,678,000 over the fiscal year 2022 enacted level and an increase
of $5,000,000 over the fiscal year 2023 budget request.
The Occupational Safety and Health Administration (OSHA) en-
forcement of safety and health laws is critical to preventing work-
place tragedies from occurring, which is why it is concerning that,
under current staffing levels, the agency would need more than 150
years to inspect each workplace under its jurisdiction. To restore
OSHA’s enforcement capacity, the Committee includes
$712,015,000, an increase of $100,000,000 over the fiscal year 2022
enacted level and $10,610,000 over the fiscal year 2023 budget re-
quest for this critical worker protection agency.
The Committee also recommends $319,424,000 for the National
Labor Relations Board, an increase of $45,200,000 over the fiscal
year 2022 enacted level and the same as the fiscal year 2022 budg-
et request. This increase will restore the NLRB’s capacity to pro-
tect workers’ rights to union representation and collective bar-
gaining.
POLICY HEARINGS
The Committee continued to fulfill its responsibility to conduct
oversight of programs under its jurisdiction by holding nine sub-
committee hearings—including four budget hearings and three pol-
icy hearings, as well as subcommittee hearings to take testimony
from Members of Congress and public witnesses.
Social and Emotional Learning and Whole Child Approaches in K–
12 Education
The Subcommittee held a hearing on ‘‘Social and Emotional
Learning (SEL) and Whole Child Approaches in K–12 Education,’’
during which the Subcommittee heard from a panel of national ex-
perts on the robust evidence of effectiveness for whole child inter-
ventions, including SEL. The Subcommittee focused on how high-
quality SEL programs that support students’ social, emotional, and
cognitive development result in lasting positive academic and life
outcomes. In addition, the Subcommittee explored how dedicated
Federal resources for these approaches are vital to expanding their
reach nationwide.
Healthy Aging: Maximizing the Independence, Well-Being, and
Health of Older Adults
The Subcommittee held a hearing to discuss some of the top
health issues facing seniors, with a particular focus on the impor-
tance of senior nutrition, elder justice, mental health, and falls pre-
vention programs. The Subcommittee recognizes that the country’s
senior population is growing, and that the Labor, Health and
Human Services, Education, and Related Agencies bill funds sev-
eral key agencies, including the Administration for Community
Living (ACL), CDC, and SAMHSA, that provide direct services to
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support seniors’ independence, health, and overall well-being. The
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Committee heard from four aging experts about some of the most
significant challenges to healthy aging, and the need for specialized
prevention, treatment, and support services to support seniors’
physical and mental well-being.
Tackling Teacher Shortages
The Subcommittee held a hearing on ‘‘Tackling Teacher Short-
ages,’’ during which the Subcommittee heard from a panel of na-
tional experts on the scope and severity of nationwide teacher
shortages. The Subcommittee discussed root causes of teacher
shortages and explored acute challenges with the retention and re-
cruitment of educators of color and special educators. In addition,
the Subcommittee identified strategies to help rebuild educator
pipelines and address shortages and highlight needed investments
in programs funded in this bill that support educator pipelines and
address challenges related to recruitment and retention.
TITLE I—DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING ADMINISTRATION
Appropriation, fiscal year 2022 ......................................................... $10,481,739,000
Budget request, fiscal year 2023 ....................................................... 11,570,169,000
Committee Recommendation ............................................................. 11,763,847,000
Change from enacted level ......................................................... +1,282,108,000
Change from budget request ...................................................... +193,678,000
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 2022 ......................................................... $3,912,338,000
Budget request, fiscal year 2023 ....................................................... 4,410,999,000
Committee Recommendation ............................................................. 4,597,632,000
Change from enacted level ......................................................... +685,294,000
Change from budget request ...................................................... +186,633,000
Training and Employment Services provides funding for Federal
job training programs authorized primarily by the Workforce Inno-
vation and Opportunity Act of 2014 (WIOA).
Adult Employment and Training Activities.—For Adult Employ-
ment and Training Activities, the Committee recommends
$940,649,000, which is $70,000,000 more than the fiscal year 2022
enacted level and $40,662,000 more than the fiscal year 2023 budg-
et request.
Youth Employment and Training Activities.—For Youth Employ-
ment and Training Activities, the Committee recommends
$1,033,130,000, which is $100,000,000 more than the fiscal year
2022 enacted level and $69,293,000 more than the fiscal year 2023
budget request.
Dislocated Worker Employment and Training Activities.—For
Dislocated Worker Employment and Training Activities, the Com-
mittee recommends $1,161,553,000, which is $86,000,000 more
than the fiscal year 2022 enacted level and $6,275,000 more than
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the fiscal year 2023 budget request.
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Dislocated Worker Assistance National Reserve.—The Committee
recommends $457,386,000 for the Dislocated Workers National Re-
serve, an increase of $156,527,000 more than the fiscal year 2022
enacted level and $70,000,000 below the fiscal year 2023 budget re-
quest.
The Committee recommendation includes $100,000,000, an in-
crease of $50,000,000 over the fiscal year 2022 enacted level and
is the same as the fiscal year 2023 budget request, for Strength-
ening Community College Training Grants to support a new grant
competition. This funding will continue to help better align work-
force development efforts with postsecondary education and build
off lessons learned from the Trade Adjustment Assistance Commu-
nity College and Career Training Grant program. The Committee
continues to direct the Department to follow the program require-
ments as laid out in House Report 116–62, except that the 120 day
requirement for the solicitation shall not apply.
The Committee recommendation also includes $50,000,000 for a
new program designed to assist communities experiencing disloca-
tions occurring in fossil fuel and other energy related industries. A
part of the Interagency Working Group on Coal and Power Plant
Communities and Economic Revitalization, this program builds
upon the Obama Administration’s POWER+ initiative and is in-
tended to support the economic well-being of workers and commu-
nities impacted by changes in the coal, oil, gas, and other indus-
tries.
The Committee strongly encourages continued investment in
areas with high rates of unemployment and substance use disorder
impacted by the loss of employment in the coal industry. This in-
dustry has experienced significant employment reduction in the
past decade and sustained investment to transition workers to new
industries is necessary to offset challenging economic conditions.
The Committee is aware of the high, unmet demand for cyberse-
curity and software development skills in both the Department of
Defense (DoD) and the private sector and appreciates the Sec-
retary’s attention to this priority. Given the high wages and job se-
curity associated with jobs in these areas, combined with the bene-
fits for national security and the economy at large, the Committee
directs the Secretary to utilize appropriate discretionary or manda-
tory funds available for the purpose of high skill job training to es-
tablish grants for qualified training and educational institutions to
help increase training capacity to meet this demand. The Depart-
ment is also strongly encouraged to coordinate with partners with-
in the DoD to ensure the program is effectively targeted to meet
existing needs.
The Committee includes $5,000,000 for the Department of Labor
to establish an Automation Impacted Industries Pilot Program to
award competitive grants to industry or sector partnerships to sup-
port demonstration and pilot projects relating to the training needs
of workers who are, or are likely to become, dislocated workers as
a result of automation. Under this program, grantees may use the
funds for one or more of the following: 1) Providing training serv-
ices, which may include training services that prepare workers for
in-demand industry sectors or occupations; 2) providing assistance
for employers in developing a staff position for an individual who
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will be responsible for supporting training services provided under
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the grant; 3) purchasing equipment or technology necessary for
training services; 4) providing job search and other transitional as-
sistance to workers in industries with high rates of job loss; 5) pro-
viding a training stipend to workers for training services; 6) pro-
viding integrated education and training.
The Committee provides $45,000,000 for the Workforce Oppor-
tunity for Rural Communities program, to provide enhanced work-
er training in the Appalachian, Delta, and Northern Border re-
gions.
The Committee encourages the Department to develop dem-
onstration and pilot programs that facilitate education and training
programs in the field of advanced manufacturing. Eligible entities
include local educational entities (e.g., technical college, community
college, a manufacturing extension center, or an entity that assists
educationally underserved communities) partnering with manufac-
turers that employ individuals who have advanced manufacturing
skills. These programs should (1) develop skills and competencies
of workers in communities with expected growth in advanced man-
ufacturing; (2) provide education and training for available and an-
ticipated jobs in advanced manufacturing; (3) educate individuals
about career advancement opportunities within advanced manufac-
turing; (4) strengthen community college partnerships with manu-
facturing extension centers and advanced manufacturing busi-
nesses in an effort to meet the needs of businesses for adaptability
in training of workers; and (5) give priority to incumbent workers,
dislocated workers, and unemployed individuals.
The Committee recognizes that the environmental health work-
force is vital to protecting the health and safety of the public. The
Committee encourages the Secretary, in coordination with Federal,
State, local, and tribal government agencies, and private-sector and
nongovernmental entities, to develop model standards and guide-
lines for credentialing environmental health workers. The Com-
mittee further encourages the Secretary to develop a comprehen-
sive and coordinated plan for developing the environmental health
workforce to meet national needs. This plan should include per-
formance measures to more clearly determine the extent to which
these programs and activities are meeting the Department’s stra-
tegic goal of strengthening the environmental health workforce;
identify any gaps between existing programs and activities and fu-
ture environmental health workforce needs; identify actions to ad-
dress such identified gaps; and identify any additional statutory
authority that is needed by the Department to implement such
identified actions. The Committee requests this plan no later than
360 days after the date of enactment of this Act.
The Committee recognizes that there is a significant number of
immigrants that arrive in America, fluent in English and holding
degrees and credentials in health care from their home countries.
Because of the significant barriers of translating these foreign cer-
tifications into required American certifications, many immigrants
are underemployed, resulting in a lower quality of life and contrib-
uting to the shortage of health care professionals. The Committee
recommends that the Secretary of Labor release guidance that
identifies ways to bridge the gap between unemployed immigrants
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and health care professions.
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The Committee supports efforts by organizations to advance
worker training for individuals who are survivors of abuse, aban-
donment, or trauma. The Committee further supports worker train-
ing projects that provide wraparound services to these individuals
and recognizes the value and need to support the ‘‘whole’’ worker,
including access to new clothing, shoes, home essentials, family hy-
giene items, relevant worker resources, and life skill classes to fos-
ter healing and create long-term goals.
Native Americans.—For the Indian and Native American pro-
grams, the Committee recommends $63,800,000, which is
$6,800,000 more than the fiscal year 2022 enacted level and the
same as the fiscal year 2023 budget request.
Migrant and Seasonal Farmworkers.—For the National Farm-
worker Jobs program, the Committee recommends $105,000,000,
which is $9,604,000 more than the fiscal year 2022 enacted level
and $8,289,000 more than the fiscal year 2023 budget request.
The Committee directs the Secretary to ensure that additional
funding made available in fiscal year 2023—above the fiscal year
2022 enacted level—is available to all eligible organizations.
YouthBuild.—For the YouthBuild program, the Committee rec-
ommends $145,000,000, which is $45,966,000 more than the fiscal
year 2022 enacted level and the same as the fiscal year 2023 budg-
et request.
Reintegration of Ex-Offenders.—The Committee recommends
$150,000,000 for training and reintegration activities for individ-
uals with criminal legal histories or who have been justice system-
involved, which is $47,921,000 more than the fiscal year 2022 en-
acted level and the same as the fiscal year 2023 budget request.
The Committee directs the Department to ensure grantees estab-
lish formal partnerships with employers and that program partici-
pants receive industry recognized credentials and training in fields
that prepare them for successful reintegration, including ensuring
participants receive training and credentials in fields where their
criminal 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 includes a set-aside of $50,000,000 for competi-
tive grants to national and regional intermediaries. The Committee
encourages the Department to prioritize grants to national inter-
mediaries and community-based organizations with recognized ex-
pertise and nationwide employer partners that will address the in-
equities deepened by the pandemic by serving populations with
multiple barriers to employment and providing wraparound serv-
ices to the individuals served.
The Committee is aware that recent re-entry programs are an
excellent way to help address workforce challenges, including those
in the advanced manufacturing sector. The Committee directs the
Department to provide an update in the fiscal year 2024 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.
Workforce Data Quality Initiative.—The Committee recommends
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$6,000,000 for the Workforce Data Quality Initiative, which is the
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same as the fiscal year 2022 enacted level and the fiscal year 2023
budget request. The Committee supports the work of States in
using these funds to create and utilize data to align preschool
through workforce systems.
Apprenticeship Grants.—The Committee recommends
$303,000,000 for the apprenticeship grants program, which is
$68,000,000 more than the fiscal year 2022 enacted level and the
same as the fiscal year 2023 budget request. The Committee estab-
lished this program in 2016 to expand work-based learning pro-
grams in in-demand industries through registered apprenticeships.
Registered apprenticeships are a proven strategy for meeting the
needs of our nation’s workforce and industry simultaneously.
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 also directs the Department to pro-
vide quarterly briefings on all spending activities under this pro-
gram to the Committee. The Committee strongly supports efforts to
expand Registered Apprenticeships to traditionally underrep-
resented communities.
In addition, the Committee continues to note that apprentice-
ships are an important path to the middle-class, with those com-
pleting 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 Committee directs the Department to accelerate ef-
forts to recruit and retain women as part of these programs and
to ensure equal compensation.
The Committee recognizes that the creative economy was se-
verely impacted by COVID–19 and encourages the Department to
partner with the National Endowment for the Arts and the Na-
tional Endowment for the Humanities to explore the feasibility and
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expansion of Registered Apprenticeship programs for creative
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workers who previously received income through creative, cultural,
or artistic-based pursuits to produce ideas, content, goods, and
services, without regard to whether such income is earned through
employment as an independent contractor or as an employee for an
employer.
The Committee continues to be concerned about nationwide
shortages of qualified drinking water and wastewater operation
professionals, especially in rural areas, and urges the Secretary to
address these challenges through apprenticeship opportunities con-
sistent with the National Guideline Standards of Apprenticeship
for Water and Wastewater System Operations Specialists.
The Committee notes that apprenticeship programs contribute to
higher wages and fewer injuries for workers in the energy industry.
The Committee also notes that as the United States combats cli-
mate change, we need to expand the clean energy workforce. How-
ever, we currently lack sufficient apprenticeship programs in the
clean energy sector. Therefore, the Committee continues to encour-
age prioritization of apprenticeships in clean energy and encour-
ages the Department of Labor to accelerate efforts to support ap-
prenticeship programs that increase the number of trained workers
in the clean energy sector with an emphasis in regions anticipating
a loss in fossil fuel industry jobs.
The Committee appreciates the Administration’s actions to en-
sure high-quality training opportunities by taking steps to rescind
the industry registered apprenticeship program. The Committee
strongly supports expansion of registered apprenticeships, youth
apprenticeships, and pre-apprenticeship programs to create more
job training opportunities—especially in the face of shifting work-
force needs and in-demand career skills. In light of this need, the
Committee encourages the Secretary to identify key sectors, includ-
ing advanced manufacturing, with growing workforce demands that
adapt well within apprenticeship models and develop streamlined
plans with key stakeholders to execute apprenticeship programs.
The Committee supports efforts by organizations to advance
worker training for individuals who are survivors of abuse, aban-
donment, or trauma. The Committee further supports worker train-
ing projects that provide wraparound services to these individuals
and recognizes the value and need to support the ‘‘whole’’ worker,
including access to new clothing, shoes, home essentials, family hy-
giene items, relevant worker resources, and life skill classes to fos-
ter healing and create long-term goals.
National Youth Employment Program.—For the National Youth
Employment Program, the Committee recommends $75,000,000,
which is the same as the fiscal year 2023 budget request. This new
competitive grant program will provide funding for youth employ-
ment programs, including summer and year-round opportunities.
Veterans’ Clean Energy Training Program.—For the Veterans’
Clean Energy Training Program, the Committee recommends
$10,000,000, which is the same as the fiscal year 2023 budget re-
quest. This new competitive grant program will prepare veterans
and their spouses for careers in clean energy.
Civilian Climate Corps.—For the Civilian Climate Corps, the
Committee recommends $15,000,000, which is the same as the fis-
cal year 2023 budget request. This new grant pilot will rely on
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strong DOL partnerships with other Federal agencies to focus on
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job training and paid community service for underrepresented pop-
ulations in clean energy and climate mitigation.
Community Project Funding.—Within the funds included in this
account, $132,114,000 shall be used for the projects, and in the
amounts, specified in the table titled ‘‘Labor, HHS, Education In-
corporation of Community Project Funding Items’’ at the end of
this report.
JOB CORPS
Appropriation, fiscal year 2022 ......................................................... $1,748,655,000
Budget request, fiscal year 2023 ....................................................... 1,778,964,000
Committee Recommendation ............................................................. 1,798,655,000
Change from enacted level ......................................................... +50,000,000
Change from budget request ...................................................... +19,691,000
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 $1,627,325,000, which is $24,000,000 more than the fis-
cal year 2022 enacted level and $24,314,000 more than the fiscal
year 2023 budget request.
Construction, Rehabilitation, and Acquisition.—The Committee
recommends $133,000,000 for construction, rehabilitation, and ac-
quisition activities of Job Corps centers, which is $20,000,000 more
than the fiscal year 2022 enacted level and the same as the fiscal
year 2023 budget request.
Administration.—The Committee recommends $38,330,000 for
the administrative expenses of the Job Corps program, which is
$6,000,000 more than the fiscal year 2022 enacted level and
$4,623,000 below the fiscal year 2023 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.
The Committee continues to be concerned with the administra-
tion of the Job Corps program, including the underutilization of
centers relative to on-board strength, industry-standard training,
and performance incentives.
As millions of disconnected youth struggle with housing, food in-
security, and unemployment, the Committee supports the full re-
sumption of Job Corps operations, including the reintegration of
nonresidential students into normal classes, similar to other
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schools and institutes of higher education across the country.
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The Committee has previously expressed concern regarding the
impact of the transition to fixed-price Job Corps contracts on staff
compensation. Currently, the Department exempts Job Corps
prime contracts from compliance with the McNamara-O’Hara Serv-
ice Contract Act. The Committee directs the Department to provide
a report within 90 days of enactment of this Act explaining the ra-
tionale for this exemption and an estimate of the costs of requiring
all Job Corps contracts to comply with this statute. The Committee
further directs the Department to estimate the costs of compliance
if Job Corps academic and trade instructors were classified as non-
exempt for the purposes of the Fair Standards Act.
COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS
Appropriation, fiscal year 2022 ......................................................... $405,000,000
Budget request, fiscal year 2023 ....................................................... 405,000,000
Committee Recommendation ............................................................. 450,000,000
Change from enacted level ......................................................... +45,000,000
Change from budget request ...................................................... +45,000,000
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
unemployed persons aged 55 and older whose family income is
below 125 percent of the poverty level.
The Committee recommends $450,000,000 for the Community
Service Employment for Older Americans program, which is
$45,000,000 more than the fiscal year 2022 enacted level and the
fiscal year 2023 budget request.
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
Appropriation, fiscal year 2022 ......................................................... $540,000,000
Budget request, fiscal year 2023 ....................................................... 494,400,000
Committee Recommendation ............................................................. 494,400,000
Change from enacted level ......................................................... ¥45,600,000
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.
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE
OPERATIONS
Appropriation, fiscal year 2022 ......................................................... $3,711,331,000
Budget request, fiscal year 2023 ....................................................... 4,258,173,000
Committee Recommendation ............................................................. 4,213,960,000
Change from enacted level ......................................................... +502,629,000
Change from budget request ...................................................... ¥44,213,000
The total includes $4,124,894,000 from the Employment Security
Administration Account from the Unemployment Trust Fund and
$89,066,000 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-
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surance (UI) Compensation, the Committee recommends
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$3,184,635,000, which is $333,819,000 more than the fiscal year
2022 enacted level and the same as the fiscal year 2023 budget re-
quest. The recommendation provides additional resources for States
to increase staffing capacity and to accommodate sustained in-
creases 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 2023, for every 100,000 increase in the total
average weekly insured unemployment (AWIU) above 1,778,000, an
additional $28,600,000 shall be made available to States from the
Unemployment Trust Fund.
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
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
$258,000,000 is made available pursuant to the Bipartisan Budget
Act of 2018 (P.L. 115–123), which is $125,000,000 more than the
fiscal year 2022 enacted level and equal to the fiscal year 2023
budget request.
UI Integrity Center of Excellence (UIICE).—The recommendation
provides $9,000,000 for the continued support of UIICE.
Unemployment Compensation National Activities.—The Com-
mittee recommends $118,000,000 for National Activities, which is
$100,000,000 more than the fiscal year 2022 enacted level and
$50,174,000 below the fiscal year 2023 budget request. This in-
crease in funding is intended to help modernize information tech-
nology systems and support States in administering the UI pro-
gram.
The Committee supports ongoing efforts by the Department’s
Employment and Training Administration to collaborate with state
workforce agencies to modernize unemployment insurance manage-
ment systems. The Committee continues to urge the department to
develop a comprehensive long-term strategy for delivery of assist-
ance to state workforce agencies, as outlined in House report 117–
96.
Employment Service.—The Committee recommends $723,862,000
for the Employment Service allotment to States, which is
$48,810,000 more than the fiscal year 2022 enacted level and
$25,000,000 more than the fiscal year 2023 budget request.
The Committee also recommends $25,000,000 for Employment
Service National Activities, which is the same as the fiscal year
2022 enacted level and $2,682,000 more than the fiscal year 2023
budget request.
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-
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ities. Since 1933, this Federal-State partnership has facilitated the
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20
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, under the previous Administration, the
Department’s issued a final rule that marked a dangerous depar-
ture from this operation. As such, 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
$94,810,000 for the Foreign Labor Certification (FLC) program,
which is $15,000,000 more than the fiscal year 2022 enacted level
and $3,721,000 below the fiscal year 2023 budget request. The rec-
ommendation includes $68,528,000 for Federal administration, an
increase of $10,000,000 over the fiscal year 2022 enacted level and
$1,721,000 below the fiscal year 2023 budget request, that is in-
tended to be used to ensure effective oversight and enforcement of
employer regulations, and $26,282,000 for grants to States, an in-
crease of $5,000,000 over the fiscal year 2022 enacted level and
$2,000,000 below the fiscal year 2023 budget request.
Heat-Related Deaths.—The Committee recognizes that farm
workers ensure our nation’s food supply at the risk of their own
health and safety, toiling under extreme temperatures and other
dangerous conditions. Agriculture had the highest average rate of
heat-related deaths of all industry sectors. More specifically, agri-
culture had roughly three times the rate of heat-related death com-
pared to construction, which is the industry with the second high-
est rate of heat-related death, and 35 times the risk of heat related
death compared to other industry sectors. The Committee believes
that no workers should die of heat. Heat death and illness can be
prevented by very simple measures, such as access to drinking
water, shade, and rest breaks. The Committee urges the DOL to
consider what immediate steps they can take to prevent heat ill-
ness and death while the OSHA rulemaking is in progress. In par-
ticular, the Committee urges the DOL to consider what protections
could be put into place to protect workers at H–2A employers from
heat illness and death, such as requiring a heat illness prevention
plan as part of the H–2A labor certification process.
Workforce Information.—To better understand the growing threat
heat-related illness poses to climate-vulnerable agricultural work-
ers, the Committee encourages the Department to assess heat-re-
lated illness prevention and response through the National Agricul-
tural Worker Survey. Specifically, the Committee encourages the
Employment and Training Administration (ETA) to ensure work-
ers’ access to drinking vessels, potable water, restrooms, and shade
are addressed by the National Agricultural Workers Survey. The
Committee also directs ETA to incorporate questions about the in-
cidence and prevalence of heat-related illness during agricultural
employment and whether workers have been training on the job
about heat-related illness. The Committee directs ETA to include
a report to Congress on the findings from these questions of the
survey as part of its annual report on the National Agricultural
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Worker Survey.
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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 continues to encourage
the Secretary to consider rulemaking to improve the experience of
employers 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 $67,653,000 for One-Stop Career Centers and
Labor Market Information, which is $5,000,000 more than the fis-
cal year 2022 enacted level and $18,000,000 below the fiscal year
2023 budget request. The recommendation also includes language
authorizing the Secretary to transfer certain funding to the Office
of Disability Employment Policy for research and demonstration
projects.
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 2022 ......................................................... $164,415,000
Budget request, fiscal year 2023 ....................................................... 222,633,000
Committee Recommendation ............................................................. 209,200,000
Change from enacted level ......................................................... +44,785,000
Change from budget request ...................................................... ¥13,433,000
The recommendation includes $144,465,000 from the General
Fund of the Treasury and $64,735,000 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.
Prize Competition.—The Committee continues to encourage the
Department, in coordination with the Office of Science and Tech-
nology Policy, to establish a prize competition consistent with the
requirements of section 24 of the Stevenson-Wydler Technology In-
novation Act of 1980, to support eligible programs designed to pre-
pare high school students to enter and succeed in an in-demand in-
dustry sector or occupation.
National Guard Job ChalleNGe.—The 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 in the aftermath of the economic fallout
associated with the pandemic. The Committee encourages the De-
partment to build upon its collaboration with Youth ChalleNGe
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programs and offer youth occupational skills training, individual-
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ized career and academic counseling, work-based learning opportu-
nities, and leadership development activities.
Gun Violence.—The Committee encourages the Department to
prioritize Workforce Innovation and Opportunity funding opportu-
nities, like the Young Adult Reentry Partnership and YouthBuild,
to support reintegration, transitional employment, long-term
impactful positions, union positions, and living wages for systems-
involved youth and older adults in cities disproportionately im-
pacted by daily gun violence.
Higher Education Workforce Development Initiative.—The Com-
mittee encourages the Department of Labor to partner with the De-
partment of Education to explore the feasibility of creating work-
force development programs at 4-year higher education institutions
to align workforce development efforts and post-secondary edu-
cation and support expanded skills instruction, apprenticeships,
and other work-based learning opportunities, including cooperative
education and upskilling and reskilling efforts in industries like
manufacturing, information technology, healthcare, and energy,
among others. The Committee encourages the Department to model
the Higher Education Workforce Development Innovation program
similarly to the Strengthening Community College Training Grants
Program.
Electric Vehicle Mechanics.—The Committee recognizes the grow-
ing need of high skilled mechanics and workforce development in
the automotive field to prepare for advances in the electric vehicle
industry. The Committee encourages the Department of Labor and
the Department of Education to explore the feasibility of working
with industry partners, labor groups, and nonprofit experts to de-
velop curriculum and training programs to further career pathways
for electric vehicle mechanics. The collaboration should also develop
recommendations of advanced training programs for established ca-
reer mechanics to grow skilled labor outcomes and deepen their
skills and knowledge to meet the needs of the future.
Disaggregated Data by Race.—The Committee is aware that few
federal or federally funded workforce training programs track out-
comes by race. The Committee recommends careful evaluation of
disaggregated racial data in order to advance racial equity and
minimize racial disparities in workforce training. The Committee
requests a report from ETA within 120 days of enactment of this
Act on efforts to evaluate disaggregated racial data in federally-
funded workforce training programs.
Reducing Homelessness.—The Committee recognizes that employ-
ment that pays a living wage and can support the cost of housing
is a key to reducing homelessness. The Office of Workforce Invest-
ment (OWI) is responsible for a national workforce investment sys-
tem that provides workers with the information, advice, job search
assistance, supportive services, and training for in-demand indus-
tries and occupations needed to get and keep good jobs. The Com-
mittee urges OWI to provide workforce boards with incentives and
guidance to promote coordination with local homelessness systems
to ensure that employment services are accessible and useful to
people who are homeless or have recently left homelessness.
Justice Involved Workers.—The Committee supports the Depart-
ment of Labor’s intention to expand education, skills training, and
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work experience programs to connect justice-involved individuals
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with employment opportunities to obtain and retain jobs. The Com-
mittee continues to recommend that Federal workforce develop-
ment funding under covered education and training programs be
available to eligible recipients with a demonstrated capacity to de-
velop and improve the availability of employment and transitional
job programs that support work-based learning activities designed
to increase reentry employment as an equitable workforce ap-
proach. To increase alignment of work experience opportunities
across federal programs, the committee also directs the Depart-
ment to enter into a cooperative agreement with national nonprofit
organizations that have an established partnership with the SNAP
Employment & Training program at the Department of Agri-
culture.
Regional Councils and Councils of Governments.—The Com-
mittee encourages the Department to list regional councils and
councils of governments as eligible entities in competitions for Fed-
eral funding whenever local governments or non-profit agencies are
eligible entities. Furthermore, the Committee encourages the De-
partment to seek opportunities for regional councils and councils of
governments to serve as lead applicants and grantees to encourage
and expand greater regional collaboration.
EMPLOYEE BENEFITS SECURITY ADMINISTRATION
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $185,000,000
Budget request, fiscal year 2023 ....................................................... 233,867,000
Committee Recommendation ............................................................. 233,867,000
Change from enacted level ......................................................... +48,367,000
Change from budget request ...................................................... –––
The Employee Benefits Security Administration (EBSA) assures
the security of retirement, health and other workplace-related ben-
efits of working Americans.
The Committee recommends $233,867,000 for EBSA, which is
$48,367,000 above the fiscal year 2022 enacted level and the same
as the fiscal year 2023 budget request.
Mental Health Parity and Addiction Equity Act (MHPAEA) Com-
pliance.—The Committee has included resources for the Employee
Benefits Security Administration (EBSA) to fully implement Sec-
tion 203 of Division BB of the Consolidated Appropriations Act,
2021. Section 203 requires that all group health plans perform
comparative analyses of the design and application of nonquantita-
tive treatment limitations (NQTLs) to ensure those imposed on
mental health and substance use disorder benefits are not more re-
strictive than limitations for medical and surgical benefits.
The Committee is encouraged that EBSA formed a MHPAEA
NQTL Task Force composed of experienced investigators, health
policy experts, technical experts from EBSA’s regional and national
offices, and attorneys from the Office of the Solicitor of Labor to as-
sist in the implementation of the new provisions. The Committee
encourages EBSA to continue to enhance its MHPAEA NQTL en-
forcement program by increasing the investigative resources dedi-
cated to NQTL review and analysis. To the extent resources allow,
the Committee also encourages EBSA to create templates and tools
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for collecting and scoring the comparative analyses and rendering
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decisions on compliance; enhance coordination, standardization and
MHPAEA-related decision-making uniformity among regional of-
fices; and conduct follow-up investigations into group health plans
whose comparative analyses indicate likely noncompliance or areas
in which further examination is needed to determine compliance.
PENSION BENEFIT GUARANTY CORPORATION
Appropriation, fiscal year 2022 ......................................................... $472,955,000
Budget request, fiscal year 2023 ....................................................... 493,314,000
Committee Recommendation ............................................................. 493,314,000
Change from enacted level ......................................................... +20,359,000
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 2022 ......................................................... $251,000,000
Budget request, fiscal year 2023 ....................................................... 307,678,000
Committee Recommendation ............................................................. 312,678,000
Change from enacted level ......................................................... +61,678,000
Change from budget request ...................................................... +5,000,000
The Wage and Hour Division (WHD) enforces Federal minimum
wage, overtime pay, recordkeeping, and child labor requirements of
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
Polygraph Protection Act, the Family and Medical Leave Act, the
Davis Bacon Act, and the Service Contract Act.
The Committee recommends $312,678,000 for WHD, which is
$61,678,000 above the fiscal year 2022 enacted level and
$5,000,000 above the fiscal year 2023 budget request. The increase
will support additional investigators to combat wage theft and pro-
tect workers. The Committee urges WHD to explore and expand
strategic enforcement approaches to the agency’s work to make the
most of this increase.
Retaliation.—Because retaliation and the threat of retaliation re-
main a critical challenge to workers’ ability to exercise their work-
place rights, the Committee requests for WHD to provide informa-
tion regarding its volume of retaliation complaints, the status of
those complaints, and how WHD is working effectively to protect
workers from retaliation in the fiscal year 2024 Congressional
Budget Justification.
Accessibility.—The Committee notes the importance of making
sure all workers can access WHD’s resources, including workers of
color, immigrant workers, workers in rural communities or with
limited access to transportation, and workers with disabilities. The
Committee encourages WHD to undertake efforts to improve acces-
sibility of WHD offices, translate WHD documentation and signage
into languages spoken by 5 percent or more of the population in a
given WHD region, and translate WHD’s online webpages, com-
plaint forms, and resources to match regional needs. In hiring in-
vestigators, the Committee encourages WHD to focus on employing
and retaining a greater number of multilingual investigators. In
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addition, the Committee encourages WHD to establish protocols
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that permit workers to participate in investigations and hearings
remotely where appropriate.
Community-based Organizations and Partnerships.—The Com-
mittee believes that community-based organizations are critical in
establishing necessary trust, connecting workers with agencies, fa-
cilitating communication between agencies and workers, and de-
ploying enforcement resources strategically. Working with commu-
nity-based organizations helps agencies cooperate with workers
who might otherwise be difficult to reach, including workers em-
ployed by small businesses, workers with literacy challenges, work-
ers with limited access to broadband, and workers in high-hazard
industries most vulnerable to wage violations. Therefore, the Com-
mittee urges WHD to increase its capacity to conduct outreach and
collaborate with community-based organizations.
U and T Visa Certification.—The Committee notes the critical
role WHD plays in completing U and T visa certifications on behalf
of victims of crime and victims of trafficking in the workplace. En-
suring that all workers, regardless of immigration status, can par-
ticipate in WHD investigations and exercise their workplace rights
is critical to the full and effective enforcement of Federal labor
laws. The Committee urges WHD to use resources provided in fis-
cal year 2023 to ensure the efficient and timely processing and cer-
tification of all certification requests.
Domestic Workers.—The Committee is concerned that domestic
workers are particularly vulnerable to workplace exploitation, in-
cluding wage theft, verbal abuse, trafficking, and sexual assault.
Domestic work commonly takes place in private homes, where
workers are often isolated and alone. This workforce is predomi-
nantly female, and represents populations that are already vulner-
able, including immigrant women and women of color. The Com-
mittee is concerned by the limited enforcement of workplace rights
for this population and the severe power imbalance between domes-
tic workers and their employers. In response to these concerns, the
Committee includes new bill language directing the Secretary to
use funds made available under WHD to establish a national hot-
line to support domestic workers. In addition, the Committee urges
WHD to prioritize investigations in sectors where workers are more
vulnerable to wage theft, including domestic work, long term care,
and home health care.
Misclassification.—The Committee is concerned that cases of
workers being misclassified as independent contractors have been
steadily rising in recent years, a development that transfers costs
of doing business to workers, denies them the rights and protec-
tions of bedrock workplace protections, and depletes federal coffers
by limiting payroll taxes. The Committee urges the WHD to use
the full extent of its existing powers to enforce laws related to em-
ployee classification and to undertake such rulemaking action as
may be necessary to execute Congress’s direction under 29 USC
202.
Warehouse Workers.—The Committee recognizes that temporary
warehouse workers have been the backbone of efforts to address
the supply chain issues that the United States experienced during
the COVID–19 pandemic. The Committee strongly supports in-
creased oversight to prevent wage theft from warehouse workers
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and is encouraged by the WHD’s initiative on Warehouse and Lo-
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gistics workers. The Committee requests a report within 90 days
of enactment of this Act detailing the steps the WHD is taking to
address wage theft among warehouse workers, including non-union
temporary warehouse workers. In addition, the Committee requests
a progress report on the initiative on Warehouse and Logistics
workers, including steps to provide education, outreach, enforce-
ment to increase compliance and reduce industry violations.
OFFICE OF LABOR MANAGEMENT STANDARDS
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $45,937,000
Budget request, fiscal year 2023 ....................................................... 49,951,000
Committee Recommendation ............................................................. 45,937,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... ¥4,014,000
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 recommends $44,937,000 for OLMS, which is the
same as the fiscal year 2022 enacted level and $4,014,000 below
the fiscal year 2023 budget request.
Persuader Reporting.—The Committee is concerned about uneven
compliance with rules regarding reporting of persuader activity and
urges the Department to review its rules and policies on persuader
reporting and take all appropriate actions to strengthen its rules
and enforcement to ensure maximum compliance and reporting of
persuader activity. Further, the Committee urges the Department
to consider proposing a revision to its rules to require disclosure on
the LM–10 form as to whether the filer is a federal contractor,
whether the persuader activity relates to employees working on or
in connection with the federal contract, and with which agency or
agencies the employer contracts.
OFFICE OF FEDERAL CONTRACT COMPLIANCE PROGRAMS
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $108,476,000
Budget request, fiscal year 2023 ....................................................... 147,051,000
Committee Recommendation ............................................................. 147,051,000
Change from enacted level ......................................................... +38,575,000
Change from budget request ...................................................... –––
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-
tional origin.
The Committee recommends $147,051,000 for OFCCP, which is
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$38,575,000 above the fiscal year 2022 enacted level and the same
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27
as the fiscal year 2023 budget request. The Committee supports
OFCCP’s efforts to make sure contractors and subcontractors are
adhering fully to EO 11246.
OFFICE OF WORKERS’ COMPENSATION PROGRAMS
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $120,129,000
Budget request, fiscal year 2023 ....................................................... 145,977,000
Committee Recommendation ............................................................. 145,977,000
Change from enacted level ......................................................... +25,848,000
Change from budget request ...................................................... –––
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 $143,772,000 in Gen-
eral Funds from the Treasury, which is $25,848,000 above the fis-
cal year 2022 enacted level and the same as the fiscal year 2023
request, and $2,205,000 from the Special Fund established by the
Longshore and Harbor Workers’ Compensation Act.
SPECIAL BENEFITS
Appropriation, fiscal year 2022 ......................................................... $244,000,000
Budget request, fiscal year 2023 ....................................................... 250,000,000
Committee Recommendation ............................................................. 250,000,000
Change from enacted level ......................................................... +6,000,000
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 2022 ......................................................... $32,970,000
Budget request, fiscal year 2023 ....................................................... 36,031,000
Committee Recommendation ............................................................. 36,031,000
Change from enacted level ......................................................... +3,061,000
Change from budget request ...................................................... –––
These funds provide mandatory benefits to coal miners disabled
by black lung disease, to their survivors and eligible dependents,
and for necessary administrative costs.
The Committee recommends $36,031,000 for Special Benefits for
Disabled Coal Miners. This amount is in addition to the
$11,000,000 appropriated in fiscal year 2022 as an advance for the
first quarter of fiscal year 2023. The total program level rec-
ommendation is $3,061,000 more than the fiscal year 2022 enacted
level and the same as the fiscal year 2023 budget request.
The Committee recommendation also provides $10,250,000 as an
advance appropriation for the first quarter of fiscal year 2024.
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These funds ensure uninterrupted payments to beneficiaries.
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ADMINISTRATIVE EXPENSES, ENERGY EMPLOYEES OCCUPATIONAL
ILLNESS COMPENSATION FUND
Appropriation, fiscal year 2022 ......................................................... $63,428,000
Budget request, fiscal year 2023 ....................................................... 64,564,000
Committee Recommendation ............................................................. 64,564,000
Change from enacted level ......................................................... +1,136,000
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.
Beryllium Vendor Eligibility.—The Committee is concerned that
the Department of Labor’s interpretation of what constitutes a
‘‘covered employee’’ under the terms of the Energy Employees Oc-
cupational Illness Compensation Program Act (EEOICPA) mistak-
enly excludes some employees of beryllium vendors and facilities
and contravenes congressional intent under EEOICPA. As such,
the Committee encourages the Department to examine making eli-
gible all employees of beryllium vendors named in EEOICPA for
benefits under the Act regardless of corporate structure, past reor-
ganizations, or current ownership as a subsidiary provided those
actions were compliant with applicable federal law. The Committee
further directs the Department to submit a report to the Com-
mittee no later than 90 days after the date of enactment of this Act
that outlines the number of beneficiaries and eligible employers
covered under the EEOICPA.
BLACK LUNG DISABILITY TRUST FUND
Appropriation, fiscal year 2022 ......................................................... $331,505,000
Budget request, fiscal year 2023 ....................................................... 394,896,000
Committee Recommendation ............................................................. 394,896,000
Change from enacted level ......................................................... +63,391,000
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
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-
quired that annual operating surpluses be used to pay down the
debt until all remaining obligations are retired.
Black Lung Benefits Claims Processing.—The Committee is con-
cerned with lengthy delays in the processing of Black Lung Bene-
fits Act claims, particularly where the mine operator’s ability to
pay the claim is in question. Delays impede access to necessary
medical care while claims are pending. The Committee supports ef-
forts by the Secretary to resolve these claims expediently to ensure
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miners can receive the benefits and medical care they need. The
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29
Committee requests an update in the fiscal year 2024 Congres-
sional Budget Justification on the Department’s efforts to improve
the speed and quality of its black lung claims processing.
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $612,015,000
Budget request, fiscal year 2023 ....................................................... 701,405,000
Committee Recommendation ............................................................. 712,015,000
Change from enacted level ......................................................... +100,000,000
Change from budget request ...................................................... +10,610,000
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 2023
Budget Activity Committee
Safety and Health Standards ......................................................................................................................... $29,080,000
Federal Enforcement ....................................................................................................................................... 285,508,000
Whistleblower Programs ................................................................................................................................. 27,290,000
State Programs ............................................................................................................................................... 121,075,000
Technical Support ........................................................................................................................................... 27,007,000
Federal Compliance Assistance ..................................................................................................................... 91,608,000
State Consultation Grants .............................................................................................................................. 63,500,000
Training Grants .............................................................................................................................................. 14,287,000
Safety and Health Statistics .......................................................................................................................... 42,180,000
Executive Direction and Administration ......................................................................................................... 10,480,000
Compliance Safety and Health Officers (CSHOs).—The Com-
mittee is concerned about the significant reduction in OSHA Com-
pliance Safety and Health Officers (CSHOs) in recent decades rel-
ative to the number of workers they oversee. These CSHOs enforce
federal workplace standards across the country, inspecting work-
sites and ensuring that employers comply with worker safety and
health regulations. That is why the Committee is strongly sup-
portive of OSHA’s plans to use additional resources to support and
rebuild OSHA’s enforcement program by hiring additional CSHOs.
The Committee encourages the agency to focus on employing and
retaining multilingual officers crucial to thorough inspections of
workplaces across the country.
Elimination of the Limiting OSHA Coverage to Small Farms
Rider.—The Committee continues to eliminate the existing appro-
priations rider that prevents OSHA from conducting any activi-
ties—including compliance assistance, investigations, and enforce-
ment activities—on small farms. Agriculture is among the most
dangerous industries in the United States. However, OSHA is cur-
rently prohibited from investigating even fatalities and serious in-
juries on small farms, as well as responding to worker complaints.
Agricultural exemptions in New Deal worker protection laws,
which set the precedent for the OSHA small farms rider, were in-
cluded as compromises to secure the votes of Southern lawmakers
who opposed expanding labor rights for black farmworkers and
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sharecroppers. This is an almost 40-year-old rider that continues to
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30
have a disparate impact on racial and ethnic minorities and should
not be included in this Act. All farmworkers deserve to be protected
by the OSHA law, regardless of the size of their employer.
Penalties.—The Committee notes that OSHA penalties are
among the lowest of any Federal agency and believes they are woe-
fully inadequate in deterring workplace health and safety viola-
tions by employers. For instance, despite widespread reports that
meatpacking facilities were becoming deadly COVID–19 hotspots
as early as March 2020, OSHA waited six months before issuing
two small financial penalties totaling $29,000 to a JBS plant and
a Smithfield plant. For context, in 2019, JBS’s annual revenue was
$51.7 billion and Smithfield’s was $14 billion. To address these con-
cerns, Committee urges OSHA to adopt policies that encourage the
use of maximum penalties or a penalty multiplier for serious viola-
tions in large businesses.
Whistleblower Protection Program.—The Committee is concerned
about the increasing caseloads and unprecedented length of time
taken by OSHA to complete whistleblower investigations. OSHA’s
whistleblower investigative staff enforces protections for employees
who suffer retaliation for protected activity under more than 20
statutes, and the number of statutes continues to increase. OSHA’s
already-overburdened Whistleblower Protection Program staff has
seen a consistent increase in new complaints filed, including a
large increase in COVID–19 related complaints since the beginning
of the pandemic, which has resulted in a significant backlog of
pending investigations. The Office of Inspector General concluded
in August 2020 that when OSHA fails to respond in a timely man-
ner, it ‘‘could leave workers to suffer emotionally and financially’’
and may lead to the erosion of evidence needed for the case. To bol-
ster the Whistleblower Protection Program’s capacity to conduct
critical investigations in a timely manner in industries across the
country and bring the agency closer to compliance with statutory
requirements of more than 20 statutes, the Committee increases
resources for the Whistleblower Protection program by $5,790,000
above the fiscal year 2022 enacted level. This increase will support
OSHA’s efforts to update its decades-old Whistleblower data base
to the current OSHA Information System for OSHA’s main enforce-
ment program or to develop a new system.
Susan Harwood Training Grants.—The Susan Harwood Training
Grants to non-profit organizations reach workers in dangerous in-
dustries with critical education and training on workplace hazards
and statutory protections. The latest statistics from the Bureau of
Labor Statistics show that workplace fatalities are increasing for
Black workers and that fatality rates are higher among Hispanic
and Black workers. The Committee supports OSHA’s efforts to pro-
vide funding to non-profit, community-based groups, and other non-
profit organizations with the capability to reach workers in low-
wage industries and workers in dangerous industries. In addition,
the Committee urges OSHA to allow grantees to train on multiple
hazards. Further, the Committee encourages OSHA to ensure
grants are awarded to train workers employed in disaster recovery
and rebuilding sectors.
U and T Visas.—The Committee strongly supports efforts by
OSHA to ensure all workers, regardless of immigration status, can
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participate in OSHA investigations and exercise their workplace
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31
rights. However, the Committee notes that OSHA does not outline
a process for U and T visa certification. The Committee encourages
OSHA to evaluate the merits of establishing a policy on U and T
visa certification requests and consider assisting workers with U
and T visa certification.
OSHA Noise Standard.—The Committee is aware that the Na-
tional Institute for Occupational Safety and Health (NIOSH) esti-
mates that 22 million U.S. workers are exposed to potentially dan-
gerous levels of noise in the workplace every year and that hearing
loss is the most commonly recorded occupational illness in manu-
facturing, accounting for 1 in 9 recordable illnesses. The Committee
is also aware that the OSHA Noise Standard (20 CFR 1910.95) for
employers was established in 1983, but has not been updated since
that time even as the Department of Defense (DoD), NIOSH, and
many other countries have recommended or adopted more protec-
tive noise exposure limits. Accordingly, to better protect the Amer-
ican workforce and reduce the risk of noise-induced hearing loss,
the Committee urges OSHA to lower the current permissible expo-
sure level to 85 dBA TWA using a 3 dB exchange rate. Such a
change would substantially reduce the excess risk of developing oc-
cupational noise-induced hearing loss over a working lifetime and
be consistent with current exposure limits specified by the DoD and
voluntarily adopted by many private employers.
OSHA Heat Standard.—The Committee recognizes that with cli-
mate change, risks of heat-related illnesses continue to grow, pos-
ing serious risks to workers and their families as well as the na-
tion’s food supply and supply chains. Workers exposed to extreme
heat are disproportionately low-wage workers and workers of color.
The Committee is encouraged by the notice of proposed rulemaking
by the Department announced in October 2021. While the rule-
making is underway, the Committee is pleased that OSHA’s Na-
tional Emphasis program will create, for the first time, a nation-
wide enforcement mechanism to proactively inspect workplaces for
heat-related hazards and prevent worker injuries, illnesses, and fa-
talities.
Children in Agriculture.—The Committee is concerned that chil-
dren working in agriculture are at risk from work injuries that
could result in death. The Committee requests a report within 180
days of the date of enactment of this Act which shall include an
evaluation of data that reflects the status of child labor and related
safety and health hazards, such as the health impact of pesticide
use. The report shall include information on work-related serious
injuries to children under 18 employed in agriculture, as well as
work-related deaths of children under 18 employed in agriculture.
The report shall provide relevant details, including environmental
hazards, such as chemical or pesticide exposure; use of machinery
or tools at time of incident; work tasks performed at time of inci-
dent; and other details relating to the incident. OSHA is encour-
aged to collaborate with BLS and WHD.
Technology.—The Committee recognizes that technology is in-
creasingly incorporated into how we work. The Committee encour-
ages OSHA, in collaboration with NIOSH and stakeholders, to ex-
amine the role of technology in improving safety. In particular,
OSHA should review efforts to make technology innovation more
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accessible, to identify the most hazardous situations for the Amer-
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32
ican workforce, and to eliminate barriers to the adoption of critical
safety controls by employers. The Committee requests a briefing
with 120 days of enactment of this Act on recommendations on
these topics to specifically focus on reducing fatalities.
Interagency Collaboration.—The Committee is concerned about
the implementation and renegotiation of the 1994 Memorandum of
Understanding (MOU) between OSHA and the Food Safety and In-
spection Service (FSIS) towards establishing a process for FSIS in-
spection personnel to be trained to recognize and report serious
workplace hazards. The Committee requests a report within 90
days of enactment of this Act on the implementation status of this
renegotiated MOU that includes the agencies’ timeline and action
plan for implementation.
Asbestos.—The Committee is concerned that construction work-
ers continue to be exposed to asbestos at renovation, rehabilitation,
and restoration construction sites for both private developments
and public housing. The Committee encourages OSHA, in collabo-
ration with the Environmental Protection Agency, to prioritize ac-
tivities that proactively prevent asbestos exposure, such as in-
creased site visits. In addition, the Committee encourages OSHA to
work with employers to ensure asbestos hazards, fact sheets, and
safety protocols are publicly listed in English and Spanish and to
provide trainings to employers and employees.
Arc-flash Personal Protective Equipment.—The Committee is con-
cerned with continued lack of compliance with OSHA’s and indus-
try’s standards for arc-flash (AR) clothing and associated personal
protective equipment (PPE) requirements that have been in place
for over two decades. More than 600,000 American workers per-
forming work on or near energized electrical equipment are ex-
posed to deadly arc-flash related injuries and hazards on worksites
across the country without the required lifesaving protection. This
results in many catastrophic injuries and fatalities of American
workers every year, virtually all of which are preventable. The
Committee encourages OSHA to adopt an enforcement policy citing
existing standards such as NFPA 70E, and for requiring appro-
priate arc flash protective clothing and PPE during all live elec-
trical work performed in the United States.
MINE SAFETY AND HEALTH ADMINISTRATION
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $383,816,000
Budget request, fiscal year 2023 ....................................................... 423,449,000
Committee Recommendation ............................................................. 403,816,000
Change from enacted level ......................................................... +20,000,000
Change from budget request ...................................................... ¥19,633,000
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.
Within the total for MSHA, the Committee provides the following
amounts:
Budget Activity FY 2023
Committee
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Mine Safety and Health Enforcement ............................................................................................................ $279,509,000
Standards and Regulations Development ...................................................................................................... 6,229,000
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FY 2023
Budget Activity Committee
Assessments ................................................................................................................................................... 7,191,000
Educational Policy and Development ............................................................................................................. 39,755,000
Technical Support ........................................................................................................................................... 36,209,000
Program Evaluation and Information Resources ........................................................................................... 18,655,000
Program Administration ................................................................................................................................. 16,268,000
Coal, Metal, and Non-metal Mines.—MSHA is directed to include
in the fiscal year 2024 Congressional Budget Justification and all
future Congressional Budget Justifications historical and budget
year information on enforcement activities and outcomes, distin-
guishing between coal and metal/non-metal mines. To promote
transparency in agency spending on its enforcement activities,
MSHA shall continue to separately present annual spending on
coal and metal/non-metal mines as it has in past Congressional
Budget Justifications.
Resources and Activities.—The Committee notes significant work-
er dislocations and mine closures because of economic conditions
throughout the mining industry, and in coal mining in particular.
The Committee reiterates its support for the ongoing effort to bring
MSHA enforcement into proportion by redistributing resources and
activities to the areas where mine production is currently occurring
and where MSHA identifies the most significant safety hazards.
BUREAU OF LABOR STATISTICS
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $687,952,000
Budget request, fiscal year 2023 ....................................................... 741,744,000
Committee Recommendation ............................................................. 726,334,000
Change from enacted level ......................................................... +38,382,000
Change from budget request ...................................................... ¥15,410,000
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 $658,334,000 from the
General Fund of the Treasury and $68,000,000 from the Employ-
ment Security Administration Account in the Unemployment Trust
Fund. The recommendation does not include funds for the reloca-
tion of the BLS headquarters, which was fully funded in fiscal year
2022.
Within the total for BLS, the Committee provides the following
amounts:
FY 2023
Budget Activity Committee
Employment and Unemployment Statistics ................................................................................................... $261,454,000
Labor Market Information ............................................................................................................................... 68,000,000
Prices and Cost of Living .............................................................................................................................. 252,000,000
Compensation and Working Conditions ......................................................................................................... 92,976,000
Productivity and Technology ........................................................................................................................... 12,853,000
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Executive Direction and Staff Services .......................................................................................................... 39,051,000
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34
National Longitudinal Survey of Youth (NLSY).—The Committee
continues to recognize the importance of the National Longitudinal
Survey of Youth (NLSY), which has provided valuable information
about labor market trends for decades. The increase includes suffi-
cient resources to continue development of a new NLSY cohort.
Preserving Existing Statistical Work and Staff.—When imple-
menting the NLSY and other new investments, the Committee di-
rects BLS not to reduce or eliminate existing statistical work. Fur-
ther, the Committee directs BLS not to reduce the number of full-
time equivalent positions beyond the apportioned fiscal year 2022
full-time equivalent ceiling.
Nonprofit Sector Workforce.—The Committee recognizes the im-
portance of the nonprofit sector workforce as a critical partner to
government and a frontline service provider in communities nation-
wide and encourages BLS to examine the value in including non-
profit organizations as a distinct category of employer in quarterly
reports from its Quarterly Census of Employment and Wages
(QCEW).
Artificial Intelligence.—The Committee notes the continued de-
velopment of artificial intelligence and encourages BLS to examine
this trend’s impact on the economy.
Public Safety Telecommunicators.—The Committee recognizes
that categorizations of a ‘public safety telecommunicator’ as an ‘of-
fice and administrative support occupation’ is outdated and does
not reflect the nature of this life-saving work. The Committee en-
courages BLS to update data collection practices to be in line with
modern changes to the public safety telecommunications profession,
classifying them as a ‘protective service occupation’ and collecting
data accordingly.
Military Spouses.—The Committee recognizes the need for com-
prehensive data measuring employment among military spouses
over time. The Committee encourages BLS, in collaboration with
the Department of Defense, to assess the potential for measuring
labor market outcomes and characteristics of military spouses with
existing survey data and explore options for modifying such sur-
veys to capture this population.
BLS Data Collection Sources.—The Committee recognizes the
value and importance of real-time economic data for the purpose of
identifying economic trends and consumer sentiment. Further, as
the Department prepares future solicitations for economic data and
research, the Committee encourages the Department to conduct ro-
bust market research to identify potential new market entrants.
OFFICE OF DISABILITY EMPLOYMENT POLICY
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $40,500,000
Budget request, fiscal year 2023 ....................................................... 58,566,000
Committee Recommendation ............................................................. 58,566,000
Change from enacted level ......................................................... +18,066,000
Change from budget request ...................................................... –––
The Office of Disability Employment Policy (ODEP) provides pol-
icy guidance and leadership to eliminate employment barriers to
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people with disabilities.
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The Committee recommendation for ODEP is $58,566,000, which
is $18,066,000 above the fiscal year 2022 enacted level and the
same as the fiscal year 2023 budget request. The Committee is sup-
portive of the budget proposal for ODEP to support the planning
and implementation of Equitable Transition Model (ETM) projects
that will develop strategies to enable low-income youth with dis-
abilities, including youth experiencing homelessness, leaving foster
care, or involved in the justice system, to be more likely to transi-
tion to employment.
DEPARTMENTAL MANAGEMENT
SALARIES AND EXPENSES
Appropriation, fiscal year 2022 ......................................................... $367,697,000
Budget request, fiscal year 2023 ....................................................... 492,104,000
Committee Recommendation ............................................................. 498,917,000
Change from enacted level ......................................................... +131,220,000
Change from budget request ...................................................... +6,813,000
The Departmental Management appropriation provides funds for
the staff responsible for Departmental operations, management,
and policy development.
The Committee recommendation includes $498,609,000 from the
General Fund of the Treasury, $131,220,000 above the fiscal year
2022 enacted level and $6,813,000 above the fiscal year 2023 budg-
et request, and $308,000 from the Employment Security Adminis-
tration Account in the Unemployment Trust Fund.
Within the total for Departmental Management, the Committee
provides the following amounts:
FY 2023
Budget Activity Committee
Program Direction and Support ..................................................................................................................... $38,958,000
Departmental Evaluation ................................................................................................................................ 10,351,000
Legal Services ................................................................................................................................................ 178,183,000
International Labor Affairs ............................................................................................................................. 138,965,000
Administration and Management ................................................................................................................... 36,630,000
Adjudication .................................................................................................................................................... 42,836,000
Women’s Bureau ............................................................................................................................................. 35,361,000
Civil Rights Activities ..................................................................................................................................... 11,591,000
Chief Financial Officer ................................................................................................................................... 6,042,000
Office of the Solicitor (SOL).—The recommendation includes
$178,183,000 for SOL to bring enforcement actions on behalf of
DOL’s agencies. The SOL is encouraged to increase staffing levels
to assist in the development of investigations, negotiations, and liti-
gations to ensure workers get the relief they deserve.
Bureau of International Labor Affairs (ILAB).—Of the
$138,965,000 recommended for ILAB, the Committee directs the
Secretary to allocate not less than $40,500,000 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 crit-
ical funding for combatting child labor. The Committee directs
ILAB to use its fiscal year 2023 funding increase to place addi-
tional labor attaches in strategic countries, including, but not lim-
ited to, Honduras.
Flagship Reports on Child Labor and Forced Labor.—ILAB is di-
rected to continue its work on three key reports, including: DOL’s
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Findings on the Worst Forms of Child Labor; the List of Goods Pro-
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36
duced by Child Labor or Forced Labor; and, the List of Products
Produced by Forced or Indentured Child Labor. The Committee in-
cludes the resources requested in the fiscal year 2023 budget re-
quest for staff and contract costs to fulfill a new statutory mandate
requiring the List of Goods Produced by Child Labor or Forced
Labor to include goods that are produced with inputs that are pro-
duced with forced labor or child labor.
USMCA Implementation Act.—The Committee urges ILAB to use
USMCA Implementation 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 critical work through technical assistance that
strengthens the capacity of independent unions in USMCA priority
sectors. Further, ILAB can fund research and legal teams, includ-
ing through academic institutions, to develop sustainable programs
that train and support labor lawyers and researchers in priority
sectors. Finally, ILAB can support key USMCA objectives by fund-
ing innovative supply chain monitoring and accountability mecha-
nisms, focused on ensuring the effective recognition of workers’
rights to organize and collective bargaining in USMCA priority sec-
tors. Such efforts to develop necessary research, legal assistance
and monitoring mechanisms will collectively supplement and
strengthen core ILAB program to directly educate and train work-
ers to build independent unions.
In the fiscal year 2024 Congressional Budget Justification, ILAB
is directed to include spending plans for resources provided in the
USMCA Implementation Act for fiscal years 2020 through 2024.
Spending plans should include descriptions and amounts for
projects and staffing.
Child Labor in Cocoa.—The Committee is concerned about the
continued prevalence of child labor in the harvesting and produc-
tion of cocoa beans. Further, the Committee notes that while the
Child Labor Cocoa Coordinating Group (GLCCG) has facilitated
progress in the reduction of child labor in cocoa production, sub-
stantial levels of children remain engaged in child labor in the in-
dustry. The Committee is concerned about the progress of the
GLCCG in accordance with goals established in the Harkin-Engel
Protocol. The Committee encourages the Department to report on
indicators of progress being made by high-risk countries to elimi-
nate child labor and forced labor in the cocoa sector, including
progress being made to map all cocoa farms. In addition, the Com-
mittee encourages the Department to report on government and in-
dustry use of available best practices for management, reporting,
and verification, and on the active and meaningful participation of
worker organizations in order to provide consumers with assurance
that cocoa products are produced without the use of child labor and
forced labor.
Women’s Bureau.—Of the $35,361,000 appropriated to the Wom-
en’s Bureau, the Committee provides no less than $7,500,000 for
the Women in Apprenticeship and Nontraditional Occupations
(WANTO) program, which is $5,000,000 above the fiscal year 2022
enacted level and the fiscal year 2023 budget request. This pro-
gram helps employers and labor unions recruit, train, and retain
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women for nontraditional employment opportunities. These re-
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37
sources are essential in helping women overcome traditional bar-
riers to entry and supporting women’s full participation in the
labor force.
Operating Plan.—The Committee directs the Department to sub-
mit its annual Operating Plan to the Committees on Appropria-
tions within the 45-day statutory deadline.
Advertising Spending.—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 dis-
advantaged businesses and businesses owned by minorities and
women. The Committee directs the Department to include the fol-
lowing information in its fiscal year 2024 Congressional Budget
Justification: Expenditures for fiscal year 2022 and expected ex-
penditures for fiscal years 2023 and 2024, respectively, for (1) all
contracts for advertising services; and, (2) contracts for the adver-
tising services of‘(I) socially and economically disadvantaged small
business concerns (as defined in section 8(a)(4) of the Small Busi-
ness Act (15 U.S.C. 637(a)(4)); and (II) women- and minority-owned
businesses.
Nondisclosure Agreements.—The Committee recognizes that har-
assment, including sexual harassment and assault, continue to be
pervasive in the workplace, and that the use of predispute non-
disclosure and nondisparagement clauses as conditions of employ-
ment can perpetuate illegal conduct by silencing survivors and
shielding perpetrators. The Committee directs the Department to
include proposals in its fiscal year 2024 Congressional Budget Jus-
tification to eliminate the use of grants and contracts to employers
that use this practice.
National Equal Pay Enforcement Task Force.—The Committee
strongly urges the Secretary to establish a National Equal Pay En-
forcement Task Force (Task Force), consisting of representatives
from the Equal Employment Opportunity Commission, the Depart-
ment of Justice, the Department of Labor, and the Office of Per-
sonnel Management. The mission of the Task Force should be to
improve compliance, public education, and enforcement of equal
pay laws. The agencies in the Task Force should coordinate activi-
ties and limit potential gaps in enforcement. The Committee fur-
ther urges the Task Force to investigate challenges related to pay
inequity, advance recommendations to address those challenges,
and create action plans to implement the recommendations. The
Committee requests an update in the fiscal year 2024 Congres-
sional Budget Justification on steps to establish the Task Force.
Employees.—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 attri-
tion by principal office and appropriations account.
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 the Department are
serving these particular areas, the Committee directs the Depart-
ment to submit a report to the Committees on Appropriations on
the percentage of funds allocated by all competitive grant programs
in fiscal years 2020, 2021 and 2022 to serve individuals living in
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persistent poverty counties, as defined as a county that has had 20
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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 United States, and high-poverty
areas, as defined as any census tract with a poverty rate of at least
20 percent as measured by the 2014–2018 5-year data series avail-
able from the American Community Survey of the Census Bureau.
The Department shall report this information 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 competitive program for which at least 10 percent of the
funds allocated were not allocated to persistent poverty counties or
for which the percentage allocated to high-poverty areas in fiscal
year 2021 or 2022 was less than the average percentage of Federal
assistance allocated to high-poverty areas awarded under the pro-
gram in fiscal years 2017, 2018, and 2019, such report and briefing
shall explain why such a benchmark is unable to be met.
Study on the Health Impact of Pesticide Use on Children in Agri-
culture.—The Committee includes $1,000,000 for the Department
to contract with the National Academies of Sciences, Engineering,
and Medicine (NASEM) to study the impact of pesticide exposure
on children working in agriculture. Pesticides have a detrimental
effect on human health, with children among the particularly vul-
nerable, and low levels of pesticide exposure can affect children’s
neurological and behavioral development. The Committee encour-
ages NASEM to review other environmental hazard-related expo-
sures on children in agriculture as well.
Evidence-based Policymaking Act.—The Committee is supportive
of efforts by the Department to consider evidence of effectiveness
in grant competitions and requests an update in the fiscal year
2024 Congressional Budget Justification on implementation of the
Foundations for Evidence-based Policymaking Act (P.L. 115–435)
and implementation plans for the coming year. The Committee en-
courages the Secretary to develop guidance to ensure relevant par-
ticipants and grantees are involved in the Department-wide process
of prioritizing evidence needs, including participating in Depart-
ment led evaluations. Consistent with program statutes, the Com-
mittee encourages the Secretary to ensure that evidence of effec-
tiveness is a consideration in grant opportunities.
Organizational Priority Goals.—The Committee directs the De-
partment to comply with title 31 of the United States Code, includ-
ing the development of organizational priority goals and outcomes
such as performance outcome measures, output measures, effi-
ciency 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 2024 Congressional
Budget Justification.
Streamlining Service Delivery and Improving Customer Service.—
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
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required under 31 U.S.C. 1115. The Committee further directs the
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39
Department to include an update on the progress of these efforts
in the fiscal year 2024 Congressional Budget Justification.
Use of Force.—The Committee supports vigorous action to im-
prove training for all Federal, State, and local law enforcement offi-
cers on racial profiling, implicit bias, procedural justice, the use of
force, and the duty for officers to intervene when witnessing the
use of excessive force against civilians. The Committee therefore di-
rects the Secretary to work with the Attorney General and the Fed-
eral Law Enforcement Training Centers to implement improved,
mandatory training on these topics for all federal law enforcement
officers, along with the development of related standards that can
be applied in hiring and performance assessments. These training
requirements and standards should be based on the related provi-
sions in H.R. 1280, as passed by the House of Representatives in
March 2021.
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 requests a
briefing within 90 days of enactment of this Act on current efforts
to tabulate and submit use of force data to the FBI.
Inter-agency Collaboration.—The Committee identifies a need for
more inter-agency collaboration between the Department—includ-
ing WHD and OSHA—, Equal Employment Opportunity Commis-
sion, and the National Labor Relations Board to enforce labor and
civil rights laws fully and effectively. The Committee encourages
the agencies to review and evaluate current enforcement efforts, re-
scind harmful regulations and sub-regulatory guidance, and ensure
each agency is using all the tools and policies at their disposal to
protect workers. This includes robust coordinated outreach and
education to rebuild trust in government enforcement, especially in
communities of color.
Critical Minerals.—The Committee recognizes the importance of
critical minerals for use in the United States. In response to this
growing need, as part of the Consolidated Appropriations, Act of
2021 (P.L. 116–260), Congress authorized in section 7002 a work-
force assessment and workforce development program in the De-
partment of Labor to address mineral security. The Committee re-
quests an update on these efforts in the fiscal year 2024 Congres-
sional Budget Justification.
Residential Contractor Certification Program.—The Committee
encourages the Department to develop a system, similar to Energy
Star, to help consumers make informed decisions when hiring a
residential contractor to perform work. The Department should
work with labor unions and other stakeholders in developing such
a system. The Committee requests a briefing within 90 days of en-
actment of this Act on the Department’s plans to develop this sys-
tem.
VETERANS EMPLOYMENT AND TRAINING
Appropriation, fiscal year 2022 ......................................................... $325,341,000
Budget request, fiscal year 2023 ....................................................... 330,968,000
Committee Recommendation ............................................................. 338,841,000
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Change from enacted level ......................................................... +13,500,000
Change from budget request ...................................................... +7,873,000
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The recommendation includes $70,500,000 from the General
Fund of the Treasury and $268,341,000 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 2023
Budget Activity Committee
State Administration Grants .......................................................................................................................... $183,000,000
Transition Assistance Program ...................................................................................................................... 32,379,000
Federal Administration ................................................................................................................................... 49,548,000
Veterans Employment and Training Institute ................................................................................................ 3,414,000
Homeless Veterans Reintegration Program .................................................................................................... 70,500,000
The Committee recommendation includes $32,379,000 for the
Transition Assistance Program, which is the same as the fiscal
year 2022 enacted level and $1,000,000 more than the fiscal year
2023 budget request. This funding will enhance the quality of em-
ployment support services for transitioning service members and
allow VETS to develop and implement a course curriculum to help
military spouses overcome the challenges they face related to em-
ployment and career development.
The Committee includes $70,500,000 for the Homeless Veterans
Reintegration Program, which is $10,000,000 more than the fiscal
year 2022 enacted level and $8,000,000 more than the fiscal year
2023 budget request. Funds will be used to further support the
needs of veterans experiencing homelessness.
The Committee includes $500,000, which is the same as the fis-
cal year 2022 enacted level and the fiscal year 2023 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 2022 en-
acted level and the fiscal year 2023 budget request, to continue the
operation of the Disabled Veteran Program (DVP), which was initi-
ated by the Committee in fiscal year 2020. The DVP addresses the
high unemployment and low labor force participation rate of vet-
erans with service-connected and non-service-connected disabilities.
The DVP helps increase employment and advancement opportuni-
ties for veterans with disabilities by working with Federal, State,
and private partners to promote the hiring of veterans with disabil-
ities, improve coordination of available employment services and
supports, and to identify and share employment best practices for
hiring, retaining, and advancing veterans with disabilities in the
workforce.
Equity and Access for Homeless Veterans.—The Committee con-
tinues to direct the Department to include an update on racial eq-
uity and access to programs at the Department providing services
to homeless veterans in its fiscal year 2024 Congressional Budget
Justification. The update shall also track departmental expendi-
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gard to minority, female, and LGBTQ populations. Where avail-
able, the Department shall disaggregate data by ethnicity, age,
gender identity, and discharge status.
INFORMATION TECHNOLOGY MODERNIZATION
Appropriation, fiscal year 2022 ......................................................... $28,269,000
Budget request, fiscal year 2023 ....................................................... 47,969,000
Committee Recommendation ............................................................. 38,269,000
Change from enacted level ......................................................... +10,000,000
Change from budget request ...................................................... ¥9,700,000
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 2022 ......................................................... $90,847,000
Budget request, fiscal year 2023 ....................................................... 107,865,000
Committee Recommendation ............................................................. 99,028,000
Change from enacted level ......................................................... +8,181,000
Change from budget request ...................................................... ¥8,837,000
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 $93,187,000 from the General
Fund of the Treasury, which is $8,000,000 more than the fiscal
year 2022 enacted level, and $5,841,000 from the Employment Se-
curity Administration Account in the Unemployment Trust Fund.
Pandemic Unemployment Assistance.—The PUA program was de-
signed to ensure that critical emergency assistance was delivered
immediately, so it would be available to unemployed workers when
it was most needed. It is important to ensure that resources for
such critical emergency assistance during simultaneous public
health crisis and financial crisis should be targeted to individuals
and families who are eligible for benefits. The Committee supports
the Inspector General’s oversight activities and efforts to inves-
tigate any illegal schemes to defraud the PUA program.
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 continues a provision regarding trans-
fer authority.
Sec. 103. The Committee continues a prohibition on use of funds
to purchase goods that are in any part produced by indentured chil-
dren.
Sec. 104. The Committee continues a provision related to grants
made from funds available to the Department under the American
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Competitiveness and Workforce Improvement Act.
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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.
Sec. 111. The Committee continues a provision relating to Job
Corps.
Sec. 112. The Committee includes a new provision relating to the
Wagner-Peyser Act Staffing Flexibility regulation.
Sec. 113. The Committee includes a new provision relating to
regulations pertaining to industry recognized apprenticeship pro-
grams.
TITLE II—DEPARTMENT OF HEALTH AND HUMAN
SERVICES
HEALTH RESOURCES AND SERVICES ADMINISTRATION
Appropriation, fiscal year 2022 ......................................................... $8,891,772,000
Budget request, fiscal year 2023 ....................................................... 8,782,614,000
Committee Recommendation ............................................................. 9,574,521,000
Change from enacted level ......................................................... +682,749,000
Change from budget request ...................................................... +791,907,000
The Health Resources and Services Administration (HRSA) sup-
ports programs that provide health services to disadvantaged,
medically underserved, and special populations; decrease infant
mortality rates; assist in the education of health professionals; and
provide technical assistance regarding the utilization of health re-
sources and facilities.
The Committee recommendation for HRSA includes
$9,295,951,000 in discretionary budget authority, $256,370,000 in
mandatory funding and $15,200,000 in trust fund appropriations
for the Vaccine Injury Compensation Program Trust Fund, and
$7,000,000 for the Countermeasures Injury Compensation Pro-
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gram.
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PRIMARY HEALTH CARE
Appropriation, fiscal year 2022 ......................................................... $1,748,772,000
Budget request, fiscal year 2023 ....................................................... 1,839,022,000
Committee Recommendation ............................................................. 1,946,772,000
Change from enacted level ......................................................... +198,000,000
Change from budget request ...................................................... +107,750,000
Health Centers
The Committee recommends $1,945,772,000 for the Health Cen-
ters program, $198,000,000 above the fiscal year 2022 enacted level
and $107,750,000 above the fiscal year 2023 budget request. Health
Centers deliver affordable, accessible, quality, and cost-effective
primary health care to millions of people across the country regard-
less of their ability to pay. Programs supported by this funding in-
clude community health centers, migrant health centers, health
care for the homeless, and public housing health service grants.
The Committee includes bill language providing up to
$120,000,000 for the Federal Tort Claims Act program, the same
as the fiscal year 2022 enacted level and the fiscal year 2023 budg-
et request.
Alcee L. Hastings Program for Advanced Cancer Screening in Un-
derserved Communities.—The Committee appreciates the work and
leadership of HRSA to implement the Alcee L. Hastings Program
for Advanced Cancer Screening in Underserved Communities and
provides $15,000,000 for this activity, an increase of $10,000,000
above the fiscal year 2022 enacted level. This program is impera-
tive to redressing disparities in cancer screening in medically un-
derserved communities. In continuing to implement this program,
the Committee encourages HRSA to support approaches that lever-
age the use of community health workers and navigators providing
health services at the individual health center and, where appro-
priate, health center-controlled network level with training, over-
sight, and clinical workflow support from NCI-designated com-
prehensive cancer centers. Also, given the immense data sup-
porting the disparate impact of lung cancer on medically under-
served populations and the effectiveness of screening for this condi-
tion, the Committee strongly encourages HRSA to prioritize pro-
grams targeting lung cancer, such as screening and smoking ces-
sation counseling.
Early Childhood Development.—The Committee provides
$42,500,000 within the total for HRSA-funded Health Centers to
hire or contract for early childhood development specialists to bet-
ter integrate early developmental promotion services, as described
in the fiscal year 2023 budget request. The Committee encourages
HRSA to create a service expansion grant opportunity for health
centers, with training and technical assistance to be provided by
the Maternal and Child Health Bureau, which has a long-standing
commitment to improving the health and wellbeing of young chil-
dren and their families.
Ending the HIV Epidemic (EHE) Initiative.—The Committee pro-
vides $172,000,000 within the Health Centers program for the
EHE Initiative, $49,750,000 above the fiscal year 2022 enacted
level and the same as the fiscal year 2023 budget request. This ini-
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tions to increase the use of pre-exposure prophylaxis (PrEP) among
people at high risk for HIV transmission.
Health Care for the Homeless.—The Committee supports the ac-
tivities of the Health Care for the Homeless program, which pro-
vides funding to community-based health centers to provide low- or
no-cost health care to underserved populations using a trauma-in-
formed, harm reduction approach. Services provided by such health
centers include primary care, mental health treatment, substance
use treatment, medical respite care, case management, and enroll-
ment/benefits assistance.
Health Center Controlled Networks (HCCNs).—These networks
are the foundation of health information technology (HIT) services
for the nation’s community health centers. Health centers function
as the largest primary care network in the country, caring for 30
million patients. HCCNs are voluntary associations of community
health centers that band together to invest in HIT tools, optimize
the use of these technologies, digitally connect to health care and
community partners, and more. The HIT infrastructure requires ro-
bust Federal investment to support the demand caused by the
COVID–19 pandemic’s resulting shift in how health care is pro-
vided. The Committee encourages HRSA to provide robust support
for these networks and requests as part of the fiscal year 2024
Congressional Budget Justification an update on the status of the
network HIT infrastructure.
Integrating High-Quality Contraceptive Care.—The Committee is
aware that while most primary care physicians provide women’s
health services, many are not able to provide patients with a broad
range of contraceptive care options, including long-acting reversible
contraceptive methods that require specialized training and skill
development. The Committee includes $25,000,000 within the total
for Health Centers to support grants for training and quality im-
provement efforts to make available patient-centered contraceptive
care within health center primary care settings. Grantees may use
funds to support training and quality improvement to implement
best practices in contraceptive care, including reproductive health
screening, patient-centered contraceptive counseling, and access to
the full range of FDA-approved, cleared, or granted contraceptive
products that are determined by an individual’s medical provider
to be medically appropriate. These activities would improve health
equity, strengthen maternal health and prenatal care, and em-
power patients to decide if and when they want to become preg-
nant.
School-Based Health Centers (SBHCs) and Health Center School-
Based Service Sites.—Recognizing the critical role of Health Cen-
ters as part of our Nation’s health care safety net, and that Health
Centers providing services at sites located at schools within the
communities they serve are currently one of the most effective
sources of mental health care for children and adolescents, the
Committee includes $50,000,000, an increase of $20,000,000 above
the fiscal year 2022 enacted level, for awards to Health Centers op-
erating school-based service sites to increase their capacity to meet
the increasing demand for health services, including mental health
services. The Committee also includes $50,000,000 to make grants
to fund the School-Based Health Center Program and expand serv-
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ices at SBHCs pursuant to 42 USC 280h–5. SBHCs provide a con-
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venient access point to high-quality, comprehensive primary health
care, mental health services, preventive care, social services, and
youth development to primarily children and adolescents from low-
income families.
HRSA Strategy to Address Intimate Partner Violence and Project
Catalyst.—The Committee includes no less than $2,000,000 within
the total for Health Centers for the HRSA Strategy to Address Inti-
mate Partner Violence, the same as the fiscal year 2022 enacted
level.
Native Hawaiian Health Care Program.—The Committee pro-
vides $23,000,000 within the total for Health Centers for the Na-
tive Hawaiian Health Care Program, $1,000,000 above the fiscal
year 2022 enacted level and the fiscal year 2023 budget request.
The Native Hawaiian Health Care Systems help improve the
health status of Native Hawaiians by making health education,
health promotion, disease prevention, and Native Hawaiian tradi-
tional healing services available.
Of the total amount appropriated for the Native Hawaiian
Health Care Program, not less than $10,000,000 shall be provided
to Papa Ola Lokahi for administrative purposes authorized under
42 U.S.C. 11706, including expanded research and surveillance re-
lated to the health status of Native Hawaiians and strengthening
the capacity of the Native Hawaiian Health Care Systems to pro-
vide comprehensive health education and promotion, disease pre-
vention services, traditional healing practices, and primary health
services to Native Hawaiians.
Vaccination and Screening for Hepatitis B.—The Committee en-
courages HRSA to urge health center grantees to adopt the nec-
essary practices and policies to comply with the November 2021
Advisory Committee on Immunization Practices (ACIP) rec-
ommendation that all adults between 19 and 59 be vaccinated for
hepatitis B. To implement this policy, the Committee further en-
courages HRSA to ensure that Health Centers screen all individ-
uals for hepatitis B, offer to immunize all non-infected patients in
the 19–59 age cohort, and navigate infected individuals into care.
The Committee urges that this recommendation be implemented as
early as possible in fiscal year 2023.
Free Clinics Medical Malpractice
The Committee includes $1,000,000 for carrying out responsibil-
ities under the Federal Tort Claims Act, the same as the fiscal year
2022 enacted level and the fiscal year 2023 budget request. The
program provides medical malpractice coverage to individuals in-
volved in the operation of free clinics to expand access to health
care services to low-income individuals in medically underserved
areas.
HEALTH WORKFORCE
Appropriation, fiscal year 2022 ......................................................... $1,295,742,000
Budget request, fiscal year 2023 ....................................................... 1,619,884,000
Committee Recommendation ............................................................. 1,543,566,000
Change from enacted level ......................................................... +247,824,000
Change from budget request ...................................................... ¥76,318,000
The Bureau of Health Workforce strengthens the health care
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workforce by providing grants, scholarships, and loan repayment
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programs to help communities recruit and retain health care pro-
viders where they are most needed.
The Committee bill strikes language prohibiting HRSA funds
from being used to support section 340G–1 of the Public Health
Service Act (PHS Act), which authorizes demonstration projects to
train or employ alternative dental health care providers, including
dental therapists. Dental therapists are licensed providers who
play a similar role in dentistry to that of physician assistants in
medicine, and work under the supervision of a dentist to provide
routine dental care like exams and fillings. Ending this prohibition
on funding will give States flexibility to expand the oral health
workforce and improve access to dental care, particularly in rural
and underserved communities.
Impact of the COVID–19 Pandemic on the Health Workforce.—
The Committee looks forward to receiving the report requested in
House Report 117–96 on the impact of the COVID–19 public health
emergency on the nursing workforce and encourages HRSA to con-
tinue to analyze and make information available about the impact
of the pandemic on the broader health care workforce and strate-
gies to mitigate and address these impacts.
Registered Nursing Shortages.—The Committee is concerned
about current and projected shortages of registered nurses in the
U.S. as discussed in the HRSA publication Supply and Demand
Projections of the Nursing Workforce 2014–2030. The Committee
encourages HRSA to prioritize investments to increase the supply
of registered nurses particularly in states with the greatest pro-
jected shortages.
Report and Analysis of Technology’s Role in the Health Care
Workforce.—The Committee recognizes the important role that
HHS and its operating divisions continue to provide to support and
protect the public health workforce during the COVID–19 pan-
demic. The Committee directs HRSA to submit a report to the
Committee within 18 months of enactment of this Act on the chal-
lenges associated with hiring, recruiting, and retaining the Federal,
State, local, Tribal and territorial public health workforce. This
study should include a specific analysis of how technology, espe-
cially hands-free technology, could help to protect clinicians’ phys-
ical safety and ease the burden of patient care, thereby increasing
retention of the public health workforce.
Grant-Based Program to Include Disability Clinical Care Com-
petency Training.—The Committee strongly encourages HRSA to
consider implementation of 42 U.S.C. 293, to develop a grant-based
program in collaboration with the National Council on Disability,
professional societies, licensing and accreditation entities, health
professions schools, experts in minority health and cultural com-
petency, and public health and disability groups, and community-
based organizations to expand upon the National Initiative In De-
velopmental Medicine: Draft Curriculum, which targets a patient
population of adults with intellectual and developmental disabil-
ities, to include disability clinical care competency training inclu-
sive of all disability patient subpopulations (e.g. deaf, blind, mobil-
ity disabilities, etc.).
Addressing Workforce Shortages.—The Committee supports
HRSA’s efforts to develop the workforce needed to care for a rap-
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idly aging U.S. population. The Committee encourages HRSA to ad-
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dress the skilled care workforce needs of seniors through existing
workforce education and training programs.
National Health Service Corps (NHSC)
The Committee includes $155,600,000, an increase of $34,000,000
above the fiscal year 2022 enacted level, for NHSC to support com-
petitive awards to health care providers dedicated to working in
underserved communities in urban, rural, and tribal areas. Within
this total, the Committee includes an increase of $10,000,000 for
loan repayment for mental and behavioral health providers, includ-
ing peer support specialists, that serve in crisis centers, as de-
scribed in the fiscal year 2023 budget request. The Committee also
includes $15,600,000, the same as the fiscal year 2022 enacted
level, within the total to support NHSC awards to participating in-
dividuals that provide health services in IHS facilities, Tribally-Op-
erated Health Programs, and Urban Indian Health Programs.
Behavioral Health Demonstration Program.—The Committee
notes that racial and ethnic minority communities continue to face
acute challenges accessing behavioral health services due to the
lack of providers who speak their language or understand their cul-
ture. The Committee includes $10,000,000 within NHSC for a pilot
program to evaluate the benefit to patient access and practitioner
recruitment and retention of increasing loan repayment of upwards
of $15,000 above the maximum amount for qualified behavioral
health providers serving in Federally Qualified Health Centers
(FQHCs), preferably at which at least 20 percent of patients are
best served in a language other than English. The Committee notes
that if the qualified behavioral health provider is fluent in a lan-
guage other than English or is determined by the health center to
have achieved fluency in a language other than English during the
provider’s period of obligated service, the provider shall be paid
$15,000 above the maximum amount. The Committee also directs
HRSA to include an assessment of program utilization and impact
in the annual NHSC report to Congress.
Maternity Care Target Areas (MCTAs).—The Committee includes
$5,000,000, $4,000,000 above the fiscal year 2022 enacted level and
the same as the fiscal year 2023 budget request, within NHSC to
implement requirements contained in the Improving Access to Ma-
ternity Care Act, including establishing criteria for and identifying
MCTAs and collecting and publishing data on the availability and
need for maternity care health services in Health Professional
Shortage Areas (HPSAs).
NHSC Loan Repayment Application Process.—The Committee is
concerned that HPSA designations may not arrive in time for pro-
vider to apply for loan forgiveness through the NHSC loan repay-
ment program, and therefore must wait for the loan forgiveness ap-
plication to reopen. Given the loan repayment program is a critical
component to attract providers—particularly those in critically
needed fields like behavioral health—the Committee is concerned
that the timeline for HPSA designation process and the timeline
for NHSC loan repayment are inconsistent and could deter pro-
viders from participating in the NHSC. The Committee requests a
report within 90 days of enactment of this Act assessing the coordi-
nation of the two processes, and any improvements that could be
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made to ensure all providers working in a HPSA are eligible for the
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NHSC student loan repayment program as soon as they are hired
or the HPSA is designated during the calendar year.
Rural Demonstration Program.—The Committee notes that rural
communities continue to face acute workforce challenges, with ap-
proximately five percent of incoming medical students coming from
rural areas and only one-third of NHSC placements in rural com-
munities. The Committee includes $10,000,000 within NHSC to
conduct a pilot program to evaluate the benefit to patient access
and practitioner recruitment and retention of extending loan repay-
ment for 5 years and $200,000 for providers serving in a rural
HPSA. The Committee directs HRSA to submit a report to the
Committee within a year of enactment of this Act on program utili-
zation and impact.
Health Professions Training for Diversity
The Committee supports programs that improve the diversity of
the health care workforce. HRSA’s diversity pipeline programs, in-
cluding the Health Careers Opportunity Program, Centers for Ex-
cellence, Faculty Loan Repayment, Nursing Workforce Diversity,
and Scholarships for Disadvantaged Students, help advance patient
care and ensure opportunity for all health care providers.
Centers of Excellence (COEs).—The Committee includes
$30,422,000 for COEs, $6,000,000 above the fiscal year 2022 en-
acted level. This program provides grants to health professions
schools and other institutions to serve as resource and education
centers for the recruitment, training, and retention of underrep-
resented minority students and faculty.
Health Careers Opportunity Program (HCOP).—The Committee
includes $18,500,000 for HCOP, $3,050,000 above the fiscal year
2022 enacted level and the same as the fiscal year 2023 budget re-
quest. The Committee notes that HCOPs assist students from mi-
nority and economically disadvantaged backgrounds to navigate ca-
reers in the health professions. The Committee encourages HRSA
to continue its improvement of the diversity and distribution of
needed health care professionals through the National HCOP Acad-
emies.
Faculty Loan Repayment.—The Committee includes $1,500,000
for Faculty Loan Repayment, $274,000 above the fiscal year 2022
enacted level. This program provides loan repayment to health pro-
fession graduates from disadvantaged backgrounds who serve as
faculty at eligible health professions academic institutions.
Scholarships for Disadvantaged Students (SDS).—The Com-
mittee includes $56,014,000 for SDS, $3,000,000 above the fiscal
year 2022 enacted level and $4,044,000 above the fiscal year 2023
budget request. This program provides grants to health professions
and nursing schools to provide scholarships to students from dis-
advantaged background who have financial need.
Set-Aside for Midwifery Training.—Within the total for SDS, the
Committee includes $5,000,000, $1,500,000 above the fiscal year
2022 enacted level, to increase the number of grants awarded for
the purpose of educating midwives to address the national shortage
of maternity care providers, and specifically the lack of adequate
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diversity in the maternity care workforce.
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Primary Care Training and Enhancement
The Committee includes $54,924,000, an increase of $6,000,000
above the fiscal year 2022 level and $1,000,000 above the fiscal
year 2023 budget request, for Primary Care Training and Enhance-
ment programs, which support training and direct financial assist-
ance for future primary care clinicians, teachers, and researchers.
The Committee includes funding to support the proposal in the fis-
cal year 2023 budget request to make grants to support mental
health training for primary care professionals.
Eating Disorders Screening, Brief Intervention, Referral, and
Treatment (SBIRT).—The COVID–19 pandemic worsened eating
disorders across the Nation, with one study reporting a significant
increase in eating disorder caseloads in children’s hospitals. De-
spite the medical and psychiatric acuity associated with eating dis-
orders, many patients remain undetected and untreated, as only 20
percent of surveyed medical residency programs offer elective train-
ing in eating disorders and only six percent require such training.
Within the total for Primary Care Training and Enhancement, the
Committee provides up to $1,000,000, in coordination with
SAMHSA’s Center of Excellence for Eating Disorders, to provide
trainings for primary care health professionals to screen, briefly in-
tervene, and refer patients to treatment for the severe mental ill-
ness of eating disorders, as authorized under section 13006 of the
21st Century Cures Act.
Oral Health Training
The Committee includes $42,173,000 for Oral Health Training,
$1,500,000 above the fiscal year 2022 enacted level and the fiscal
year 2023 budget request. The Committee directs that this in-
creased funding be allocated to General Dentistry Programs, Pedi-
atric Dentistry Programs, and State Oral Health Workforce Im-
provement Grants. The Committee directs HRSA to provide con-
tinuation funding for section 748 post-doctoral training grants ini-
tially awarded in fiscal year 2020 and dental faculty loan repay-
ment program (DFLRP) grants initially awarded in fiscal years
2021 and 2022. The Committee also directs HRSA to initiate a new
DFLRP grant cycle with a preference for pediatric dentistry faculty
supervising dental students or residents and providing clinical
services in dental clinics located in dental schools, hospitals, and
community-based affiliated sites.
Action for Dental Health.—With the enactment of the Action for
Dental Health Act of 2018, the Committee encourages HRSA to ex-
pand oral health grants for innovative programs under PHS Act
Section 340G to include Action for Dental Health activities. The Ac-
tion for Dental Health program helps reduce barriers to dental care
through oral health education, prevention, and the establishment
of dental homes for underserved populations.
Interdisciplinary Community-Based Linkages
Area Health Education Centers (AHEC).—The Committee in-
cludes $48,000,000 for the AHEC program, an increase of
$3,000,000 above the fiscal year 2022 level and $4,750,000 above
the fiscal year 2023 budget request. This program links university
health science centers with community health service delivery sys-
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tems to provide education and training networks.
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Patient Safety Telesimulation Programs.—The Committee en-
courages HRSA to support the development and implementation of
patient safety telesimulation programs. Allowable use of these
funds may include increasing virtual content delivery capacity at
modeling simulation centers, establishing partnerships with med-
ical schools in providing telesimulation programs, developing tele-
simulation content and devices, developing appropriate governance
on data and data management, and outfitting HPSA locations with
necessary telesimulation hardware and software assets.
Geriatrics Workforce Enhancement Program (GWEP).—The Com-
mittee includes $48,245,000 for the GWEP program, $3,000,000
above the fiscal year 2022 level and $1,708,000 above the fiscal
year 2023 budget request. This program supports training to inte-
grate geriatrics into primary care delivery and develops academic-
primary care-community based partnerships to address gaps in
health care for older adults.
Mental and Behavioral Health Programs.—The Committee in-
cludes $44,053,000 for Mental and Behavioral Health Programs, an
increase of $5,000,000 above the fiscal year 2022 level.
Adolescent Addiction Medicine and Addiction Psychiatry Work-
force.—The Committee remains concerned by the lack of pediatric
and adolescent addiction medicine and addiction psychiatry exper-
tise. Currently, there are insufficient opportunities to effectively
train a robust mental health and substance use disorder (SUD)
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. The Committee strongly encour-
ages HRSA to include an adequate number of funding awards to
fellowship programs focused on increasing the number of board cer-
tified pediatric and adolescent addiction medicine and addiction
psychiatry subspecialists.
Graduate Psychology Education (GPE).—Within the total for
Mental and Behavioral Health Programs, the Committee rec-
ommendation includes $25,000,000, $5,000,000 above the fiscal
year 2022 enacted level, for the interprofessional GPE program to
increase the number of health service psychologists trained to pro-
vide integrated services to high-need, underserved populations in
rural and urban communities. The Committee recognizes the se-
vere impact of COVID–19 on Americans’ mental and behavioral
health and urges HRSA to strengthen investments in the training
of health service psychologists to help meet these demands.
Behavioral Health Workforce Education and Training
(BHWET).—The Committee includes $185,000,000 for the BHWET
Program, $62,000,000 above the fiscal year 2022 enacted level. This
program establishes and expands internships or field placement
programs in behavioral health, serving populations in rural and
medically underserved areas.
The Committee is concerned that increased gun violence and the
pandemic’s exacerbation of health disparities has unveiled an im-
mediate and desperate need for behavioral health professionals, in-
cluding social workers, psychologists, counselors, occupational
therapists, and psychiatrists. Neuropsychiatrists and advanced
practice behavioral nurses are specially trained to diagnose mood
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disorders or biochemical imbalances. A HRSA report, however,
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found that there will be a shortage of 250,000 mental health pro-
fessionals by 2025. The Committee supports increased funding for
BHWET to increase the quality and supply of behavioral health
professionals and access to behavioral health services, in particular
for children, adolescents, and transitional-aged youth at risk for be-
havioral health disorders. The Committee encourages HRSA to con-
tinue to collect data and analyze the scope of the shortage of behav-
ioral health professionals and barriers to careers in behavioral
health.
Behavioral Health Integration Into Community-Based Settings.—
The Committee includes $10,000,000, the same as the fiscal year
2023 budget request, to provide grants to community-based organi-
zations and local health departments to integrate navigators and
community health workers trained in Mental Health First Aid or
similar trainings into non-traditional community settings. This ef-
fort will be carried out in partnership with the Maternal and Child
Health Bureau and will help to address the behavioral health
needs of families in underserved communities.
Community Improvement Program.—The Committee includes
$10,000,000, the same as the fiscal year 2023 budget request, to de-
velop and expand community-based experiential training through
internships and field placements for behavioral health and behav-
ioral health-related professionals to prepare them to work with and
support individuals who are involved, or at risk of being involved,
in the criminal justice system.
Crisis Workforce Development.—The Committee includes
$15,000,000 for grants to support crisis workforce development.
Crisis service models present opportunities for cost savings and
more effective use of the behavioral health workforce by stabilizing
individuals experiencing behavioral health crises in less intensive
settings.
Mental and Substance Use Disorder Workforce Training Dem-
onstration.—The Committee includes $34,700,000 for this activity,
$3,000,000 above the fiscal year 2022 enacted level and $700,000
above the fiscal year 2023 budget request. This program makes
grants to institutions, including but not limited to medical schools
and FQHCs, to support training for medical residents and fellows
in psychiatry and addiction medicine, as well as nurse practi-
tioners, physician assistants, and others, to provide SUD treatment
in underserved communities.
Peer Support Specialists in the Opioid Use Disorder Workforce.—
Within the total for BHWET, the Committee includes $14,000,000,
the same as the fiscal year 2022 enacted level, to fund training, in-
ternships, and national certification for mental health and SUD
peer support specialists to create an advanced peer workforce pre-
pared to work in clinical settings.
Social Workers.—While the Committee is aware that the behav-
ioral health workforce is seeing shortages in all professions, the
Committee encourages HRSA to ensure that social workers are re-
ceiving equitable treatment from the program given their multi-
faceted roles in health care settings. Additionally, the Committee
encourages HRSA to ensure that program awardees are actively
working to recruit a diverse field of behavioral health professionals.
Substance Use Disorder Treatment and Recovery (STAR) Loan
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Repayment Program.—The Committee includes $28,000,000 for this
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program, $4,000,000 above the fiscal year 2022 enacted level and
the same as fiscal year 2023 budget request. An estimated 21 mil-
lion Americans needed treatment for SUD in 2017, but only 4 mil-
lion received any form of treatment for SUD. The Bureau of Labor
Statistics data has cited tremendous workforce shortages in the
SUD treatment profession. Without strategic investments in the
SUD workforce, this gap will not close and more lives will be lost.
This program addresses shortages in the SUD workforce by pro-
viding for the repayment of education loans for individuals working
in a full-time SUD treatment job that involves direct patient care
in either a Mental Health Professional Shortage Area or a county
where the overdose death rate exceeds the national average.
National Center for Health Workforce Analysis (NCHWA)
The Committee includes $6,663,000, $1,000,000 above the fiscal
year 2022 enacted level and the fiscal year 2023 budget request, for
the NCHWA. This program collects and analyzes health workforce
data to provide information on health workforce supply and de-
mand.
Public Health and Preventive Medicine Training Programs
The Committee includes $18,000,000 for Public Health and Pre-
ventive Medicine Training Grant Programs, $1,000,000 above the
fiscal year 2022 enacted level and the same as the fiscal year 2023
budget request. Within this total, the Committee provides an in-
crease of $500,000 for the Preventive Medicine Residency Training
Program and an increase of $500,000 for Public Health Training
Centers.
Nursing Workforce Development
The Committee recommends $324,472,000 for Nursing Workforce
Development programs authorized under title VIII of the PHS Act,
$44,000,000 above the fiscal year 2022 enacted level and
$29,500,000 above the fiscal year 2023 budget request.
Expanding Access to Nursing Education.—The Committee re-
mains concerned about workforce shortages among health care pro-
fessionals, including the nursing workforce. According to the Amer-
ican Hospital Association, nursing vacancies increased by nearly 30
percent between 2019 and 2020, with an additional 500,000 nurses
expected to retire or leave the profession by the end of this year.
Recent studies suggest that an additional 1.2 million nurses will be
required in the U.S. by 2030 to meet anticipated demand, with
States like California, Texas, and Florida projected among those
with the greatest need. The Committee also recognizes that nurs-
ing schools across the U.S. are struggling to expand capacity to
meet this rising demand for care. Significant shortages of faculty,
classroom space, and clinical training sites are commonly identified
as factors in nursing schools turning away qualified applicants in
many areas of the country. The Committee supports efforts to ex-
pand access to educational opportunities at accredited nursing
schools to qualified applicants, including low-income and minority
students, to meet this growing demand for nursing professionals.
Experiential Learning Opportunities.—The Committee is aware
that mental health is one of the most in-demand skills in nursing,
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but many nurse education training programs do not expose stu-
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dents to mental health care settings. The Committee encourages
HRSA to give priority to experiential learning opportunities grant-
ees that are partnering with behavioral and mental health hos-
pitals to increase the pipeline of nurses into this field.
Advanced Nursing Education.—The Committee includes
$105,581,000 for Advanced Nursing Education, $26,000,000 above
the fiscal year 2022 enacted level and the same as the fiscal year
2023 budget request. This program supports traineeships and fac-
ulty and curriculum development to increase the number of quali-
fied nurses in the primary care workforce.
Maternal and Perinatal Nursing Workforce Program.—Within
the total for Advanced Nursing Education, the Committee includes
$20,000,000 to increase and diversify the number of certified nurse
midwives, with a focus on practitioners working in rural and un-
derserved communities, as described in the fiscal year 2023 budget
request. These funds will support grants to accredited nurse mid-
wifery programs or other eligible entities to award scholarships to
students and registered nurses to cover the total cost of tuition for
the duration of the nurse midwifery program, as well as the plan-
ning/development of new midwife training programs.
Nursing Education, Practice, Quality, and Retention (NEPQR).—
The Committee includes $56,413,000 for NEPQR, $2,000,000 above
the fiscal year 2022 enacted level and $7,500,000 above the fiscal
year 2023 budget request. This program supports academic, serv-
ice, and continuing education projects to enhance nursing edu-
cation, improve the quality of care, increase nurse retention, and
strengthen the nursing workforce.
Nurse Practitioner Optional Fellowship Program.—The Com-
mittee provides $6,000,000, the same as the fiscal year 2022 en-
acted level, for grants to establish or expand community-based
nurse practitioner residency and fellowship training programs for
practicing postgraduate nurse practitioners in primary care or be-
havioral health, as described in House Report 117–96.
Nursing Workforce Diversity.—The Committee includes
$26,343,000 for Nursing Workforce Diversity, $3,000,000 above the
fiscal year 2022 enacted level and the fiscal year 2023 budget re-
quest. This program increases nursing education opportunities for
individuals from disadvantaged backgrounds by providing student
stipends, scholarships, and preparation and retention activities.
Nurse Corps Scholarship and Loan Repayment.—The Committee
includes $101,635,000 for Nurse Corps, $13,000,000 above the fis-
cal year 2022 enacted level and the fiscal year 2023 budget request.
This program supports scholarships and loan repayment assistance
for nurses and nursing students committed to working in commu-
nities with inadequate access to care.
Nursing Faculty Loan Program.—The Committee includes
$28,500,000 for the Nursing Faculty Loan Program, the same as
the fiscal year 2022 enacted level and the fiscal year 2023 budget
request. This program supports schools of nursing to provide loans
to students enrolled in advanced nursing education programs who
are committed to becoming nurse faculty.
Children’s Hospitals Graduate Medical Education (CHGME)
The Committee includes $385,000,000 for the CHGME payment
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program, $10,000,000 above the fiscal year 2022 enacted level and
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$35,000,000 above the fiscal year 2023 budget request. This pro-
gram helps eligible hospitals maintain graduate medical education
programs, which support the training of residents to care for the
pediatric population and enhance the supply of primary care and
pediatric medical and surgical subspecialties.
Medical Student Education
The Committee includes $60,000,000, $5,000,000 above the fiscal
year 2022 enacted level, to support colleges of medicine at public
universities located in the top quartile of States projected to have
a primary care provider shortage. The Committee directs HRSA to
give priority to applications from academic institutions located in
States with the greatest number of Federally-recognized Tribes.
The Committee also directs HRSA to give priority to applications
from public universities with a demonstrated public-private part-
nership.
Pediatric Subspecialty Loan Repayment Program
The Committee includes $15,000,000, an increase of $10,000,000
above the fiscal year 2022 enacted level, for the Pediatric Sub-
specialty Loan Repayment Program authorized in section 775 of
the PHS Act. The Committee recognizes that there are significant
shortages of pediatric subspecialists, child psychiatrists, and other
child mental health providers in underserved areas. The Com-
mittee also understands that high graduate debt load is a signifi-
cant barrier to providers choosing to complete additional training
to enable them to provide specialized care for children with special
medical and mental health care needs.
Public Health Loan Repayment Program
The Committee includes $25,000,000 to establish the Public
Health Loan Repayment Program. Funds will support loan repay-
ment for public health professionals who agree to serve three years
in a local, State, or tribal health department. This investment in
the public health workforce will contribute to our Nation’s pre-
paredness to address current and future public health emergencies.
Preventing Burnout in the Health Workforce Program
The Committee includes $25,000,000 for activities authorized in
the Dr. Lorna Breen Health Care Provider Protection Act (P.L.
117–105) to provide comprehensive and evidence-based support to
prevent suicide, burnout, and mental and behavioral health condi-
tions among health care providers.
National Practitioner Data Bank (NPDB)
The Committee includes $18,814,000 for the NPDB, the same as
the fiscal year 2022 enacted level and the fiscal year 2023 budget
request. The NPDB is a workforce tool that collects and discloses
information to authorized entities on past adverse actions of health
care practitioners, providers, and suppliers to reduce fraud and
abuse and improve health care quality.
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MATERNAL AND CHILD HEALTH
Appropriation, fiscal year 2022 ......................................................... $1,044,470,000
Budget request, fiscal year 2023 ....................................................... 1,272,930,000
Committee Recommendation ............................................................. 1,201,296,000
Change from enacted level ......................................................... +156,826,000
Change from budget request ...................................................... ¥71,634,000
The mission of the Maternal and Child Health Bureau (MCHB)
is to improve the physical and mental health, safety, and well-
being of the Nation’s women, infants, children, adolescents, and
their families.
Maternal and Child Health (MCH) Block Grant
The Committee recommends $872,700,000 for the MCH Block
Grant, $125,000,000 above the fiscal year 2022 enacted level.
States use the MCH Block Grant to improve access to care for
mothers, children, and their families; reduce infant mortality; pro-
vide pre-and post-natal care; support screening and health assess-
ments for children; and provide systems of care for children with
special health care needs.
MCH Block Grant Special Projects of Regional and National Sig-
nificance
The Committee continues bill language identifying specific
amounts for Special Projects of Regional and National Significance
(SPRANS). The Committee provides the following within SPRANS:
FY 2023
Budget Activity Committee
Set-aside for Oral Health ............................................................................................................................... $5,250,000
Set-aside for Epilepsy .................................................................................................................................... 3,642,000
Set-aside for Sickle Cell Disease ................................................................................................................... 7,000,000
Set-aside for Fetal Alcohol Syndrome ............................................................................................................ 1,000,000
Addressing Emerging Issues and Social Determinants of Mater-
nal Health.—The Committee includes $10,000,000 to create an in-
novation fund for community-based organizations to support reduc-
ing maternal mortality and adverse maternal outcomes, as de-
scribed in the fiscal year 2023 budget request. Projects may include
expanding access to maternal mental health and SUD services, pro-
viding resources to address social determinants of maternal health,
developing digital tools to enhance maternal health care, and tech-
nology-enabled collaborative learning and capacity building models
for pregnant and postpartum women.
Alliance for Innovation in Maternal Health Safety Bundles.—The
Committee includes $15,300,000, an increase of $3,300,000 above
the fiscal year 2022 enacted level and the same as the fiscal year
2023 budget request, to support continued implementation of the
Alliance for Innovation on Maternal Health program’s maternal
safety bundles to all U.S. States, the District of Columbia, and U.S.
territories, as well as tribal entities. Maternal safety bundles are
a set of targeted and evidence-based best practices that, when im-
plemented, improve patient outcomes and reduce maternal mor-
tality and severe maternal morbidity.
Behavioral Health Integration Into Community-Based Settings.—
The Committee includes $40,000,000, the same as the fiscal year
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2023 budget request, to provide grants to engage and train commu-
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nity partners in underserved communities to link mothers and chil-
dren with resources to address their mental and behavioral health
needs, as well as children’s social and emotional development. This
effort will be carried out in partnership with the Behavioral Health
Workforce Education and Training program.
Bias Recognition in Clinical Skills Testing.—The Committee in-
cludes $1,000,000, the same as the fiscal year 2023 budget request,
to support a National Academies of Sciences, Engineering, and
Medicine (NASEM) study authorized under Subtitle D, Sec. 133 of
the fiscal year 2022 Consolidated Appropriations Act (P.L. 117–
103) to make recommendations for incorporating bias recognition in
clinical skills testing for accredited schools of allopathic medicine
and osteopathic medicine.
Bias Training for Health Care Professionals.—The Committee in-
cludes $2,000,000 to make grant awards to train health care pro-
viders on identifying and avoiding implicit bias, as described in the
fiscal year 2023 budget request.
Congenital Syphilis (CS).—The Committee is concerned with the
rise in CS. A recent report by CDC cited data showing a 300 per-
cent increase in CS over the past five years. Those born with CS
can have skeletal and facial deformities, deafness, blindness, be
still born, or die shortly after birth. These conditions and deaths
are completely preventable with expanded prenatal screening and
appropriate treatment. The Committee urges HRSA to expand ef-
forts to increase multiple prenatal screening and testing for CS
throughout pregnancies to detect and treat CS at the earlier pos-
sible stage. Assuring that providers are trained on the rec-
ommended treatment of syphilis in pregnant women is a critical
component of eliminating CS.
Early Childhood Development Expert Grants.—The Committee
includes $10,000,000, $5,000,000 above the fiscal year 2022 enacted
level, to support the placement of early childhood development ex-
perts in pediatric settings with a high percentage of Medicaid and
Children’s Health Insurance Program patients. Funds will support
additional State-level awards and related technical assistance with
nationwide reach.
Group Prenatal and Postpartum Care Programs.—The Com-
mittee recognizes the important role of group prenatal and
postpartum care (GPC/PC) programs, such as Centering Pregnancy,
can have on improving prenatal care and providing support for ex-
pecting mothers. GPC/PC programs provide the opportunity for ex-
pectant mothers to learn more about pregnancy, a network of social
support, educational tools, and ultimately work towards lowering
rates of infant and maternal mortality. The Committee includes
$2,000,000 within SPRANS for grants to establish new or support
existing GPC/PC programs.
Growing and Diversifying the Doula Workforce Program.—The
Committee includes $10,000,000 to provide grants to community-
based organizations to develop and/or expand programs to recruit
doula candidates, support their training/certification, and then em-
ploy them as doulas to support improved birth outcomes in the
community, as described in the fiscal year 2023 budget request.
Hereditary Hemorrhagic Telangiectasia (HHT) Centers of Excel-
lence.—The Committee includes $2,000,000 for HHT Centers of Ex-
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cellence. This funding supports coordination and expansion of care
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for HHT patients and participation in a prospective, longitudinal
registry of HHT patients to better understand this rare disease and
accelerate the development of new diagnostic and treatment op-
tions.
Infant-Toddler Court Teams.—The Committee includes
$18,000,000 for research-based Infant-Toddler Court Teams to
change child welfare practices to improve well-being for infants,
toddlers, and their families. The Committee directs HRSA to allo-
cate the funding increase of $5,000,000 above the fiscal year 2022
enacted level to existing court team grantees.
Maternal Mental Health Hotline.—The Committee includes
$7,000,000, an increase of $3,000,000 above the fiscal year 2022
level and the same as the fiscal year 2023 budget request, to sup-
port the maternal mental health hotline. The COVID–19 pandemic
has exacerbated maternal mental health conditions, with pregnant
and new mothers experiencing anxiety and depression at a three
to four times higher rate than prior to the pandemic. The hotline
should provide 24 hours a day voice and text support that is cul-
turally and linguistically appropriate. Funds provided should also
be used to raise public awareness about maternal mental health
issues and the hotline.
Minority-Serving Institutions.—The Committee includes
$5,000,000 to establish a research network to support minority-
serving institutions to study health disparities in maternal health
outcomes, as described in the fiscal year 2022 budget request.
Oral Health and Primary Care Integration.—The Committee in-
cludes $5,250,000 to continue demonstration projects to increase
the implementation of integrating oral health and primary care
practice. The projects should model the core clinical oral health
competencies for non-dental providers that HRSA published and
initially tested in its 2014 report Integration of Oral Health and
Primary Care Practice. The Committee encourages the Chief Den-
tal Officer to continue to provide leadership in the design, moni-
toring, oversight, and implementation of the demonstration
projects.
Pregnancy Medical Home Demonstration.—The Committee in-
cludes $10,000,000 to support a demonstration providing incentives
to maternal health care providers to provide integral health care
services to pregnant women and new mothers, with the goal of re-
ducing adverse maternal health outcomes and maternal deaths, as
described in the fiscal year 2023 budget request. The Integrated
Services for Pregnant and Postpartum Women Program will award
grants to establish or operate programs to deliver integrated health
care services to pregnant and postpartum women to optimize ma-
ternal and infant health outcomes.
Regional Pediatric Pandemic Network.—The Committee provides
$18,000,000, the same as the fiscal year 2022 enacted level, to con-
tinue support for coordination among the Nation’s pediatric hos-
pitals and their communities in preparing for and coordinating
timely research-informed responses to future pandemics.
State Maternal Health Innovation Grants.—The Committee in-
cludes $39,000,000, $10,000,000 above the fiscal year 2022 enacted
level, for State Maternal Health Innovation Grants to establish
demonstrations to implement evidence-based interventions to ad-
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dress critical gaps in maternity care service delivery and reduce
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maternal mortality. The demonstrations should be representative
of the demographic and geographic composition of communities
most affected by maternal mortality.
Fetal, Infant, and Child Death Review (FIDCR).—The Committee
includes no less than $3,100,000, an increase of $1,000,000 above
the fiscal year 2022 enacted level, for the FIDCR program to ex-
pand support and technical assistance to States and tribal commu-
nities and improve the availability of data on sudden unexpected
infant deaths.
Uterine Fibroids Public Health Information Dissemination.—The
Committee encourages HRSA to work with partners to advance
awareness of uterine fibroids and promote evidence-based care for
women with fibroids. These efforts may include specific information
on minority women, who have an elevated risk to develop uterine
fibroids, and the range of available options for the treatment of
symptomatic uterine fibroids, including non-hysterectomy drugs
and devices approved under the Federal Food, Drug, and Cosmetic
Act in these awareness efforts. The Committee encourages HRSA
to work with health care-related specialty societies and health sys-
tems, as appropriate, to promote awareness of evidence-based care
for women with fibroids.
Maternal and Child Health Programs
Sickle Cell Anemia Demonstration Program
The Committee includes $8,205,000 for this program, an increase
of $1,000,000 above the fiscal year 2022 enacted level and the fiscal
year 2023 budget request. The Committee recognizes the impor-
tance of the program in supporting the comprehensive sickle cell
disease (SCD) centers in the provision of coordinated, comprehen-
sive, culturally competent, and family-centered care to people with
SCD. The Committee affirms the goals of the program to improve
care delivery and access to high quality care for people with SCD,
with a focus on increasing access to SCD specialists; increase the
number of providers with SCD expertise and knowledge of SCD
treatment methods; and enable access to the latest treatment op-
tions following evidence-based guidelines.
With the start of new five-year grant awards in fiscal year 2022,
the Committee requests an update in the fiscal year 2024 Congres-
sional Justification on how the program is supporting the growth
of comprehensive sickle cell disease centers that provide the latest
treatment options following evidence-based guidelines and have
mechanisms to identify and serve patients with SCD who are not
currently being cared for by SCD specialists.
Autism and Other Developmental Disorders
The Committee recommends $57,344,000 for Autism and Other
Developmental Disorders, $3,000,000 above the fiscal year 2022 en-
acted level. 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 de-
velopmental disabilities.
Leadership Education in Neurodevelopmental and Related Dis-
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abilities (LEND).—The Committee provides $38,245,000,
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$1,000,000 above the fiscal year 2022 enacted level, for the LEND
program to allow the existing 60 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.
Heritable Disorders
The Committee provides $21,883,000 for the Heritable Disorders
program, $2,000,000 above the fiscal year 2022 enacted level. This
program assists States to improve and expand their newborn
screening programs and to promote parent and provider education.
HRSA also supports the work of the Advisory Committee on Heri-
table Disorders in Newborns and Children, which provides states
with a Recommended Uniform Screening Panel (RUSP) to help en-
sure every infant is screened for conditions that have a recognized
treatment. With new funding provided in fiscal year 2023, the
Heritable Disorders program can continue to enhance, improve, ex-
pand and provide technical assistance to State public health new-
born screening systems as four new disorders have been added to
the RUSP in the last six years, and can continue developing and
disseminating national, regional, and State education and training
resources for parents, families, providers, and patient support
groups.
Severe Combined Immune Deficiency (SCID).—Within the total
amount for Heritable Disorders, the Committee provides
$4,000,000, the same as the fiscal year 2022 enacted level, to sup-
port wider implementation, education, and awareness of newborn
screening and follow-up for SCID and other newborn screening dis-
orders.
Healthy Start
The Committee recommends $145,000,000 for the Healthy Start
program, $13,160,000 above the fiscal year 2022 enacted level and
the fiscal year 2023 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.
The primary purpose of Healthy Start is to reduce maternal and
infant mortality and to generally improve maternal and infant
health. Grants are awarded to nonprofits, State and local health
departments, and community health centers in eligible commu-
nities with high rates of infant mortality and other adverse birth
outcomes to develop a package of innovative health and social serv-
ices for pregnant women and infants, and evaluate those services.
Funding is provided to both increase funding to existing grantees
so they can increase the number of individuals served and to sup-
port new, additional awards to community-based organizations for
targeted initiatives to reduce disparities in maternal and infant
health outcomes. The Committee requests an update in the fiscal
year 2024 Congressional Justification on existing evaluations of
Healthy Start’s effectiveness.
Maternal Mortality.—The Committee continues to provide no less
than $15,000,000, the same as the fiscal year 2022 enacted level
and the fiscal year 2023 budget request, for Healthy Start grantees
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to support nurse practitioners, certified nurse midwives, physician
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assistants, and other maternal-child advance practice health pro-
fessionals within all program sites nationwide.
Early Hearing Detection and Intervention (EHDI)
The Committee includes $18,818,000 for the EHDI program, an
increase of $1,000,000 above the fiscal year 2022 enacted level and
the fiscal year 2023 budget request. This program awards grants
to 53 States and territories to support Statewide systems of new-
born hearing screening and early intervention programs.
The Committee recognizes the requirement under the PHS Act
for EHDI funds to support prompt evaluation and diagnosis of chil-
dren referred from screening programs and appropriate edu-
cational, audiological, medical, and communication (or language ac-
quisition) interventions (including family support), for children
identified as deaf or hard-of-hearing. The Committee encourages
HRSA to provide the most accurate, comprehensive, up-to-date, and
evidence-based information to children identified as deaf or hard-
of-hearing and their families. The Committee also encourages
HRSA to work with partners to advance awareness about the wide
range of modalities available for children who are deaf and hard
of hearing, including but not limited to auditory-oral therapy, audi-
tory-verbal therapy, Signed Exact English (SEE), American Sign
Language (ASL), Total Communication (TC), and Cued Speech; as
well as a full range of assistive hearing technologies, such as hear-
ing aids and cochlear implants.
Emergency Medical Services for Children
The Committee includes $25,000,000 for Emergency Medical
Services for Children, an increase of $2,666,000 above the fiscal
year 2022 enacted level. Funding is available to every State emer-
gency medical services office to improve the quality of emergency
care for children and to support research on and dissemination of
best practices.
Screening and Treatment for Maternal Depression and Related Dis-
orders State Grants
The Committee provides $11,500,000 for the Screening and
Treatment of Maternal Depression and Related Behavioral Dis-
orders Program (MDRBD), an increase of $5,000,000 above the fis-
cal year 2022 enacted level and $1,500,000 above the fiscal year
2023 budget request. Suicide and overdose, driven by maternal
mental health conditions (MMH), are the leading cause of maternal
mortality in the first year following pregnancy. MMH conditions
impact one in five pregnant or postpartum individuals, including as
many as one in three pregnant and postpartum Black individuals.
However, 75 percent of those impacted by MMH conditions go un-
treated. The COVID–19 pandemic has exacerbated the number of
individuals experiencing MMH conditions, with pregnant and new
mothers experiencing anxiety and depression at a three to four
times higher rate than prior to the pandemic. MDRBD trains
health care providers to screen, assess, and treat for MMH condi-
tions and provide specialized psychiatric consultation to assist the
providers. The Committee directs HRSA to make grants to estab-
lish new State programs and improve or maintain existing State
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programs, prioritizing States with high rates of adverse maternal
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health outcomes. Grants shall include culturally and linguistically
appropriate approaches to assist in the reduction of maternal
health inequities. The Committee recognizes the high need
amongst States and directs MDRBD to provide technical assistance
to non-grantee States.
Pediatric Mental Health Access
The Committee includes $14,000,000 for Pediatric Mental Health
Access, an increase of $3,000,000 above the fiscal year 2022 en-
acted level and $4,000,000 above the fiscal year 2023 budget re-
quest. This program supports expanded access to behavioral health
services in pediatric primary care by supporting the development
of pediatric mental health care telehealth access programs.
Poison Control Centers
The Committee includes $26,846,000 for Poison Control Centers,
an increase of $1,000,000 above the fiscal year 2022 enacted level
and $2,000,000 above the fiscal year 2023 budget request. The Poi-
son Control Centers program supports a national network of cen-
ters that prevent and treat poison exposures by providing cost ef-
fective, quality health care advice to the public and health care pro-
viders. The Committee encourages Poison Control Centers to part-
ner with institutions of higher education in border communities to
be better equipped to combat public health outbreaks exacerbated
by the flow of people and goods across international borders.
RYAN WHITE HIV/AIDS PROGRAM
Appropriation, fiscal year 2022 ......................................................... $2,494,776,000
Budget request, fiscal year 2023 ....................................................... 2,654,781,000
Committee Recommendation ............................................................. 2,694,776,000
Change from enacted level ......................................................... +200,000,000
Change from budget request ...................................................... +39,995,000
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 2023
Budget Activity Committee
Emergency Assistance .................................................................................................................................... $691,045,000
Comprehensive Care Programs ...................................................................................................................... 1,385,517,000
AIDS Drug Assistance Program ............................................................................................................. 900,313,000
Early Intervention Program ............................................................................................................................. 211,861,000
Children, Youth, Women, and Families .......................................................................................................... 79,114,000
AIDS Dental Services ...................................................................................................................................... 13,826,000
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Education and Training Centers .................................................................................................................... 35,413,000
Special Projects of National Significance ...................................................................................................... 28,000,000
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62
FY 2023
Budget Activity Committee
Ending the HIV Epidemic Initiative ................................................................................................................ 250,000,000
Ending the HIV Epidemic (EHE) Initiative.—The Committee in-
cludes $250,000,000 within the Ryan White HIV/AIDS Program for
the EHE Initiative, an increase of $125,000,000 above the fiscal
year 2022 enacted level. Funds are distributed to high-need juris-
dictions to increase linkage, engagement, and retention in care
with the goal of increasing viral suppression among people living
with HIV.
HEALTH SYSTEMS
Appropriation, fiscal year 2022 ......................................................... $96,009,000
Budget request, fiscal year 2023 ....................................................... 94,009,000
Committee Recommendation ............................................................. 99,009,000
Change from enacted level ......................................................... +3,000,000
Change from budget request ...................................................... +5,000,000
The Health Systems Bureau supports national activities that en-
hance health care delivery in the U.S., including maintaining a na-
tional system to allocate and distribute donor organs to individuals
awaiting transplant; building an inventory of cord blood units; and
maintaining a national system for the recruitment of bone marrow
donors.
Organ Transplantation
The Committee includes $31,049,000 for the Organ Transplan-
tation program, $1,000,000 above the fiscal year 2022 enacted level
and $2,000,000 above the fiscal year 2023 budget request.
Maximizing Deceased Donor Organ Recovery, Acceptance, and
Utilization.—The Committee supports regulatory and enforcement
efforts to minimize excessive and frivolous expenses reimbursed to
Organ Procurement Organizations (OPOs) and the Organ Procure-
ment Transplantation Network (OPTN) by Medicare, including as
related to organ acquisition costs and the waitlisting of patients,
and to ensure all potential conflicts of interest of OPO and OPTN
executive and board leadership are publicly disclosed. The Com-
mittee encourages HHS to make all efforts to promote competition
for the Organ Procurement Transplantation Network (OPTN) con-
tract, including the NASEM recommendation that HRSA separate
the information technology functions of the OPTN contract. The
Committee supports this recommendation as it will both increase
the likelihood of full and open competition for all components of the
OPTN contract activities and likely lead to significant improve-
ments in the OPTN’s IT functionality, which is also a goal HRSA
highlights in their request for information published on April 8,
2022.
Living Organ Donation Reimbursement Program.—The Com-
mittee includes $8,000,000, an increase of $1,000,000 above the fis-
cal year 2022 enacted level, for the Living Organ Donation Reim-
bursement Program. The Committee supports significant expansion
of income eligibility for the program to allow as many donors as
possible to qualify and to ensure that financial reimbursement and
monetary exchange take place outside of the organ donor-organ re-
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cipient relationship to the greatest extent possible.
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Reducing Organ Discards.—The Committee expresses its support
for the procurement and transplantation of moderate-to-high Kid-
ney Donor Profile Index (KDPI) kidneys at risk of discard to allevi-
ate the organ shortage. The Committee requests a report within
180 days of enactment of this Act regarding the OPTN proposal to
remove donor service areas from allocation and the impact of this
policy on organ discards.
National Cord Blood Inventory (NCBI)
The Committee includes $19,266,000 for the NCBI, an increase
of $1,000,000 above the fiscal year 2022 level. The NCBI program
supports cord blood banks to build a genetically and ethnically di-
verse inventory of the highest quality cord blood units for trans-
plantation. To further strengthen communication and collaboration
between HRSA and cord blood banks, the Committee directs HRSA
to host quarterly stakeholder calls open to all cord blood banks con-
tracting with NCBI. These calls should serve as a forum for the
agency to solicit feedback from the cord blood banks and ensure
that the program is implemented in accordance with Congressional
intent. Such feedback should be incorporated into contracts be-
tween the agency and the cord blood banks to increase the pro-
grams reach and achieve program goals.
C.W. Bill Young Cell Transplantation
The Committee includes $33,009,000 for the C.W. Bill Young Cell
Transplantation program, an increase of $1,000,000 above the fis-
cal year 2022 level. This program supports coordinating the pro-
curement of bone marrow and umbilical cord blood units for trans-
plantation.
The Committee continues to support cell transplantation using
bone marrow, peripheral blood stem cells, and cord blood. The
Committee appreciates HRSA’s efforts to increase the diversity of
the volunteer registry and supports efforts to significantly reduce
barriers to transplant for patients. This includes increasing tar-
geted donor recruitment efforts, intervening with community refer-
ring physicians upon patient diagnosis to accelerate the path to
transplant, and propelling innovation to improve outcomes and es-
tablish new treatment options to ensure a matched donor for all
searching patients, regardless of their racial/ethnic background, so-
cioeconomic status, age, ancestry, or any other individually defin-
ing characteristic. The highest priority should be given to providing
immediate and free testing of patients’ cellular markers to quickly
determine if a there is an available matched a donor. Eliminating
these barriers would allow therapies for patients to be delivered on
time and to provide equal and successful outcomes for all.
Hansen’s Disease Program
The Committee includes $13,706,000 for the Hansen’s Disease
Program, $122,000 for Hansen’s Disease Buildings and Facilities,
and $1,857,000 for Payments to Hawaii for Treatment of Hansen’s
Disease. These funding levels are the same as the fiscal year 2022
enacted levels and the amounts requested in the fiscal year 2023
budget request. The programs support inpatient, outpatient, long-
term care, as well as training and research in Baton Rouge, Lou-
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isiana; 11 outpatient clinic sites in the continental U.S. and Puerto
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Rico; facility-related expenses for the buildings of the Gillis W.
Long Hansen’s Disease Center; and medical care and treatment of
persons with Hansen’s disease in hospital and clinic facilities at
Kalaupapa, Molokai, and Honolulu, Hawaii.
RURAL HEALTH
Appropriation, fiscal year 2022 ......................................................... $331,062,000
Budget request, fiscal year 2023 ....................................................... 373,709,000
Committee Recommendation ............................................................. 375,675,000
Change from enacted level ......................................................... +44,613,000
Change from budget request ...................................................... +1,966,000
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; and for the outreach and treatment of coal
miners and others with occupation-related respiratory and pul-
monary impairments.
Rural Health Outreach Programs
The Committee includes $90,975,000 for Rural Health Outreach
Programs, an increase of $5,000,000 above the fiscal year 2022 en-
acted level and $975,000 above the fiscal year 2023 budget request.
This program supports projects that demonstrate new and innova-
tive modes of outreach in rural areas, such as integration and co-
ordination of health services.
Rural Maternity and Obstetrics Management Strategies
(RMOMS).—The Committee recommendation includes no less than
$8,000,000 for RMOMS, an increase of $2,000,000 above the fiscal
year 2022 enacted level. RMOMS supports grants to improve access
to and continuity of maternal and obstetrics care in rural commu-
nities by increasing the delivery of and access to preconception,
pregnancy, labor and delivery, and postpartum services, as well as
developing sustainable financing models for the provision of mater-
nal and obstetrics care.
Rural Health Research and Policy Development
The Committee includes $11,076,000 for Rural Health Research
and Policy Development, the same as the fiscal year 2022 enacted
level and the fiscal year 2023 budget request. Funding supports the
Federal Office of Rural Health Policy’s activities to analyze, advise
the Secretary, and provide information to the public regarding
issues that affect the availability, access to, and quality of health
care in rural areas.
Rural Health Research Centers.—In the next competition for
Rural Health Research Centers, the Committee strongly encour-
ages the Federal Office of Rural Health Policy to prioritize States
that have not previously hosted such a center. The Committee sup-
ports centers in areas that have a demonstrated collaborative part-
nership with research and education in the pharmacological and
physician space. Further, the Committee strongly encourages the
Office to explore establishing a center which encompasses research
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related to biomedical and cancer research, opioid abuse, delivery of
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rural healthcare, and training for rurally focused residency pro-
grams.
Rural Health Flexibility Grants
The Committee includes $68,500,000 for Rural Health Flexibility
Grants, $6,223,000 above the fiscal year 2022 enacted level and
$10,991,000 above the fiscal year 2023 budget request. These pro-
grams support States to assist small and critical access rural hos-
pitals to remain economically viable and to provide high-quality
care. Within this total, the Committee includes no less than
$5,000,000 for the Rural Emergency Hospitals Technical Assistance
Program and no less than $20,942,000 for the Small Rural Hospital
Improvement Program.
State Offices of Rural Health
The Committee includes $12,500,000 for State Offices of Rural
Health, the same as the fiscal year 2022 enacted level and the fis-
cal year 2023 budget request. HRSA supports the establishment
and operation of State offices of rural health to strengthen rural
health care delivery system.
Black Lung Clinics
The Committee includes $12,190,000 for Black Lung Clinics, an
increase of $345,000 above the fiscal year 2022 enacted level and
the same as the fiscal year 2023 budget request. This program
funds clinics that treat respiratory and pulmonary diseases of ac-
tive and retired coal miners, steel mill workers, agricultural work-
ers, and others with occupationally-related respiratory and pul-
monary impairments.
Radiation Exposure Screening and Education Program (RESEP)
The Committee includes $2,734,000 for the RESEP program, an
increase of $845,000 above the fiscal year 2022 enacted level and
the same as the fiscal year 2023 budget request. This program pro-
vides grants for the education, prevention, and early detection of
radiogenic cancers and diseases resulting from exposure to ura-
nium during mining and milling at nuclear test sites.
Rural Health Residency Program
The Committee includes $12,700,000 for the Rural Health Resi-
dency Program, an increase of $2,200,000 above the fiscal year
2022 enacted level and the same as the fiscal year 2023 budget re-
quest. This program funds physician residency training programs
that support physician workforce expansion in rural areas.
The Committee commends the Federal Office of Rural Health
Policy for their efforts to expand the physician workforce in rural
areas and supports continuation and expansion of the program to
develop new rural residency programs, or Rural Training Pro-
grams.
Rural Communities Overdose Response Program (RCORP)
The Committee includes $160,000,000, an increase of $25,000,000
above the fiscal year 2022 enacted level, for the RCORP program,
and allows for the expanded focus on behavioral health care, in-
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cluding SUD, needs in rural communities. The Committee is par-
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ticularly interested in programs that address health equity and
reach rural populations that have historically suffered poorer be-
havioral health outcomes relative to their counterparts. Within the
funding provided, the agreement includes $10,000,000 to continue
the Rural Centers of Excellence (COE) program in order to collabo-
ratively identify, implement, and evaluate innovative SUD and
broader behavioral health approaches to build the evidence-base for
effective prevention, treatment, and recovery programs in rural
communities across the U.S.; and through the addition of a fourth
coordinating COE, track, synthesize, and disseminate national and
State-level SUD policies and research, including any effective inter-
ventions and outcomes identified.
Rural Health Clinic Behavioral Health Initiative
The Committee includes $5,000,000 to support expanded access
to behavioral health services at rural health clinics, as described in
the fiscal year 2023 budget request.
FAMILY PLANNING
Appropriation, fiscal year 2022 ......................................................... $286,479,000
Budget request, fiscal year 2023 ....................................................... 400,000,000
Committee Recommendation ............................................................. 500,000,000
Change from enacted level ......................................................... +213,521,000
Change from budget request ...................................................... +100,000,000
The Family Planning program administers Title X of the PHS
Act. This program supports preventive and primary health care
services at health centers nationwide by increasing access to afford-
able contraceptive education, services, and supplies; STD preven-
tion, screening, and treatment; cervical and breast cancer
screenings; first-line infertility services; and other community and
health care services. The Title X program is a vital component of
the health care safety net and is essential to addressing health in-
equities.
The Committee directs the Secretary to ensure that grantees cer-
tify 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. The bill requires that all recipients of funds under
this heading offer services consistent with the best available evi-
dence-based standards, including the Quality Family Planning
guidelines from the CDC and the Office of Population Affairs
(OPA).
Recommendations for Quality Family Planning Services.—The
Committee directs the Secretary to continue the process of revising
‘‘Providing Quality Family Planning Services,’’ evidence-based rec-
ommendations that were last updated in 2017, and to ensure the
robust participation of both the CDC’s Division of Reproductive
Health and OPA in this effort. Revisions should incorporate new
evidence and support comprehensive reproductive and sexual
health needs of all people. The Committee requests a briefing on
the status of this process no later than 180 days of enactment of
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this Act.
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Estimated Need for Services.—The Committee requests the Sec-
retary conduct a study, within 270 days of enactment of this Act,
determining the current estimated need for Title X services, updat-
ing the 2016 study published in the American Journal of Public
Health. The Committee requests that, as in the previous work, the
CDC’s Division of Reproductive Health and OPA collaborate on this
effort.
HRSA-WIDE ACTIVITIES AND PROGRAM SUPPORT
Appropriation, fiscal year 2022 ......................................................... $1,259,484,000
Budget request, fiscal year 2023 ....................................................... 230,709,000
Committee Recommendation ............................................................. 934,857,000
Change from enacted level ......................................................... ¥324,627,000
Change from budget request ...................................................... +704,148,000
This account supports telehealth programs, operation of the 340B
drug pricing program, community projects, and the cost of Federal
staff and related activities to coordinate, direct, and manage the
programs of HRSA.
HRSA Chief Dental Officer.—The Committee is disturbed to
learn that despite its directive to have HRSA ensure that the Chief
Dental Officer (CDO) is functioning at an executive level with re-
sources and staff to lead oral health programs and initiatives
across HRSA, no such authority has been delegated. The Com-
mittee urges HRSA to hire a CDO and restore the position with ex-
ecutive level authority and resources to oversee and lead dental
programs and initiatives across the agency. The CDO is also ex-
pected to serve as the agency representative on oral health issues
to international, national, State, and/or local government agencies,
universities, and oral health stakeholder organizations. The Com-
mittee requests an update as part of the fiscal year 2024 Congres-
sional Justification on how the CDO is serving as the agency rep-
resentative with executive level authority on oral health issues to
international, national, State and/or local government agencies,
universities, and oral health stakeholder organizations.
Oral Health Literacy.—The Committee includes $300,000 to 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 health care prevention
and education, including prevention of oral disease such as early
childhood and other caries, periodontal disease, and oral cancer.
The Committee encourages HRSA to ensure that the Chief Dental
Officer plays a key role in the design, monitoring, oversight, and
implementation of this project.
Targeted Investments in Impoverished Areas.—The Committee
supports targeted investments in impoverished areas, particularly
in persistent poverty counties and in other high-poverty census
tracts. For purposes of this Act, the term ‘‘high-poverty area’’
means any census tract with a poverty rate of at least 20 percent
as measured by the 2016–2020 5-year data series available from
the American Community Survey of the Census Bureau and the
term ‘‘persistent poverty counties’’ means any county that has had
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30 years, as measured by the 1993 Small Area Income and Poverty
Estimates, the 2000 decennial census, and the most recent Small
Area Income and Poverty Estimates, or any territory or possession
of the U.S. The Committee directs HRSA to develop and implement
measures to increase the share of investments in high-poverty cen-
sus tracts with a poverty rate of at least 20 percent as measured
by the 2016–2020 5-year data series available from the American
Community Survey of the Census Bureau, and any other impover-
ished areas the Department determines to be appropriate areas to
target. The Committee directs HRSA to submit a report to the
Committee within 180 days of enactment of this Act that includes
the amount of funds that were targeted to such areas; the percent
change from fiscal year 2022 in the amount of funds that were tar-
geted toward such areas; and, to the extent practicable, an assess-
ment of the economic impact of the program on the areas, including
data on the categories of individuals impacted by the targeting of
funds to such areas under the program, disaggregated by house-
hold income, race, gender, age, national origin, disability status,
and whether the individuals live in an urban area, suburban area,
or rural area.
Office of Pharmacy Affairs (OPA)
The Committee includes $13,238,000 for OPA, $2,000,000 above
the fiscal year 2022 enacted level. OPA administers the 340B drug
pricing program, which was designed to help safety net providers
maintain, improve, and expand patient access to health care serv-
ices. The 340B program has lowered the cost of outpatient drugs
to health clinics and nonprofit and public hospitals that serve a dis-
proportionate share of low-income and rural patients. These enti-
ties provide additional services and benefits to their communities
with the savings realized.
The Committee recognizes that the 340B program is a critical
lifeline to safety net providers, including FQHCs, FQHC Look-
Alikes, children’s hospitals, Ryan White HIV/AIDS clinics, and
other safety-net hospitals and providers. These covered entities are
model stewards of the program and reinvest 340B savings to reach
more patients and provide more comprehensive services.
The Committee is concerned by the fact that the number of phar-
maceutical manufacturers that are violating the 340B statute has
dramatically increased, threatening the ability of safety-net pro-
viders to care for patients in need. The Committee is pleased that
HRSA has continued to take steps to enforce the statute and take
action against companies that curtail the use of 340B drugs in con-
tract pharmacies, refer violations of the statute by manufacturers
to the HHS Office of Inspector General, and appeal litigation in
these matters. The Committee encourages HRSA to continue to use
its authority and any available measures, including the imposition
of civil penalties, where appropriate, to hold those drug manufac-
turers in violation of the law directly accountable. The Committee
urges HRSA to continue to take actions to safeguard covered enti-
ties’ lawful access to discounted drugs.
Telehealth
The Committee includes $37,050,000 for Telehealth, an increase
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of $2,000,000 above the fiscal year 2022 enacted level. Funds sup-
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69
port the Office for the Advancement of Telehealth, which promotes
the effective use of technologies to improve access to health services
for people who are isolated from health care and to provide dis-
tance education for health professionals.
Provider Bridge.—The Committee includes $500,000 within the
total for Telehealth for the Provider Bridge program. With funds
appropriated in the Coronavirus License Portability Grant Pro-
gram, HRSA established the Provider Bridge Program to empower
medical professionals to safely and efficiently deliver urgently-
needed care to communities during public health emergencies. To
date, over 400 entities and 85,000 healthcare professionals have le-
veraged this national tool connecting health care professionals with
State agencies and health care entities to quickly verify credentials
and professional background information. Specifically, the platform
provides a directory of State and Federal COVID–19 resources, al-
lows health care professionals to submit professional background
information, produces official and verified digital documents of li-
censure and credentialing information, and provides access to a
database of information for volunteer clinicians willing to provide
care.
Telehealth Centers of Excellence.—The Committee supports the
continued development of Telehealth Centers of Excellence to con-
tinue to validate technologies and reimbursement mechanisms, es-
tablish training protocols, and develop comprehensive templates for
States to integrate telehealth into their state health provider net-
works.
Rural Telehealth Initiative.—The Committee supports the Memo-
randum of Understanding entered into on August 31, 2020, estab-
lishing a Rural Telehealth Initiative among HHS, the Federal
Communications Commission, and the Department of Agriculture.
Together, this important initiative can leverage expertise of each
respective agency and improve collaboration amongst entities
tasked with addressing rural telehealth access. This initiative rec-
ognizes the unique problems facing rural Americans that need ac-
cess to critical care services through telehealth platforms. The
Committee encourages agencies involved in this initiative to
prioritize opportunities to continue the expansion of telehealth
services, close the digital divide, and not leave rural communities
behind.
Community Project Funding
Within the funds included in this account, $726,569,000 shall be
used for the projects, and in the amounts, specified in the table ti-
tled ‘‘Labor, HHS, Education Incorporation of Community Project
Funding Items’’ at the end of this report. The Committee includes
$6,000,000 within this total for agency administrative expenses.
VACCINE INJURY COMPENSATION PROGRAM
Appropriation, fiscal year 2022 ......................................................... $13,200,000
Budget request, fiscal year 2023 ....................................................... 26,200,000
Committee Recommendation ............................................................. 15,200,000
Change from enacted level ......................................................... +2,000,000
Change from budget request ...................................................... ¥11,000,000
The Committee includes $15,200,000 for administrative costs as-
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sociated with the Vaccine Injury Compensation Program, an in-
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crease of $2,000,000 above the fiscal year 2022 enacted level. This
program provides compensation for individuals with vaccine-associ-
ated injuries or deaths.
COVID–19 Vaccine Liability.—The FDA has approved one
COVID–19 vaccine for children 5 and older and granted emergency
use authorization for a second COVID–19 vaccine for children 12
and older. The ACIP recommends that every eligible person receive
the COVID–19 vaccine, including children aged 5 and older. Under
the National Childhood Vaccine Injury Act (NCVIA), this rec-
ommendation requires the Secretary to add the COVID–19 vaccine
to the VICP within two years. As the public anticipates the transi-
tion of COVID–19 vaccine injury compensation claims from the
Countermeasure Injury Compensation Program (CICP) to the
VICP, the Committee requests a report within 60 days of enact-
ment of this Act regarding HHS’s transition plan for COVID–19
vaccine injury compensation claims. This report should include a
specific timeline for the rulemaking process to add COVID–19 vac-
cines to the Vaccine Injury Table, as well as a plan for how pend-
ing claims already filed with the Countermeasure Injury Com-
pensation program will be handled. The plan should also include
any anticipated resources needed to facilitate this transition and
quickly process pending claims as well as how HHS will inform
current and potential petitioners of their options.
COVERED COUNTERMEASURES PROCESS FUND
Appropriation, fiscal year 2022 ......................................................... $5,000,000
Budget request, fiscal year 2023 ....................................................... 15,000,000
Committee Recommendation ............................................................. 7,000,000
Change from enacted level ......................................................... +2,000,000
Change from budget request ...................................................... ¥8,000,000
The Committee includes $7,000,000 for administrative costs asso-
ciated with the Countermeasures Injury Compensation Program
(CICP), an increase of $2,000,000 above the fiscal year 2022 en-
acted level. The CICP provides benefits to individuals who are seri-
ously injured as a result of a vaccination, medication, device, or
other item recommended to diagnose, prevent or treat a declared
pandemic, epidemic or security threat.
CENTERS FOR DISEASE CONTROL AND PREVENTION
Appropriation, fiscal year 2022 ......................................................... $8,457,204,000
Budget request, fiscal year 2023 ....................................................... 10,730,159,000
Committee Recommendation ............................................................. 10,499,354,000
Change from enacted level ......................................................... +2,042,150,000
Change from budget request ...................................................... ¥230,805,000
The Committee recommendation for the Centers for Disease Con-
trol and Prevention (CDC) program level includes $9,540,696,000
in discretionary budget authority, $55,358,000 in mandatory funds
under the terms of the Energy Employees Occupational Illness
Compensation Program Act, and $903,300,000 in transfers from the
Prevention and Public Health (PPH) Fund.
CDC’s mission is to protect America from health, safety, and se-
curity threats, which it accomplishes by supporting core public
health functions at State, local, and tribal health departments, de-
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tecting and responding to new and emerging health threats, pro-
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moting health and safety, and providing leadership in the public
health workforce.
IMMUNIZATION AND RESPIRATORY DISEASES
Appropriation, fiscal year 2022 ......................................................... $868,155,000
Budget request, fiscal year 2023 ....................................................... 1,250,930,000
Committee Recommendation ............................................................. 1,083,155,000
Change from enacted level ......................................................... +215,000,000
Change from budget request ...................................................... ¥167,775,000
The Committee recommendation includes $663,805,000 in discre-
tionary budget authority and $419,350,000 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 2023
Budget Activity Committee
Immunization Program ................................................................................................................................... $825,797,000
Acute Flaccid Myelitis .................................................................................................................................... 6,000,000
Influenza Planning and Response ................................................................................................................. 251,358,000
Cost Estimates.—The Committee urges that the report on esti-
mated funding needs of the Section 317 Immunization Program be
updated and submitted not later than February 1, 2023. The up-
dated 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 re-
sources continues to evolve. It should also include specific informa-
tion on the estimated cost to fully address evidence-based public
health strategies that could be funded through CDC to improve
coverage for human papillomavirus (HPV) and influenza.
Immunization Program.—The Committee includes an increase of
$175,000,000 to enhance immunization efforts, including increasing
awardee base awards with a focus on expanding and sustaining
critical immunization program infrastructure.
Immunization Rates.—The Committee is concerned about the
marked decline in routine vaccines as a result of the pandemic. The
Committee encourages CDC to continue surveillance and labora-
tory efforts, and to promote HPV vaccination in support of the Ad-
ministration’s Cancer Moonshot Initiative. In addition, the Com-
mittee requests information in the fiscal year 2024 Congressional
Budget Justification on how the Advisory Committee on Immuniza-
tion Practices (ACIP) can support both routine and emergency re-
views in real time to ensure timely access to immunizations. Fur-
thermore, the Committee recognizes that office-based physicians
are trusted sources of health care information and delivery, and en-
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courages CDC to consider their role in vaccination efforts.
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Improving Immunization Information System Infrastructure and
Data.—The Committee encourages CDC to engage with States and
local jurisdictions to assess gaps and greatest areas of need to work
toward all Immunization Information Systems (IIS) adopting and
adhering to national standards to support the capture of data for
all vaccinations administered across the life course, and have se-
cure bi-directional information sharing capabilities both inter- and
intra-State and with other IIS, health information exchanges,
health data systems and entities, including data repositories to
achieve interoperability levels needed to capture reliable, complete,
real-time vaccine administration data.
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.
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.
HIV/AIDS, VIRAL HEPATITIS, SEXUALLY TRANSMITTED DISEASES, AND
TUBERCULOSIS PREVENTION
Appropriation, fiscal year 2022 ......................................................... $1,345,056,000
Budget request, fiscal year 2023 ....................................................... 1,470,556,000
Committee Recommendation ............................................................. 1,463,556,000
Change from enacted level ......................................................... +118,500,000
Change from budget request ...................................................... ¥7,000,000
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 2023
Budget Activity Committee
Domestic HIV/AIDS Prevention and Research ................................................................................................ $1,046,712,000
HIV Initiative .......................................................................................................................................... 245,000,000
School Health-HIV .................................................................................................................................. 46,081,000
Viral Hepatitis ................................................................................................................................................ 54,500,000
Sexually Transmitted Infections ..................................................................................................................... 179,310,000
Tuberculosis .................................................................................................................................................... 140,034,000
Infectious Diseases and the Opioid Epidemic ............................................................................................... 43,000,000
Access to PrEP.—The Committee notes the importance of expand-
ing HIV pre-exposure prophylaxis (PrEP) nationally to improve ac-
cess to medications and essential support services, community and
provider outreach, to make progress towards ending the HIV epi-
demic.
Ending the HIV Epidemic Initiative.—The Committee includes
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an increase of $50,000,000 for the fourth year of the Ending the
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HIV Epidemic initiative. The Committee commends CDC for in-
cluding dedicated funding within this initiative for sexually trans-
mitted infection clinics. The Committee notes the important role
that self-testing has played in the response to the COVID–19 pan-
demic and encourages CDC to explore opportunities to facilitate ac-
cess to HIV self-testing.
Hepatitis.—The Committee includes an increase of $13,500,000
to enhance efforts to eliminate the public health threat of viral hep-
atitis. The Committee is aware of the November 2021 ACIP rec-
ommendation that all adults between ages 19 and 59 be vaccinated
for hepatitis B, and urges CDC to take any associated action as
early as possible. In addition, the Committee urges CDC to expand
the viral hepatitis disease tracking and surveillance capabilities of
States to permit an effective targeting of resources and evaluation
of program effectiveness. Furthermore, the Committee encourages
CDC to expand outreach and communications efforts and related
initiatives to promote hepatitis C screening during pregnancy with
the goal of ensuring that every pregnant individual gets tested for
hepatitis C during each pregnancy.
Infectious Diseases and the Opioid Epidemic.—The Committee in-
cludes an increase of $25,000,000 to expand activities to target the
infectious disease consequences of the public health crisis involving
injection drug use, including expanding the implementation of and
access to high quality syringe services programs nationwide.
School Health.—The Committee includes an increase of
$10,000,000 to bolster school capacity for evidence-based sexual
health education, and access to sexual health services and safe and
supportive environments.
Sexually Transmitted Infections.—The Committee includes an in-
crease of $15,000,000 to address the high rates of sexually trans-
mitted infections (STIs). The Committee directs CDC to utilize a
portion of the increase to move the grant year forward by one
month to provide for a more efficient expenditure of funds and im-
prove grantee activities, with the intention that the grant year will
be moved forward by one month each year for the next three years,
contingent on the availability of funds. In addition, the Committee
encourages CDC to maximize the impact of available resources,
prevent the largest number of infections, and increase health eq-
uity by allocating funding to States and local jurisdictions using
data driven methods incorporating burden of disease provided that
a portion of these funds be used to ensure that no grantee receives
less than the amount received in fiscal year 2022. Furthermore, the
Committee encourages CDC to work with other agencies, as appro-
priate, to develop innovative approaches including the use of tele-
health platforms and at home specimen collection to increase
screening, treatment, and education to curb the spread of STIs in
vulnerable populations.
Tuberculosis.—The Committee includes an increase of $5,000,000
to enable CDC, along with State and local entities, to provide TB
screening, identification, treatment and prevention services, and to
support the TB Trials Consortium. The Committee is concerned
that the COVID–19 pandemic caused significant impacts on indi-
viduals with TB and on State and local TB programs, including
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delays in care for people with TB and postponement of identifica-
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tion and treatment of individuals with latent TB infection, stalling
efforts to eliminate TB in the U.S.
EMERGING AND ZOONOTIC INFECTIOUS DISEASES
Appropriation, fiscal year 2022 ......................................................... $693,272,000
Budget request, fiscal year 2023 ....................................................... 703,272,000
Committee Recommendation ............................................................. 799,272,000
Change from enacted level ......................................................... +106,000,000
Change from budget request ...................................................... +96,000,000
The Committee recommendation includes $747,272,000 in discre-
tionary appropriations and $52,000,000 in transfers from the PPH
Fund.
Programs funded under Emerging and Zoonotic Infectious Dis-
eases (EZID) support the prevention and control of infectious dis-
eases through surveillance, outbreak investigation and response,
research, and prevention.
Within the total for EZID, the Committee recommends the fol-
lowing amounts:
FY 2023
Budget Activity Committee
Antibiotic Resistance Initiative ...................................................................................................................... $202,000,000
Vector-borne Diseases .................................................................................................................................... 87,103,000
Prion Disease .................................................................................................................................................. 7,500,000
Chronic Fatigue Syndrome ............................................................................................................................. 5,400,000
Emerging Infectious Diseases ........................................................................................................................ 214,997,000
Harmful Algal Blooms .................................................................................................................................... 3,500,000
Food Safety ..................................................................................................................................................... 80,000,000
National Healthcare Safety Network .............................................................................................................. 31,000,000
Quarantine ...................................................................................................................................................... 65,772,000
Advanced Molecular Detection ....................................................................................................................... 50,000,000
Epidemiology and Laboratory Capacity .......................................................................................................... 40,000,000
Healthcare-Associated Infections ................................................................................................................... 12,000,000
Advanced Molecular Detection.—The Committee includes an in-
crease of $15,000,000 and recognizes the value of the Advanced Mo-
lecular Detection program through its crosscutting and collabo-
rative work that introduces and helps establish biotechnology-fo-
cused innovation to public health programs across CDC and in
State and local health departments.
Antibiotic Resistance.—The Committee includes an increase of
$20,000,000 to enhance capacity to combat the growing threat of
antibiotic resistant bacteria. The Committee recognizes the impor-
tance of addressing the problem of antibiotic-resistant bacteria
through a One Health approach and by tracking resistance through
local, regional, national, and global surveillance. In addition, the
Committee urges CDC to develop improved data collection and sur-
veillance of Clostridioides Difficle (C diff.), including working with
State and local partners as part of the Nationally Notifiable Dis-
eases Surveillance System. The Committee urges CDC to assist
State and local partners in increasing awareness of antibiotic stew-
ardship as it relates to C diff. The Committee requests an update
in the fiscal year 2024 Congressional Budget Justification on these
activities.
Emerging Infectious Diseases.—The Committee includes an in-
crease of $20,000,000 for emerging infectious disease work, includ-
ing laboratory capacity and wastewater surveillance. The Com-
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mittee commends CDC for implementing the National Wastewater
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Surveillance System (NWSS) with partners at health laboratories
and academic institutions to better track COVID–19. The Com-
mittee encourages CDC to support staff sharing arrangements
among multiple local health departments implementing NWSS and
efforts to stand up systems in rural settings that do not have ac-
cess to centralized wastewater treatment services. The Committee
requests information in the fiscal year 2024 Congressional Budget
Justification on best practices in developing wastewater surveil-
lance programs in rural settings, and strategies to increase partici-
pation in the NWSS among State and local governments, institu-
tions of higher education, and correctional facilities.
Food Safety.—The Committee includes an increase of
$12,000,000 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 surveil-
lance, improve foodborne outbreak detection and investigations, en-
hance food safety prevention efforts, and maintain vigilance for
emerging threats to our nation’s food supply.
Harmful Algal Blooms.—The Committee includes an increase of
$1,000,000 to support monitoring and health reporting concerns re-
lated to harmful algal blooms (HABs). The Committee urges CDC
to continue work on affected waters, with a focus on freshwater
and the related dangers to drinking water supplies. CDC has a
unique role in better understanding the intersection of public
health and environmental impacts of HABs using a One Health ap-
proach to: (1) increase outreach efforts to States and local public
health officials to use these monitoring and reporting systems; and
(2) work with a variety of agencies that currently collaborate on
HABs. The scope of future research may expand to include improv-
ing laboratory methods for HAB-related toxins in biological speci-
mens and clinical diagnostic methods to identify HAB-related
symptoms and illnesses, optimizing emergency response capacities,
and identifying and addressing the impacts of harmful algal toxins
to humans. There is an important nexus between freshwater and
health through drinking water and recreation, and CDC is urged
to expand their work regionally to understand HABs impact on our
nation’s largest fresh bodies of water. In addition, CDC is urged to
work with other agencies to integrate disparate sets of data to
allow for a broader understanding of the spatial and temporal dy-
namics of the environmental and health impacts of harmful algal
blooms.
Live Animal Imports.—The Committee notes the importance that
live cargo inspections maintain standards of animal welfare and
occur in the shortest practicable period. In addition, the Committee
recognizes CDC’s efforts to eliminate canine rabies in the U.S. and
encourages CDC to provide a clear framework for those seeking to
bring canines into the U.S.
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 its participation in the Interagency Working Group
for ME/CFS.
Mycotic Diseases.—The Committee provides an increase of
$2,000,000 in Emerging Infectious Diseases for mycotic diseases,
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including, but not limited to, surveillance and prevention, building
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capacity in the State and local health departments, cooperative
agreements, education of the public and healthcare providers, and
laboratory support. The Committee requests an update in the fiscal
year 2024 Congressional Budget Justification on how this funding
is being utilized.
National Healthcare Safety Network.—The Committee includes
an increase of $10,000,000 and recognizes the value of this system
for healthcare quality measurement and improvement. The Com-
mittee supports the modernization of the system’s infrastructure
resulting in increased timeliness and accuracy, reduced burden on
healthcare facilities, and the ability to collect urgent data.
Prion.—The Committee includes an increase of $1,000,000 to ad-
vance efforts on human prion diseases, rapidly progressive and
fatal neurodegenerative diseases that occur in both humans and
animals, and recognizes the critical work of the National Prion Dis-
ease Pathology Surveillance Center.
Quarantine.—The Committee includes an increase of $15,000,000
to enhance programs to protect the U.S. from infectious diseases,
including expanded coverage at the most heavily trafficked airports
and land border crossings and increased capacity for health
screenings.
Vector-Borne Diseases.—The Committee includes an increase of
$12,000,000 for enhanced vector-borne disease activities, including
Lyme Disease and tickborne diseases. The Committee includes
funding to support training and the development of communities of
practice in vector-borne disease prevention and control for the re-
gions of the U.S. that account for the largest burden of vector-borne
disease. The Committee urges CDC to increase provider and public
awareness of Lyme and known tickborne diseases (TBD) in dif-
ferential diagnoses, to practice shared decision making, to be aware
of the existence of two sets of differing Lyme Disease Clinical
Guidelines, and to encourage the public to take preventive meas-
ures. The Committee requests an update in the fiscal year 2024
Congressional Budget Justification on the use of advanced and
emerging technologies for the development of improved diagnostics,
including a timeline on when improved diagnostics may become
commercially available for Lyme disease. In addition, the Com-
mittee notes that the pandemic response necessitated the disrup-
tion of mosquito control and abatement efforts by many State and
local health departments and notes the importance of continuing
mosquito prevention efforts. The Committee is aware of the ongo-
ing challenges faced by the U.S. territories in the Caribbean and
the Pacific regarding control and management of vector-borne dis-
eases. The Committee urges CDC to support the training and re-
search needs of the U.S. territories and encourages the use of the
Mosquito Abatement for Safety and Health Program to provide
grants and technical assistance to States and political subdivisions
to prevent and control mosquito-borne diseases. In addition, the
Committee requests CDC, in consultation with other appropriate
agencies, to provide information in the fiscal year 2024 Congres-
sional Budget Justification on the ecological structure and epide-
miological factors that must be known and monitored to estimate
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the mosquito-borne infectious disease outbreak risk.
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CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION
Appropriation, fiscal year 2022 ......................................................... $1,338,664,000
Budget request, fiscal year 2023 ....................................................... 1,612,264,000
Committee Recommendation ............................................................. 1,601,914,000
Change from enacted level ......................................................... +263,250,000
Change from budget request ...................................................... ¥10,350,000
The Committee recommendation includes $1,346,964,000 in dis-
cretionary appropriations and $254,950,000 in transfers from the
PPH Fund.
Programs supported within Chronic Disease Prevention and
Health Promotion provide national leadership and support for
State, tribal, and community efforts to promote health and well-
being through the prevention and control of chronic diseases.
Within the total provided, the Committee recommends the fol-
lowing amounts:
FY 2023
Budget Activity Committee
Tobacco ........................................................................................................................................................... $251,500,000
Nutrition, Physical Activity, and Obesity ........................................................................................................ 58,420,000
High Obesity Rate Counties .................................................................................................................. 16,500,000
School Health ................................................................................................................................................. 27,400,000
Glaucoma ........................................................................................................................................................ 4,000,000
Vision and Eye Health .................................................................................................................................... 2,500,000
Alzheimer’s Disease ........................................................................................................................................ 35,500,000
Inflammatory Bowel Diseases ........................................................................................................................ 1,000,000
Interstitial Cystitis .......................................................................................................................................... 1,100,000
Excessive Alcohol Use .................................................................................................................................... 6,000,000
Chronic Kidney Disease .................................................................................................................................. 8,500,000
Chronic Disease Education and Awareness ................................................................................................... 6,000,000
Prevention Research Centers ......................................................................................................................... 29,961,000
Heart Disease and Stroke .............................................................................................................................. 147,105,000
Diabetes .......................................................................................................................................................... 156,129,000
National Diabetes Prevention Program .......................................................................................................... 38,300,000
Breast and Cervical Cancer ........................................................................................................................... 244,500,000
WISEWOMAN ........................................................................................................................................... 37,620,000
Breast Cancer Awareness for Young Women ................................................................................................. 8,960,000
Cancer Registries ........................................................................................................................................... 56,440,000
Colorectal Cancer ........................................................................................................................................... 45,294,000
Comprehensive Cancer ................................................................................................................................... 26,425,000
Johanna’s Law ................................................................................................................................................ 12,500,000
Ovarian Cancer ............................................................................................................................................... 14,500,000
Prostate Cancer .............................................................................................................................................. 15,205,000
Skin Cancer .................................................................................................................................................... 5,000,000
Cancer Survivorship Resource Center ............................................................................................................ 725,000
Oral Health ..................................................................................................................................................... 20,750,000
Safe Motherhood/Infant Health ...................................................................................................................... 143,000,000
Arthritis ........................................................................................................................................................... 11,000,000
Epilepsy .......................................................................................................................................................... 13,000,000
National Lupus Registry ................................................................................................................................. 10,500,000
Racial and Ethnic Approaches to Community Health ................................................................................... 75,950,000
Good Health and Wellness in Indian Country ....................................................................................... 26,500,000
Social Determinants of Health ....................................................................................................................... 100,000,000
Million Hearts ................................................................................................................................................. 10,000,000
National Early Child Care Collaboratives ...................................................................................................... 5,000,000
Hospitals Promoting Breastfeeding ................................................................................................................ 9,750,000
Alzheimer’s Disease.—The Committee includes an increase of
$5,000,000 to support provisions enacted in the Building Our Larg-
est Dementia (BOLD) Infrastructure for Alzheimer’s Act (P.L. 115–
406), including the implementation of the Road Map Series, ex-
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Alzheimer’s and other dementias public health infrastructure
across the country.
Breast and Cervical Cancer.—The Committee includes an in-
crease of $10,000,000 to increase the provision of critical, lifesaving
breast cancer screening and diagnostic services to uninsured and
underinsured women, supporting the Cancer Moonshot goal to in-
crease the percentage of women served by the National Breast and
Cervical Cancer Early Detection Program (NBCCEDP) who have
rarely or never been screened. In addition, the Committee is con-
cerned with the public health impact from triple-negative breast
cancer, named as such because it tests negative for estrogen recep-
tors, progesterone receptors, and excess HER2 protein and thus
does not respond to treatments developed for these subtypes. The
Committee supports efforts to increase awareness of triple negative
breast cancer and incorporate diagnoses strategies in existing
breast cancer screening, diagnosis and linkage to care health pro-
grams. Furthermore, the Committee encourages recipients to im-
plement navigator programs to help patients overcome barriers and
have the resources they need. The Committee requests information
in the fiscal year 2024 Congressional Budget Justification outlining
current activities to support navigation services.
Cancer.—The Committee includes a total increase of $32,250,000
for cancer prevention and control activities in this account. The
Committee supports the Administration’s inclusion of CDC in the
Cancer Moonshot initiative, recognizing the importance of public
health efforts in cancer prevention, screening, early detection, and
reducing disparities in quality of care. In addition to the programs
discussed separately under this account, the Committee includes:
an increase of $3,000,000 to expand awareness and prevention ef-
forts for Breast Cancer Awareness for Young Women; an increase
of $5,000,000 to enhance the work of the National Program of Can-
cer Registries; an increase of $2,000,000 for colorectal cancer; an
increase of $6,000,000 for the National Comprehensive Cancer Con-
trol Program; an increase of $2,000,000 for Johanna’s Law that
raises awareness of the five main types of gynecological cancer; an
increase of $2,000,000 to advance ovarian cancer prevention, early
detection, risk assessment, and access to the standard of care; an
increase of $1,000,000 for skin cancer; and an increase of $250,000
for the Cancer Survivorship Resource Center.
Chronic Disease Education and Awareness.—The Committee in-
cludes an increase of $3,000,000 to expand public health education
and awareness activities that help to improve surveillance, diag-
nosis, and proper treatment for chronic diseases. This competitive
grant program expands and advances CDC’s work with stake-
holders on education, outreach, and public awareness activities for
a variety of chronic diseases for which there is a clear disparity in
public and professional awareness that are not already specified
under CDC in this report. As this program matures, CDC is urged
to identify and facilitate opportunities for coordination and best
practices among grantees to benefit from shared goals and if appro-
priate, with smaller partners and rare disease organizations that
receive funding through other chronic disease programs.
Chronic Kidney Disease.—The Committee includes an increase of
$5,000,000 to accelerate activities to increase awareness, diagnosis,
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nerships to support community-based activities that enhance
health systems’ capacity to identify, risk-stratify, and manage indi-
viduals with CKD. The Committee urges CDC to support activities
addressing inherited kidney diseases, such as polycystic kidney dis-
ease (PKD) and encourages CDC to continue to discuss the avail-
ability and feasibility of any potential data sources for surveillance
of PKD.
Diabetes.—The Committee includes an increase of $5,000,000 to
prevent diabetes and its complications, and to reduce inequities
through prevention strategies, translational research, and edu-
cation. In addition, the Committee includes an increase of
$5,000,000 for the Diabetes Prevention Program to expand efforts
of this public-private partnership that provides diabetes prevention
for people with prediabetes. The Committee supports the dissemi-
nation of community-based prevention and control programs and
encourages flexibility to organizations serving low-income popu-
lations to address barriers these populations face in achieving
weight loss outcomes.
Early Child Care Collaboratives.—The Committee includes an in-
crease of $1,000,000 to enable training of early care and education
providers in the implementation of healthy eating and physical ac-
tivity best practices, including strategies for engaging families.
Funds will also support technical assistance for integration of
healthy eating and physical activity best practices into existing
State and local professional development systems’ early care and
education settings, and health initiatives. The Committee also en-
courages the program to serve a mix of rural, suburban and urban
areas, including areas with high childhood obesity rates.
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
binge eating, through the Youth Risk Behavior Surveillance Sys-
tem and the Behavioral Risk Factor Surveillance System.
Epilepsy.—The Committee includes an increase of $2,500,000 for
epilepsy. The Committee commends CDC for its ongoing leadership
of this successful program and its effective community collabora-
tions, and encourages further efforts to eliminate stigma, improve
awareness and education, and better connect people with the
epilepsies to health and community services.
Excessive Alcohol Use Prevention.—The Committee includes an
increase of $1,000,000 to expand alcohol epidemiology capacity
through improved data collection on excessive drinking and related
harms in more States, and monitoring identifying strategies to re-
duce youth exposure to alcohol and alcohol marketing.
Farm-to-School.—The Committee includes $2,000,000 within Nu-
trition, Physical Activity, and Obesity to continue research and
education activities related to farm to school programs that result
in promoting healthy eating habits for students.
Food Allergies.—The Committee includes $2,000,000 for a school-
based effort to address food allergies and reduce potentially fatal
anaphylactic reactions.
Glaucoma.—The Committee requests information in the fiscal
year 2024 Congressional Budget Justification on efforts to reach Af-
rican American and Hispanic communities through the glaucoma
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program.
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Heart Disease and Stroke.—The Committee includes a total in-
crease of $15,500,000 to address cardiovascular diseases. The Com-
mittee includes an increase of $2,000,000 to support, strengthen,
and expand evidence-based initiatives at the State, local, tribal,
and territorial level. The Committee recognizes the vital impor-
tance of addressing cardiovascular disease among women, particu-
larly women of color, and further recognizes that the resulting
costs to the health care system of unrecognized cardiovasular dis-
ease in women can be substantially reduced with appropriate pub-
lic awareness and prevention efforts. The Committee includes an
increase of $7,500,000 for the WISEWOMAN program to be ex-
panded to additional States, growing the number of low-income,
uninsured and underinsured women who are assessed and con-
nected to resources. The Committee also includes an increase of
$6,000,000 for the Million Hearts initiative to increase education
and outreach about the importance of healthy behaviors, regular
heart screenings, and prevention measures.
High Obesity Rate Counties.—The Committee continues to sup-
port the rural extension and outreach service grants for rural coun-
ties with an obesity prevalence of over 40 percent. CDC is encour-
aged to give preference to projects in States where at least 10 per-
cent of counties meet the requirements of the program.
Inflammatory Bowel Diseases.—The Committee commends the
ongoing work of CDC to better understand the incidence and preva-
lence of Crohn’s disease and ulcerative colitis, as well as disparities
in patterns of care and health outcomes for this patient population
through the Incidence, Prevalence, and Treatment Patterns of IBD
in the United States (INPUT) study. The Committee is concerned
about new information from the INPUT Study indicating that so-
cial determinants of health contribute to disparities in diagnosis
and patterns of care and encourages CDC to continue supporting
the INPUT study to better understand these disparities in children
and in adults related to race, socioeconomic status and other fac-
tors, and to identify potential interventions to reduce disparities in
care and outcomes. The Committee also encourages CDC to develop
a strategic framework for the next iteration of the INPUT study
and to produce a concept plan for an education and awareness cam-
paign focused on communicating these messages to healthcare pro-
viders, patients, and caregivers.
Interstitial Cystitis.—The Committee requests an update in the
fiscal year 2024 Congressional Budget Justification on education,
outreach, and public awareness activities related to interstitial cys-
titis.
Lupus.—The Committee includes an increase of $1,000,000 for
activities to advance public health knowledge about lupus, which
will lead to improved care for those living with the disease.
Multiple Myeloma.—The Committee is concerned about the bur-
den of multiple myeloma on patients and their caregivers. The
Committee encourages CDC to increase outreach and education of
myeloma among high-risk individuals especially among African
Americans, Hispanics, and other communities of color.
Nutrition, Physical Activity and Obesity.—The Committee sup-
ports CDC’s efforts to promote healthy behaviors at every stage of
life by encouraging regular physical activity, good nutrition, and
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Oral Health.—The Committee includes an increase of $1,000,000
to expand support to State and territorial health departments in
their efforts to reduce oral disease and improve oral health through
effective interventions.
Prevention Research Centers.—The Committee includes an in-
crease of $3,000,000 to expand the national network conducting
prevention research and translating research results into policy
and public health practice that address local health needs.
Prostate Cancer.—The Committee includes an increase of
$1,000,000 to bolster public awareness of prostate cancer risks,
screening, and treatment, and improve surveillance of this disease.
The Committee encourages CDC to increase outreach and edu-
cation among high-risk men, especially African-American men. In
addition, the Committee encourages CDC to consider an interactive
simulation decision aid for men at risk of prostate cancer, and to
establish a resource center with educational materials to assist in
decision-making for men, their partners, and providers.
Racial and Ethnic Approaches to Community Health (REACH).—
The Committee includes a total increase of $10,000,000 to continue
scaling this program to all States and territories, and to support
grantees in building capacity for collaboration and disseminating
evidence-based strategies in communities. REACH is a vital initia-
tive to help eliminate healthcare disparities in minority commu-
nities. The Committee’s recommended level includes an increase of
$4,000,000 for Good Health and Wellness in Indian Country.
Safe Motherhood and Infant Health.—The Committee includes a
total increase of $60,000,000 for this portfolio of programs to im-
prove the health of pregnant and postpartum individuals and their
babies, including to reduce disparities in maternal and infant
health outcomes. The total funding allows for the expansion of Ma-
ternal Mortality Review Committees (MMRCs) and Perinatal Qual-
ity Collaboratives (PQCs) to additional States and territories and
for increased support to current States and territories, as well as
increased support for other programs including Sudden Unex-
plained Infant Death (SUID). The Committee supports CDC’s ef-
forts to provide technical assistance to existing State MMRCs to
build stronger data systems, improve data collection to ensure the
accuracy and completeness, and create consistency in data collec-
tion. The Committee encourages CDC to establish data collection
guidelines and to provide technical assistance to State MMRCs re-
garding the unique concerns of rural and underserved commu-
nities. The Committee encourages CDC to work with States to in-
clude and report data from birth centers in the Maternity Practices
in Infant Nutrition and Care Survey and the Levels of Care Assess-
ment Tool. In addition, the Committee encourages CDC to collect
and report PQC data by race and ethnicity to mitigate inequities
in overuse of cesarean sections. The Committee also encourages
PQCs, whenever feasible, to include all care settings (hospital,
birth center, home) and midwives with all nationally recognized
credentials (certified nurse-midwives, certified professional mid-
wives, certified midwives) for shared learning and teaching in this
quality improvement work. The Committee also encourages CDC to
increase awareness through PQCs of newer options and tech-
nologies for postpartum hemorrhage management. In addition, the
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analysis, including the expansion of the SUID and Sudden Death
in the Young Case Registry, to improve SUID prevention strate-
gies. Furthermore, the Committee supports the CDC’s past efforts
to promote the engagement of fathers and partners in addressing
maternal mortality and severe morbidity. The Committee encour-
ages CDC to continue these efforts and to consider opportunities to
build on the PRAMS for Dads pilot projects by expanding such pilot
projects into additional States.
School Health.—The Committee includes an increase of
$10,000,000 to expand the number of States in the Healthy Schools
program.
Social Determinants of Health.—The Committee includes an in-
crease of $92,000,000 to award competitive grants to State, local,
territorial, or tribal jurisdictions to support the development of So-
cial Determinants of Health Accelerator Plans, the implementation
of those plans, and to improve the health of Medicaid beneficiaries.
Such plans should include a description of the health and social
outcome objectives of the Social Determinants Accelerator Plan;
identify target populations that would benefit from implementation
of the plan including Medicaid-eligible individuals; and identify
non-governmental, private, or public health organizations and com-
munity organizations that would participate in the development of
the plan. Grantees may use a portion of grant funding to convene
government entities, public and private stakeholders, and to en-
gage qualified research experts in developing Accelerator Plans.
Tobacco.—The Committee includes an increase of $10,000,000 so
that CDC, States and territories can continue efforts to more
robustly respond to the public health threat caused by youth use
of e-cigarettes and other tobacco products, to reduce tobacco use
among disparate populations and in areas and regions with high
tobacco prevalence and mortality, and to expand the highly suc-
cessful and cost-effective Tips from Former Smokers media cam-
paign.
In addition, the Committee encourages CDC, in consultation with
the Food and Drug Administration (FDA), Director of the Center
for Tobacco Products, and any other relevant agency, to develop an
additional question on National Youth Tobacco Survey to assess
youth consumption of premium cigars. For purposes of this section,
the term premium cigar shall be the definition agreed upon by
DOJ, FDA and industry in the case of Cigar ssociation of America
vs. FDA.
Vision and Eye Health.—The Committee includes an increase of
$1,000,000 to initiate efforts to reinstate national-level surveillance
of vision impairment and eye disease.
BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITIES AND
HEALTH
Appropriation, fiscal year 2022 ......................................................... $177,060,000
Budget request, fiscal year 2023 ....................................................... 195,310,000
Committee Recommendation ............................................................. 225,060,000
Change from enacted level ......................................................... +48,000,000
Change from budget request ...................................................... +29,750,000
This account supports efforts to conduct research on and address
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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 2023
Budget Activity Committee
Birth Defects .................................................................................................................................................. $19,000,000
Fetal Death ..................................................................................................................................................... 1,900,000
Fetal Alcohol Syndrome .................................................................................................................................. 12,000,000
Folic Acid ........................................................................................................................................................ 3,150,000
Infant Health .................................................................................................................................................. 8,650,000
Autism ............................................................................................................................................................ 33,100,000
Disability & Health ......................................................................................................................................... 49,000,000
Tourette Syndrome .......................................................................................................................................... 2,500,000
Early Hearing Detection and Intervention ...................................................................................................... 10,760,000
Muscular Dystrophy ........................................................................................................................................ 7,500,000
Attention Deficit Hyperactivity Disorder ......................................................................................................... 1,900,000
Fragile X ......................................................................................................................................................... 2,000,000
Spina Bifida ................................................................................................................................................... 7,500,000
Congenital Heart ............................................................................................................................................ 8,250,000
Public Health Approach to Blood Disorders ................................................................................................... 10,900,000
Hemophilia Activities ...................................................................................................................................... 3,500,000
Hemophilia Treatment Centers ....................................................................................................................... 5,100,000
Thalassemia ................................................................................................................................................... 2,100,000
Neonatal Abstinence Syndrome ...................................................................................................................... 3,250,000
Surveillance for Emerging Threats to Mothers and Babies .......................................................................... 33,000,000
Autism.—The Committee includes an increase of $10,000,000 to
expand the Autism and Developmental Disabilities Monitoring
(ADDM) Network and to re-establish surveillance of cerebral palsy
at two ADDM sites.
Blood Disorders.—The Committee includes an increase of
$3,500,000 for sickle cell data collection and analysis. The Com-
mittee encourages CDC to provide technical assistance to addi-
tional States with a higher prevalence of sickle cell disease, so that
they can successfully participate in this grant program to better
identify affected individuals in their states and better meet their
needs.
Congenital Heart Defects.—The Committee includes an increase
of $1,000,000 to advance congenital heart disease-related public
health research and surveillance initiatives.
Early Hearing Detection and Intervention.—The Committee is
aware of the significant racial and ethnic disparities in care facing
children with hearing loss, and the effect unaddressed congenital
hearing loss has on communication skills, psychosocial develop-
ment, educational progress, and language development. The Com-
mittee encourages CDC to expand their work to improve surveil-
lance of early hearing detection and intervention systems to ensure
access to timely identification of congenital and acquired hearing
loss and develop materials to enhance connection to follow up serv-
ices among racial and ethnic minorities, and other medically under-
served populations.
Fetal Alcohol Spectrum Disorders.—The Committee includes an
increase of $1,000,000 to expand efforts related to fetal alcohol
spectrum disorders.
Fetal Death.—The Committee includes an increase of $1,000,000
to expand research, surveillance and data collection activities re-
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available, and evaluate evidence-based awareness and educational
activities on stillbirth prevention.
Fragile X and Fragile X-Associated Disorders.—The Committee
commends CDC’s efforts to identify and define the population im-
pacted by fragile X (FX) and all conditions associated with the gene
mutation with the goal of understanding the public health impact
of these conditions. To help this effort, the Committee urges CDC
to support additional strategies to promote earlier identification of
children with FX. The Committee also urges CDC to work to en-
sure underserved populations at risk of FX conditions are being
properly diagnosed and are aware of medical services available.
Improving the Health of People with Intellectual Disabilities.—
The Committee includes an increase of $10,000,000 for the ex-
panded provision of year-round, grassroots activities in commu-
nities to create opportunities for health screenings and access to
quality healthcare, and health and wellness programming for peo-
ple with intellectual disabilities. These efforts enhance the lives of
individuals while eliminating stigmas and stereotypes.
Muscular Dystrophy.—The Committee includes an increase of
$1,000,000 to enhance Muscular Dystrophy research and disease
surveillance initiatives, including the Duchenne Muscular Dys-
trophy Care Considerations. The Committee looks forward to CDC’s
report describing how the Muscular Dystrophy Program funding is
allocated, including evaluation of the impact of the Care Consider-
ations as well as differences in care and outcomes between Cer-
tified Duchenne Care Centers and non-certified centers with the
MD-STARnet network. Finally, the Committee encourages CDC to
work with stakeholders to extract and evaluate the utility of com-
mon data elements in electronic health records to improve care, un-
derstand disease outcomes, and model disease progression.
Spina Bifida.—The Committee requests an update in the fiscal
year 2024 Congressional Budget Justification on efforts to address
the transitional and adult care needs of the growing, aging spina
bifida community.
Surveillance for Emerging Threats to Mothers and Babies Net-
work (SET-NET).—The Committee includes an increase of
$20,000,000 to increase efforts and expand the reach of SET-NET
to detect and respond to emerging threats to mothers and babies.
Tourette Syndrome.—The Committee includes an increase of
$500,000 to enhance efforts focused on Tourette Syndrome.
PUBLIC HEALTH SCIENTIFIC SERVICES
Appropriation, fiscal year 2022 ......................................................... $651,997,000
Budget request, fiscal year 2023 ....................................................... 798,537,000
Committee Recommendation ............................................................. 867,497,000
Change from enacted level ......................................................... +215,500,000
Change from budget request ...................................................... +68,960,000
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.
Within the total, the Committee recommends the following
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FY 2023
Budget Activity Committee
Health Statistics ............................................................................................................................................. $190,397,000
Surveillance, Epidemiology, and Informatics ................................................................................................. 298,100,000
Advancing Laboratory Science ....................................................................................................................... 23,000,000
Public Health Data Modernization ................................................................................................................. 250,000,000
Public Health Workforce ................................................................................................................................. 106,000,000
Advancing Laboratory Science.—The Committee includes an in-
crease of $10,000,000 to strengthen CDC’s laboratory science and
safety, as CDC scientists and laboratories must be capable and pre-
pared to meet evolving health threats, and maintain the highest
standards of laboratory quality and safety oversight. The Com-
mittee is concerned about the suspension of parasitic lab services
which clinicians and patients rely upon and urges prompt resump-
tion of all services.
Familial Hypercholesterolemia.—The Committee includes
$100,000 to support public health efforts focused on this inherited
genetic disorder to improve diagnosis and care delivery and prevent
heart disease.
National Center for Health Statistics (NCHS).—The Committee
includes an increase of $10,000,000 for NCHS, a component of our
nation’s public health infrastructure, to monitor the health of our
Nation and to make much-needed investments in the next genera-
tion of surveys and products.
National Neurological Conditions Surveillance System.—The
Committee includes $5,000,000 within Surveillance, Epidemiology,
and Informatics to continue efforts on the two initial conditions.
Primary Immunodeficiencies.—The Committee includes
$3,500,000, an increase of $500,000, for education, awareness, and
genetic sequencing surveillance related to primary
immunodeficiencies. This program has proven effective in identi-
fying undiagnosed patients and linking them to centers of care.
Public Health Data Modernization Initiative.—The Committee in-
cludes an increase of $150,000,000 for the Data Modernization Ini-
tiative (DMI) to build upon current work to create modern, inte-
grated, and real-time public health surveillance with CDC, State,
territorial, local and tribal partners. The Committee acknowledges
the need for sustained funding for this public health infrastructure
to continue to move from siloed and brittle public health data sys-
tems to connected, resilient, adaptable, and sustainable systems to
achieve real change. Essential to this significant effort are core
data standards and support to recruit and retain the data science
workforce. This is a massive undertaking by CDC, and it will only
be successful with the commitment to improvement by the entire
agency, and active engagement with partners. The Committee reit-
erates that the NCHS is to be fully integrated in the DMI.
Public Health Workforce.—The Committee includes an increase of
$45,000,000 to aid in the rebuilding of the public health workforce.
The Committee recognizes that a robust and well-trained public
health workforce is critical to maintaining a highly effective public
health infrastructure.
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ENVIRONMENTAL HEALTH
Appropriation, fiscal year 2022 ......................................................... $228,350,000
Budget request, fiscal year 2023 ....................................................... 401,850,000
Committee Recommendation ............................................................. 328,850,000
Change from enacted level ......................................................... +100,500,000
Change from budget request ...................................................... ¥73,000,000
The Committee recommendation includes $311,850,000 in discre-
tionary appropriations and $17,000,000 in transfers from the PPH
Fund.
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
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 2023
Budget Activity Committee
Environmental Health Laboratory ..................................................................................................................... $71,750,000
Newborn Screening Quality Assurance Program ..................................................................................... 22,000,000
Newborn Screening /Severe Combined Immunodeficiency Diseases ...................................................... 1,250,000
Environmental Health Activities ....................................................................................................................... 23,000,000
Safe Water ........................................................................................................................................................ 8,600,000
Amyotrophic Lateral Sclerosis (ALS) Registry .................................................................................................. 10,000,000
Climate and Health .......................................................................................................................................... 75,000,000
Trevor’s Law ..................................................................................................................................................... 2,000,000
Environmental and Health Outcome Tracking Network ................................................................................... 34,000,000
Asthma ............................................................................................................................................................. 33,500,000
Childhood Lead Poisoning ................................................................................................................................ 66,000,000
Lead Exposure Registry .................................................................................................................................... 5,000,000
Amyotrophic Lateral Sclerosis (ALS) Registry.—The Committee
recognizes that the National ALS Registry is a unique scientific re-
source in the fight to understand and prevent ALS. The Committee
urges CDC to continue its investment in research that will lead to
interventions to reduce the incidence of ALS and encourages CDC
to further examine the potential risks of ALS through State and
local environmental reports where there is an increased prevalence
of ALS to further understand the disease’s etiology.
Asthma.—The Committee includes an increase of $3,000,000 for
the National Asthma Control Program to increase the number of
States carrying out programmatic activities. In addition, the Com-
mittee recognizes that States receiving funding under CDC’s Na-
tional Asthma Control Program utilize the EXHALE strategy to
better control asthma and reduce asthma-related hospitalizations,
emergency department visits, and healthcare costs. The Committee
requests a report within one year of the date of enactment of this
Act on the activities that have been undertaken by each State
grantee to address the outdoor environment component of their
asthma control program.
Childhood Lead Poisoning.—The Committee includes an increase
of $25,000,000 to support the expansion of direct CDC assistance
and funding to additional State and local public health depart-
ments. The Committee recognizes that CDC’s expertise and tech-
nical assistance can be a valuable asset. Furthermore, the Com-
mittee encourages CDC to require that States receiving funding for
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lead prevention report all blood tests in a standardized format
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through the Nationally Notifiable Noninfectious Diseases and Con-
ditions reporting system.
Climate and Health.—The Committee includes an increase of
$65,000,000 to expand to more States and territories to identify po-
tential health effects associated with climate change and imple-
ment health adaptation plans. Climate-related events affect every-
one, but not everyone is affected equally.
Newborn Screening.—The Committee includes an increase of
$3,000,000 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
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. The increase in funding will enable
States to establish testing for new conditions and improve testing
of current conditions; build technical capacity in States by pro-
viding education, training and technical assistance to address test-
ing challenges and determine appropriate testing methods for rapid
screening; and ensure test results for new conditions are accurate
by improving test result interpretation and expanding data ana-
lytic capacity.
Vessel Sanitation Program.—The Committee includes $4,000,000
to support the critical public health functions of the vessel sanita-
tion program. The Committee requests additional information in
the fiscal year 2024 Congressional Budget Justification on the pro-
gram budget, including user fee and no year funding balances, esti-
mated user fee collections, and the anticipated workload.
INJURY PREVENTION AND CONTROL
Appropriation, fiscal year 2022 ......................................................... $714,879,000
Budget request, fiscal year 2023 ....................................................... 1,283,169,000
Committee Recommendation ............................................................. 897,779,000
Change from enacted level ......................................................... +182,900,000
Change from budget request ...................................................... ¥385,390,000
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.
Within the total, the Committee recommends the following
amounts:
FY 2023
Budget Activity Committee
Domestic Violence and Sexual Violence ........................................................................................................... $37,700,000
Child Maltreatment ................................................................................................................................. 7,250,000
Child Sexual Abuse Prevention ............................................................................................................... 3,000,000
Community and Youth Violence Prevention ..................................................................................................... 100,000,000
Domestic Violence Community Projects ........................................................................................................... 9,500,000
Rape Prevention ............................................................................................................................................... 71,750,000
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Suicide Prevention ............................................................................................................................................ 22,000,000
Adverse Childhood Experiences ........................................................................................................................ 10,000,000
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FY 2023
Budget Activity Committee
National Violent Death Reporting System ........................................................................................................ 34,500,000
Traumatic Brain Injury ..................................................................................................................................... 11,250,000
Elderly Falls ...................................................................................................................................................... 4,050,000
Drowning ........................................................................................................................................................... 2,000,000
Injury Prevention Activities ............................................................................................................................... 31,950,000
Opioid Overdose Prevention and Surveillance ................................................................................................. 515,579,000
Injury Control Research Centers ...................................................................................................................... 12,500,000
Firearm Injury and Mortality Prevention Research .......................................................................................... 35,000,000
Adverse Childhood Experiences.—The Committee includes an in-
crease of $3,000,000 to expand efforts including technical assist-
ance to States to analyze data and burden.
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.
CDC’s child sexual abuse prevention research includes opportuni-
ties to improve surveillance systems and data collection, increase
the understanding of risk and protective factors, and develop and
disseminate effective prevention efforts.
Community and Youth Violence Prevention.—The Committee in-
cludes an increase of $84,900,000 for a new evidence-based commu-
nity violence intervention, which aims to prevent intentional vio-
lence, such as mass casualty violence or gang violence. The Com-
mittee continues to recognize all forms of violence as a health crisis
that is in desperate need of increased data collection and funding
to support effective prevention and intervention efforts grounded in
public health approaches. There is increasing evidence of the pro-
found negative effects of violence and the exposure to violence on
child development, the long-term mental and physical health of af-
fected populations, and the economic development of communities,
especially communities of color. The Committee encourages CDC to
fund a broad range of interventions, including programs to provide
de-escalation and conflict mitigation skills.
Core State Injury Prevention Program (Core SIPP).—The Com-
mittee includes an increase of $3,000,000 for Core SIPP to enhance
efforts to identify and respond to injury threats with data-driven
public health actions.
Domestic Violence and Sexual Violence.—The Committee includes
an increase of $2,000,000 for intimate partner violence. The Com-
mittee notes the importance of the collection, reporting, and shar-
ing of data on domestic violence and sexual violence across agen-
cies. The Committee looks forward to receiving the National Do-
mestic Violence Prevention Action Plan in 2023, as requested in
House Report 117–96.
Domestic Violence Community Projects.—The Committee includes
an increase of $4,000,000 to expand the reach of the Domestic Vio-
lence Prevention Enhancement and Leadership Through Alliances
(DELTA) program.
Drowning.—The Committee includes an increase of $1,000,000 to
support proven drowning prevention programs with national orga-
nizations working with underserved and diverse youth, to support
State drowning surveillance efforts, and to begin implementation of
a national plan on water safety.
Elderly Falls.—The Committee includes an increase of
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$2,000,000, doubling efforts related to fall prevention.
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Firearm Injury and Mortality Prevention Research.—The Com-
mittee includes an increase of $22,500,000 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, including emergency room data on nonfatal gunshot injuries.
The Committee continues to be concerned by the prevalence of fire-
arm-related violence across the country, especially in our nation’s
schools, and urges CDC to conduct policy evaluation research to
prevent violence in our schools. Furthermore, the Committee recog-
nizes that community gun violence, such as gang violence, con-
stitutes 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, reflecting the
diversity of the victims of gun violence. Furthermore, the Com-
mittee urges CDC to investigate the impact of access to teen and
youth services in a community on rates of community violence.
High School Sports Injuries.—The Committee encourages CDC to
consider the feasibility of collecting and reporting data related to
injuries in high school sports to improve the safety of student ath-
letes.
Injury Control Research Centers.—The Committee includes an in-
crease of $3,500,000 to increase the number of awards for multi-
disciplinary research on the causes, outcomes, and prevention of in-
juries and violence.
National Violent Death Reporting System.—The Committee in-
cludes an increase of $10,000,000 to increase efforts so that data
can inform prevention efforts and save lives, including collecting
data on gender identity and sexual orientation.
Opioid Abuse and Overdose Prevention.—The Committee includes
an increase of $25,000,000 to enhance activities, including outreach
capacity and to help eliminate racial disparities in overdose deaths
and improve access to prevention and treatment services. In addi-
tion, the Committee notes that CDC is currently conducting efforts
focused on chronic pain as directed in House Report 117–96, and
requests an update in the fiscal year 2024 Congressional Budget
Justification on the status of these efforts. In addition, the Com-
mittee requests an update in the fiscal year 2024 Congressional
Budget Justification on the percentage of funding provided to local
communities for each entity receiving funds under this heading.
Rape Prevention.—The Committee includes an increase of
$15,000,000 to support rape prevention and education programs.
Suicide.—The Committee includes an increase of $2,000,000 to
expand surveillance and comprehensive prevention efforts, as sui-
cide is devastating communities across the U.S. In addition, the
Committee requests report, in consultation with SAMHSA, within
180 days of the date of enactment of this Act on the impact of on-
line forums promoting suicide on suicide rates, including the popu-
larization of a specific method and disseminating information on its
antidote. If the data for creating such a report is insufficient, CDC
is directed to provide recommendations for how existing databases
can be supplemented or the creation of new ones to capture this in-
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formation.
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Traumatic Brain Injury.—The Committee provides an increase of
$4,000,000 to initiate concussion surveillance, particularly among
children and youth.
NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
Appropriation, fiscal year 2022 ......................................................... $351,800,000
Budget request, fiscal year 2023 ....................................................... 345,300,000
Committee Recommendation ............................................................. 363,300,000
Change from enacted level ......................................................... +11,500,000
Change from budget request ...................................................... +18,000,000
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 2023
Budget Activity Committee
National Occupational Research Agenda ....................................................................................................... $121,000,000
Agriculture, Forestry, and Fishing ......................................................................................................... 29,500,000
Education and Research Centers ................................................................................................................... 33,000,000
Personal Protective Technology ...................................................................................................................... 24,000,000
Mining Research ............................................................................................................................................. 62,500,000
National Mesothelioma Registry and Tissue Bank ........................................................................................ 1,200,000
Firefighter Cancer Registry ............................................................................................................................ 5,500,000
Other Occupational Safety and Health Research .......................................................................................... 116,100,000
Agriculture, Forestry, and Fishing.—The Committee includes an
increase of $2,000,000 to expand efforts to protect workers in this
sector by providing leadership in applied research, disease and in-
jury surveillance, education and prevention.
Education and Research Centers.—The Committee includes an
increase of $2,000,000 to support efforts to reduce work-related in-
juries and illnesses through prevention research, education, and
implementation of programs to improve occupational health and
safety and minimize the dangers faced by workers across the coun-
try.
Firefighter Cancer Registry.—The Committee includes an in-
crease of $2,500,000, as the registry prepares to recruit and enroll
participants.
Occupational Injury and Illness.—The Committee requests a re-
port within 180 days of the date of enactment of this Act on the
estimate of the total incidence and economic burden of fatal and
nonfatal occupational injury and illness in the U.S. The report
shall adjust for known underreporting of occupational injury and
illness, estimate the incidence or prevalence of occupational ill-
nesses from public health data through attributable risk propor-
tions or other standard methodologies, and estimate both medical
and indirect costs, such as lost earnings, benefits, and home pro-
duction. This report shall also estimate the proportion of the total
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economic burden not absorbed by worker’s compensation insurance
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and shifted onto federal programs such as Medicare, Medicaid, and
Social Security Disability Insurance.
Personal Protective Technologies.—The Committee includes an in-
crease of $2,000,000 to enhance efforts regarding personal protec-
tive technologies in response to the COVID–19 pandemic and to
protect workers every day.
PFAS Exposure.—The Committee urges CDC to include farming
and agricultural sectors in its PFAS exposure research on health
impacts.
Radiation Exposure in Medical Procedures.—The Committee
notes that many patients, doctors and health care workers are ex-
posed to excessive radiation during medical procedures. The Com-
mittee requests a report within 90 days of the date of enactment
of this Act on appropriate standards of practice recommendations
for providers to follow to increase the use of radiation protection
technologies such as non-lead/non-vinyl/PVC shielding and reduce
avoidable exposures.
Total Worker Health.—The Committee includes an increase of
$2,000,000 to expand the Total Worker Health program, which sup-
ports and conducts ground-breaking research to advance the over-
all safety, health, and well-being of U.S. workers.
World Trade Center Health Program.—The Committee recognizes
that thousands of eligible members of the World Trade Center
Health Program (WTCHP) reside in States outside of New York
today. In consideration of migration trends and with a greater need
to provide clinical services, in particular, monitoring and treatment
of WTCHP certified conditions, and improve access to research
within the regions where eligible members live, the Committee en-
courages CDC to assess where eligible persons are located when
planning future Clinical Centers of Excellence competitions.
ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION
PROGRAM
Appropriation, fiscal year 2022 ......................................................... $55,358,000
Budget request, fiscal year 2023 ....................................................... 55,358,000
Committee Recommendation ............................................................. 55,358,000
Change from enacted level ......................................................... –––
Change from budget request ...................................................... –––
The Energy Employees Occupational Illness Compensation Pro-
gram provides compensation to employees and survivors of employ-
ees of Department of Energy facilities and private contractors who
have been diagnosed with a radiation-related cancer, beryllium-re-
lated disease, or chronic silicosis as a result of their work. NIOSH
estimates occupational radiation exposure for cancer cases, con-
siders and issues determinations for adding classes of workers to
the Special Exposure Cohort, and provides administrative support
to the Advisory Board on Radiation and Worker Health.
GLOBAL HEALTH
Appropriation, fiscal year 2022 ......................................................... $646,843,000
Budget request, fiscal year 2023 ....................................................... 747,843,000
Committee Recommendation ............................................................. 757,843,000
Change from enacted level ......................................................... +111,000,000
Change from budget request ...................................................... +10,000,000
Through its Global Health activities, CDC coordinates, cooper-
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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.
Within the total, the Committee recommends the following
amounts:
FY 2023
Budget Activity Committee
Global AIDS Program ...................................................................................................................................... $128,921,000
Global Tuberculosis ........................................................................................................................................ 14,722,000
Global Immunization Program ........................................................................................................................ 230,000,000
Polio Eradication ................................................................................................................................... 180,000,000
Other Global/Measles ............................................................................................................................ 50,000,000
Parasitic Diseases and Malaria ..................................................................................................................... 31,000,000
Global Public Health Protection. .................................................................................................................... 353,200,000
Global Health Security.—The Committee supports CDC’s work to
protect global health security through programs that detect, pre-
vent, and respond to infectious diseases and other health threats,
including the development of new tools, especially diagnostics, the
application of advanced molecular detection for the identification
and tracking of diseases and disease variants at home and abroad,
and core technical contributions to developing and validating tools
for use by U.S. bilateral and multilateral global health programs
and laboratory efforts to monitor and combat drug and insecticide
resistance, functions essential to ensuring that global health pro-
grams are responsive, efficient, and tailored for maximum impact.
The Committee urges CDC to ensure that the importance of re-
search and development to global health security is appropriately
reflected in their international engagements.
Global Public Health Protection.—The Committee includes an in-
crease of $100,000,000 to support CDC’s mission to protect the
health of our nation including by working across the globe. The
Committee supports CDC’s global efforts to detect epidemic threats
earlier, respond more effectively, and prevent avoidable crises.
Parasitic Disease and Malaria.—The Committee provides an in-
crease of $4,000,000 recognizing the important role CDC plays in
the fight against malaria and parasitic disease and encourages
CDC to continue to research, monitor, and evaluate efforts for ma-
laria and parasitic disease in collaboration across the agency and
with other agencies.
Polio Eradication.—The Committee includes an increase of
$2,000,000 to advance polio eradication efforts.
Population-based Surveillance Platforms.—The Committee pro-
vides $10,000,000 to support existing longitudinal population-based
infectious disease surveillance platforms that enable 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
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Tuberculosis.—The Committee includes an increase of $5,000,000
to advance tuberculosis prevention, diagnosis, and treatment ef-
forts.
PUBLIC HEALTH PREPAREDNESS AND RESPONSE
Appropriation, fiscal year 2022 ......................................................... $862,200,000
Budget request, fiscal year 2023 ....................................................... 842,200,000
Committee Recommendation ............................................................. 882,200,000
Change from enacted level ......................................................... +20,000,000
Change from budget request ...................................................... +40,000,000
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-
tentional. PHPR supports needs assessments, response planning,
training, epidemiology and surveillance, and upgrades for labora-
tory capacity and communications systems.
Within the total, the Committee recommends the following
amounts:
FY 2023
Budget Activity Committee
Public Health Emergency Preparedness Cooperative Agreement .................................................................. $735,000,000
Academic Centers for Public Health Preparedness ....................................................................................... 8,200,000
CDC Preparedness and Response .................................................................................................................. 139,000,000
Public Health Preparedness Cooperative Agreements.—The Com-
mittee includes an increase of $20,000,000 to enhance investments
in State, local, and territorial health departments to quickly detect,
monitor, and respond to health threats. Public health system in-
vestments serve as the backbone for disaster and outbreak re-
sponse in every State and the pandemic has shown that increased
funding for preparedness is necessary for a baseline of consistent
protection. The Committee directs that grant recipients incorporate
Limited English Proficient (LEP) Individuals into their emergency
response. Grant recipients must ensure that they are conducting
tailored and robust outreach efforts to LEP communities. In addi-
tion, the Committee requests the fiscal year 2024 Congressional
Budget Justification include a State distribution table, which
should also include how funding is being allocated to local health
departments and how States are determining these allocations.
BUILDINGS AND FACILITIES
Appropriation, fiscal year 2022 ......................................................... $30,000,000
Budget request, fiscal year 2023 ....................................................... 55,000,000
Committee Recommendation ............................................................. 55,000,000
Change from enacted level ......................................................... +25,000,000
Change from budget request ...................................................... –––
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-
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Maintenance Backlog.—The Committee includes an increase of
$25,000,000 to make significant progress on reducing CDC’s back-
log of maintenance and repairs.
CDC-WIDE ACTIVITIES AND PROGRAM SUPPORT
Appropriation, fiscal year 2022 ......................................................... $493,570,000
Budget request, fiscal year 2023 ....................................................... 968,570,000
Committee Recommendation ............................................................. 1,118,570,000
Change from enacted level ......................................................... +625,000,000
Change from budget request ...................................................... +150,000,000
This account supports public health leadership and support ac-
tivities at CDC.
The Committee recommendation includes $958,570,000 in discre-
tionary funds and $160,000,000 in transfers from the PPH Fund.
Within the total, the Committee recommends the following
amounts:
FY 2023
Budget Activity Committee
Preventive Health and Health Services Block Grant ..................................................................................... $160,000,000
Public Health Leadership and Support .......................................................................................................... 123,570,000
Infectious Disease Rapid Response Reserve Fund ........................................................................................ 35,000,000
Public Health Infrastructure and Capacity .................................................................................................... 750,000,000
Center for Forecasting and Outbreak Analytics ............................................................................................. 50,000,000
Center for Forecasting and Outbreak Analytics.—The Committee
includes funding for the new Center for Forecasting and Outbreak
Analytics to facilitate the use of data, modeling, and analytics to
improve preparedness and response. The Committee urges CDC to
continue to work with schools of public health and other academic
institutions to engage the nation’s expertise in disease modeling,
public health data analysis, research, and training to build work-
force capacity in this emerging field.
Infectious Disease Rapid Response Reserve Fund.—The Com-
mittee includes an increase of $15,000,000. 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 in-
fectious disease crisis. Funds are available until expended.
Local Health Departments.—The Committee notes that Federal
funding intended for both State and local health departments does
not consistently reach local health departments beyond those di-
rectly-funded and recognizes the important role of local health de-
partments in our nation’s governmental public health partnership
to protect the public’s health.
Preventive Health and Health Services Block Grant.—The Com-
mittee continues to support the Preventive Health and Health
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.
Public Health Infrastructure and Capacity.—The Committee in-
cludes an increase of $550,000,000 to provide consistent and reli-
able funding for State, local, territorial, Federal public health agen-
cies. This disease-agnostic funding can be used to address cross-
cutting needs, including bolstering the public health workforce, ad-
dressing local priorities, ensuring capacity to meet urgent needs
during emergencies, and improving data collection and sharing
processes. The Committee encourages CDC to provide States with
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departments that do not receive funding directly. The Committee
further urges CDC to publicly track and report on the suballocation
of funding through State health departments to local health depart-
ments. The Committee directs that no less than 70 percent of this
funding be awarded to health departments.
Public Health Leadership and Support.—The Committee includes
an increase of $10,000,000 to support CDC’s foundational public
health activities and to facilitate partnerships.
NATIONAL INSTITUTES OF HEALTH
Appropriation, fiscal year 2022 ......................................................... $44,959,000,000
Budget request, fiscal year 2023 ....................................................... 45,233,218,000
Committee Recommendation ............................................................. 47,459,000,000
Change from enacted level ......................................................... +2,500,000,000
Change from budget request ...................................................... +2,225,782,000
The Committee recommendation for the National Institutes of
Health (NIH) program level includes $46,038,300,000 in discre-
tionary appropriations and $1,420,700,000 in Public Health Service
Act (PHS Act) section 241 evaluation set-aside transfers.
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 (Cures Act), including a total of
$216,000,000 for the Cancer Moonshot Initiative; $541,000,000 for
the All of Us precision medicine initiative (including $419,000,000
from the Cures Act); and $620,000,000 for the Brain Research
through Application of Innovative Neurotechnologies (BRAIN) Ini-
tiative (including $450,000,000 from the Cures Act).
The Committee includes specific funding allocations for several
initiatives and activities detailed in the Institute- and Center-spe-
cific sections below.
NATIONAL CANCER INSTITUTE (NCI)
Appropriation, fiscal year 2022 ......................................................... $6,912,522,000
Budget request, fiscal year 2023 ....................................................... 6,713,851,000
Committee Recommendation ............................................................. 7,378,579,000
Change from enacted level ......................................................... +466,057,000
Change from budget request ...................................................... +664,728,000
The Committee recommendation includes $7,162,579,000 in dis-
cretionary appropriations and $216,000,000 made available in the
Cures Act.
Mission.—NCI leads, conducts, and supports cancer research
across the Nation to advance scientific knowledge and help all peo-
ple live longer, healthier lives.
Brain Cancer.—The Committee recognizes that certain types of
brain cancers are associated with high mortality and morbidity
rates. Brain and other nervous system cancers have a five-year sur-
vival rate of 33 percent. Certain brain tumors that occur in hu-
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cancers in dogs share many of the same molecular underpinnings
of their human counterparts. There is great potential for devel-
oping treatments for brain cancers that will benefit dogs and hu-
mans and provide an intermediate step to evaluate human treat-
ments in a more meaningful and related species. The Committee
encourages NIH to continue to support research that brings to-
gether researchers and clinicians from pediatrics, adult oncology,
veterinary medicine, and biomedical engineering to leverage the
linkage between brain cancers in dogs and humans to evaluate and
develop treatments and safe delivery systems to benefit both spe-
cies.
Cancer Immunotherapy and Correlative Research.—Under-
standing the complex factors that determine whether a particular
cancer immunotherapy will succeed for a given patient is a vital
area of research. Central to this research is the analysis of blood,
tumor, and other tissues in conjunction with the outcome of clinical
trials (known as correlative studies), which can help explain why
a treatment worked or not, and why it did or did not produce seri-
ous side effects, as well as providing critical insights to help opti-
mize subsequent trials. For example, by evaluating peripheral
blood and tumor biopsies obtained from patients prior to and dur-
ing treatment, researchers can better understand the factors that
influence successful anti-tumor immune response and the develop-
ment of treatment resistance. In general, correlative studies are
most useful when conducted in a timely manner as an integrated
part of clinical trials. The Committee urges NCI to continue to ex-
plore approaches to support and streamline the incorporation of
correlative studies in immunotherapy trials and commends NCI for
the establishment of the Cancer Immune Monitoring and Analysis
Centers (CIMACS) and the Cancer Immunologic Data Commons
(CIDC) as part of the Cancer Moonshot. This network carries out
comprehensive molecular analysis of clinical trial specimens for
biomarkers and pathways associated with response to
immunotherapy and conducts correlative studies and profiling of
tumors and immune cells for NCI-funded early trials of
immunotherapy. The Committee encourages NCI to continue fund-
ing for correlative studies through existing funded networks.
Cancer Moonshot.—The Committee directs NIH to transfer
$216,000,000 from the NIH Innovation Account to NCI to support
the Cancer Moonshot initiative. These funds were authorized in the
Cures Act.
The Committee also encourages NCI to leverage Cancer Moon-
shot efforts to continue supporting research aimed at addressing
health disparities and expanding the scientific understanding of
the genetic and molecular drivers of cancer, including for diseases
with significant differences in outcomes between White and non-
White patients, such as acute myeloid leukemia (AML). According
to research using data from NCI’s Surveillance, Epidemiology, and
End Results (SEER) Program, there is a wide disparity and higher
mortality rate among African American patients compared to
White patients with AML. The Committee encourages NCI to con-
tinue intramural and extramural research efforts to identify the
underlying causes of health disparities associated with AML, in-
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Cancer Survivorship.—As of January 2019, there were an esti-
mated 16.9 million cancer survivors in the U.S. and the number of
cancer survivors is projected to increase to 22.2 million by 2030.
The Committee encourages NCI to continue to address the unique
needs of cancer survivors with resources to support cancer sur-
vivors whether through additional research on essential elements
of survivorship care, leveraging Federal resources, or improving co-
ordination among providers. An investment in quality of life after
a diagnosis is a critical component of our Nation’s fight against the
disease.
Cancer Vaccines.—The Committee recognizes that the success of
the COVID 19 vaccines—which became available less than a year
from the outset of the pandemic and now deliver up to 95 percent
protection rates—is because these vaccines were built on mes-
senger RNA technology, or mRNA, an approach that had been initi-
ated for cancer research. The Committee understands that with
further research, mRNA cancer vaccines could potentially be
among the most cost-effective methods of preventing recurrences
and the high costs of cancer care. In addition, the fiscal year 2023
budget request explicitly acknowledged that a potential area of
transformative research within NIH is the preparation of mRNA
vaccines against common forms of cancer. The Committee encour-
ages NIH to continue to support research efforts that move the
field forward for mRNA vaccines in cancer. Areas of particular sci-
entific opportunity include focus on enhancing immune recognition
of solid tumors, overcoming suppression in the tumor microenviron-
ment, and personalization of mRNA vaccines. Together, these strat-
egies have high potential for increasing the effectiveness for cancer
immunotherapy treatment and prevention.
Childhood Cancer Data Initiative (CCDI).—The Committee in-
cludes no less than $50,000,000 for the CCDI, the same as the fis-
cal year 2022 level. Within this total, the Committee includes no
less than $750,000 to continue to support enhancement of the
CCDI Molecular Characterization Initiative and other efforts as ap-
plicable through continued expansion to focus on ultra-rare tumor
types, such as atypical teratoid rhabdoid tumor (ATRT), and other
ultra-rare pediatric tumor types with limited therapeutic options.
The effort should include comprehensive clinical and molecular
data for each patient to the extent possible. The dataset should in-
clude clinical, radiographic, histopathologic, and molecular informa-
tion to the extent possible and be stored in a manner that allows
for interrogation of patient level data. The data collected will be
used to identify risk factors, aid in prognostication and treatment
recommendations, and assist with the development of novel thera-
peutics for these diseases.
Childhood Cancer STAR Act.—The Committee includes no less
than $30,000,000, the same as the fiscal year 2022 enacted level,
for continued implementation of sections of the Childhood Cancer
Survivorship, Treatment, Access, and Research (STAR) Act to ex-
pand existing biorepositories for childhood cancer patients enrolled
in NCI-sponsored clinical trials to collect and maintain relevant
clinical, biological, and demographic information on children, ado-
lescents, and young adults, with an emphasis on selected cancer
subtypes (and their recurrences) for which current treatments are
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and adolescent survivorship research. This amount also includes
the $2,000,000 provided for the CDC’s ongoing efforts to enhance
cancer registry case capture efforts for childhood and adolescent
cancers.
Clinical Trials Reporting of Data.—The Committee recognizes
that children have often been historically underrepresented in clin-
ical trials. However, children with cancer participate in clinical
trials at a high rate, thanks in large part to NCI support for clin-
ical trials through the Children’s Oncology Group, the Pediatric
Early Phase Clinical Trials Network, the Pediatric Brain Tumor
Consortium, and NCI’s Pediatric Oncology Branch at the NIH Clin-
ical Center. The Committee encourages NCI to continue to make
information available to the public regarding adult trials that allow
enrollment of patients under age 18.
Colorectal Cancer.—The Committee recognizes that colorectal
cancer is the second leading cause of cancer death for men and
women in the U.S. While colorectal cancer incidence rates in indi-
viduals over 50 have largely stabilized or declined due to signifi-
cant advancements in preventive screening, incidence rates for
early-onset colorectal cancer (individuals diagnosed at ages 20 to
49) have been consistently increasing. Three out of four early-onset
colorectal cancer patients have no family history of the disease and
over 60 percent of early-onset colorectal cancer patients are diag-
nosed at a late stage. There are several racial/ethnic disparities in
colorectal cancer screening and outcomes. Black individuals have
the highest incidence and mortality and face lower survival than
White individuals. American Indians/Alaskan Natives also have
elevated rates and deaths compared to the general population and
represent the only racial/ethnic group for whom colorectal cancer
mortality rates are not declining. Racial and ethnic minorities are
also more likely than White individuals to present with late-stage,
incurable disease. Notably, the sharpest increase in metastatic,
early-onset colorectal cancer is among people 20 to 39 years old, es-
pecially Black and Hispanic individuals. Mortality rates across all
ages for late-stage colorectal cancer have remained stagnant due to
minimal progress in treatments for colorectal cancer patients.
Given these challenges, the Committee urges NCI to prioritize
research on colorectal cancer. The Committee directs NCI to submit
a plan to the Committee within 180 days of enactment of this Act
guided by a multidisciplinary and multi-agency advisory council to
include diverse representatives from the colorectal cancer commu-
nity, including colorectal cancer patients, patient organizations, in-
dustry, academic researchers, and community-based providers, to
include all relevant health care agencies. Specifically, this plan
should identify research priorities, gaps, and opportunities, and in-
clude detailed sections focused on the following non-exhaustive list
of topics: the lack of progress in the development of effective thera-
peutics for colorectal cancer, the rising rates of colorectal cancer in
people under the age of 50, with a special focus on the rapidly in-
creasing rates of early onset colorectal cancer in the 20 to 39 year
old age range; and the persistent health disparities in colorectal
cancer prevalence, screening, and outcomes. The plan should de-
scribe how NCI plans to play a role in addressing these challenges
and what existing and future innovative grant mechanisms can be
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Deadliest Cancers.—The Recalcitrant Cancer Research Act
(RCRA) of 2012 focuses on cancers with a five-year survival rate
below 50 percent, which account for 44 percent of all U.S. cancer
deaths. In House Report 117–96, the Committee directed NCI to
develop a scientific framework using the process outlined in the
RCRA for gastric and esophageal cancers. The Committee also
notes that NCI has taken an important step by receiving approval
for a Program in Origins of Gastroesophageal Cancers from the Na-
tional Cancer Advisory Board and Board of Scientific Advisors.
Given the toll all recalcitrant cancers exact on society and the lack
of diagnostic and treatment resources currently available to help
patients, the Committee encourages NCI to continue to invest in
the most promising research opportunities to advance progress
against each of the deadliest cancers (gastric, esophageal, and GE
junction; liver, including cholangiocarcinoma; lung, including meso-
thelioma; ovary; pancreas; and brain, including adult and pediatric
brain tumors), and to provide an update on research focused on
each of these areas in the fiscal year 2024 Congressional Justifica-
tion.
Endometrial Cancer.—The Committee remains concerned about
the significant racial and ethnic disparities in mortality rates for
endometrial cancer that adversely impact Black women. The age-
adjusted mortality rate for Black women with endometrial cancer
is nearly twice the rate of White women, which is partly attributed
to cancer stage at diagnosis. The Committee commends NCI’s ef-
forts to address these disparities through projects like the Dis-
covery and Evaluation of Testing for Endometrial Cancer in Tam-
pons (DETECT) Study, and encourages NCI to continue supporting
research activities that will lead to the development of targeted
interventions to improve early diagnosis among Black women with
endometrial cancer. The Committee also encourages NCI to re-
search innovative community-based outreach methods to improve
access to high-quality care, with the goal of increasing enrollment
and participation by Black women in clinical trials. The Committee
requests an update on NCI’s activities regarding endometrial can-
cer in the fiscal year 2024 Congressional Justification, including
progress made in endometrial cancer early diagnosis, survival
rates, and clinical trial enrollment by race and ethnicity.
Environmental Exposures and Cancer in Firefighters.—The Com-
mittee is aware that firefighters have increased rates of cancer di-
agnoses and death relative to the general population. Firefighters
are exposed to a complex mix of known and possible cancer-causing
chemicals through breathing hazardous substances and absorbing
them through their skin. Despite an understanding of the risks as-
sociated with firefighter environmental exposures, there has been
no large-scale, systematic examination of the mechanisms by which
the environmental exposures experienced by these frontline re-
sponders can cause cancer. The Committee recognizes the work
NIH and CDC/NIOSH have performed to better understand the
cancer risks firefighters may experience and encourages these
agencies to continue conducting this research, including efforts
measuring environmental exposures in firefighters and deter-
mining the mechanisms by which these exposures lead to increased
cancer incidence, morbidity, and mortality. The Committee also en-
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uity among firefighters, including through inclusion of participants
across race, ethnicity, gender, and workplace environment groups
to evaluate potential differences in exposures and risk.
Glioblastoma (GBM).—Glioblastoma is a cancer with less than a
five percent five-year relative survival rate, and the average sur-
vival time from diagnosis has improved by only six months over the
last 30 years. To date, there have only been five drugs and one
medical device approved by the FDA for the treatment of GBM.
With prior Congressional investment in NCI programs,
glioblastomas have been molecularly characterized, resulting in a
new and promising understanding of these tumors, including the
identification of potential clinical strategies and agents, trial de-
signs, and imaging and pathology technologies.
The Committee commends NCI for its establishment and initial
implementation of the GBM Therapeutics Network (GTN). The
GTN’s cross-cutting teams’ capabilities to conduct pre-clinical stud-
ies and early-phase clinical trials enables the careful evaluation of
potential treatments, including small molecule drugs,
immunotherapies, radiation, and devices. The overall goal of the
GTN is advancing progress towards future cures and improved
quality of life for GBM patients.
Given this initial progress, the Committee urges NCI to continue
to enhance and accelerate its implementation of the GTN and con-
tinue to fund to the full extent necessary so that this program can
rapidly launch clinical trials that speed access to promising quali-
fied treatments to patients consistent with NCI’s Glioblastoma
Working Group recommendations in 2019.
Gynecologic Cancers.—The Committee continues to be concerned
about the growing racial, socioeconomic, and geographic disparities
in gynecologic cancers. In contrast to most other common cancers
in the U.S., relative survival for women with newly diagnosed ad-
vanced cervical or endometrial cancer has not significantly im-
proved since the 1970s. Furthermore, historical data demonstrates
that Black and Latina women with gynecologic cancers are not as
likely to receive standard therapy and/or die more frequently. The
current COVID–19 pandemic has only exacerbated the health care
disparities that were already present in minority and underrep-
resented communities. For example, in early 2021, CDC published
findings that cervical cancer screenings among women aged 21–29
in California decreased by as much as 78 percent during the pan-
demic. This is concerning because cervical cancer incidence and
mortality rates are disproportionately higher in Hispanic women
and non-Hispanic Black women.
The Committee urges NCI to expand the number of clinical
trials, research grants, and contract opportunities for investigators
that focus on discoveries that will positively impact access to pre-
vention, early detection, diagnosis, and treatment for gynecologic
cancers and address these now well-documented disparities. The
Committee requests an update on NCI’s research program for
gynecologic cancers in the fiscal year 2024 Congressional Justifica-
tion, including specific grants and strategies where the intent is to
overcome these racial disparities in gynecologic cancers outcomes
and opportunities to increase participation of minority women in
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Health Disparities Research.—The Committee commends NCI for
supporting research related to cancer health disparities, including
studies on the molecular basis for disparities that could lead to im-
proved screening and treatment strategies, as well as best practices
for increasing participation of underrepresented populations in
NCI-supported clinical trials. The Committee includes an increase
of $10,000,000 for NCI to support research related to identifying
and reducing health disparities as described in the fiscal year 2023
budget request.
HPV Associated Cancers.—The Committee encourages NCI to ex-
pand research related to human papillomavirus (HPV) and HPV-
associated cancers.
Improve Native American Cancer Outcomes.—The Committee
continues to be concerned that Native Americans experience overall
cancer incidence and mortality rates that are strikingly higher
than non-Native populations and encourages NCI to expand re-
search efforts to reduce American Indian cancer disparities and im-
prove outcomes. The Committee notes NCI’s successful efforts
through the Cancer Moonshot’s Accelerating Colorectal Cancer
Screening and Follow-Up through Implementation Science
(ACCSIS) program, and parallel efforts by NCI Designated Cancer
Centers collaborating with American Indian communities, that are
improving colorectal cancer screening, follow-up, and referral for
care among populations that have low colorectal cancer screening
rates. The Committee encourages NCI to continue efforts such as
the ACCSIS initiative to develop durable capacity for tribally-en-
gaged cancer disparities research through an integrated program of
research, education, outreach, and clinical access.
Liver Cancer.—The Committee notes that liver cancer is the sec-
ond most common cause of cancer worldwide, with cases in the U.S.
increasing over 250 percent since 2000. The incidence of liver can-
cer is three times higher in men than women, and the burden is
higher in African Americans, Hispanics, and Asians. The incidence
of liver cancer geographically parallels the prevalence of viral hepa-
titis, with hepatis B estimated to cause up to 60 percent of the
cases of liver cancer. For these reasons, the Committee applauds
NCI for its collaboration in the effort to update the Strategic Plan
for Trans-NIH Research to Cure Hepatitis B. The Committee also
is supportive of the NCI intramural Liver Cancer Program, the
Hepatobiliary and Hepatocellular Carcinoma (HCC) SPOREs, the
new Diversity SPORE, the Translational Liver Cancer Network,
the Hepatocellular Carcinoma Epidemiology Consortium, the large
Genome-Wide Association Study (GWAS) of liver cancer and the
need to expand the GWAS study to include a focus on Hispanic and
African Descent populations. The Committee also urges NCI to con-
tinue its support of the Translational Liver Cancer Consortium,
which supports research focused on early detection, and to support
research to explore the usefulness of current and new interventions
in reducing HBV associated HCC and whether early treatment
with direct action antivirals or other strategies can reduce cancer
risk.
Lung Cancer.—The recent decline in cancer mortality fueled by
progress in lung cancer is directly attributable to NIH-funded re-
search to inform development of new effective therapeutics and to
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derstanding of the molecular underpinnings of lung cancer and
identification of additional oncogene driver subsets has led to rapid
development of new targeted therapies, which, together with efforts
to broaden uptake of comprehensive biomarker testing, has the po-
tential to deliver the promise of precision medicine to more patients
than ever before. The Committee encourages NIH and its Office of
Disease Prevention to continue to fund important research across
each of these areas to broaden the base of lung cancer survivors
across different disease types, including small cell lung cancer.
Lung Cancer Disparities.—The Committee is concerned that lung
cancer disproportionally impacts communities of color. The Com-
mittee commends NCI for its role in supporting research that es-
tablished low-dose computed tomography as an effective lung can-
cer screening approach and for the Institute’s continued research in
this area, which has directly informed updates to the United States
Preventive Services Task Force (USPSTF) lung cancer screening
guidelines. In 2021, USPSTF expanded the recommended age
range for screening to 50 to 80 years (previously 55 to 80 years)
and reduced the pack-year history to 20 pack-years of smoking
(previously 30 pack-years). By expanding who is eligible for screen-
ing, the changes to this recommendation are particularly relevant
to Black people and to women. Data shows that both groups tend
to smoke fewer cigarettes than White men. Data also shows that
Black people have a higher risk of lung cancer than White people.
These changes will mean that many more Black people and women
who smoke will be eligible for this potentially life-saving screening.
Unfortunately, lung cancer screening is currently underutilized.
Therefore, the Committee encourages NCI to continue to support
research focused on approaches to encourage broader uptake of
lung cancer screening among the USPSTF recommended popu-
lations, including evaluating strategies with a focus on increasing
screening uptake among communities with lung cancer death rates
higher than the national average, with a goal of reducing lung can-
cer mortality disparities among people of color and women.
Melanoma.—As UV radiation is established as the primary car-
cinogen for melanoma, the Committee urges NCI to continue to
support research directed at genomic and mechanistic characteris-
tics of mutagenesis; optimization of prevention strategies; and early
detection and risk declassification strategies that leverage artificial
intelligence, access to large databases, noninvasive technologies,
and molecular markers that will support precision medicine.
Although SEER data show a decline in mortality with the advent
of new categories of treatment, some patients do not respond to ini-
tial treatment, and many of the responders have disease that will
recur. The Committee encourages NCI to expand research on mech-
anisms of primary and secondary drug resistance and validation of
predictive biomarkers that allow selection of optimal therapy and
prediction of comprehensive longitudinal monitoring. Basic and
translational goals should be facilitated through development and
use of ever-improving models of human melanoma.
Building on the success of adjuvant therapies, and the promising
results of neoadjuvant therapies, the Committee encourages NCI to
continue support of research addressing tumor cell dormancy and
metastases. The Committee encourages NCI to explore opportuni-
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ties for multicenter trials that will determine whether shorter
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courses of therapy will decrease toxicity while maintaining benefit,
refine adjuvant therapies, and continue to develop neoadjuvant
therapies.
The Committee also encourages NCI to continue to support re-
search on novel targets, especially for rare subtypes. The Com-
mittee requests an update on these requests and the status of NCI-
funded melanoma research in the fiscal year 2024 Congressional
Justification.
Metastatic Cancer Research.—While the early detection and
treatment of early-stage disease for many cancers results in cures,
for most tumors, metastatic cancer remains incurable. More than
90 percent of cancer deaths are due to metastatic disease. In addi-
tion to genetic alterations in the cancer itself, recent research has
revealed that there is a genetic basis for susceptibility to meta-
static cancer or resistance to metastasis. More research is required
to develop a comprehensive understanding of this complex process
involving tumor and host interactions. Clinical trials are an impor-
tant aspect of that progress, and diverse representation of patients
in clinical trials is integral to the development of medications and
therapies that effectively treat metastatic disease. Ethnicity, gen-
der, age, and genetics all play a role in the safety and efficacy of
a treatment for an individual. The Committee commends NIH and
the Department of Defense (DoD) for work already underway to
support research needs and opportunities identified in the April
2018 Task Force Report to Congress on Metastatic Cancer. The
Committee encourages NIH to maintain collaborative efforts with
DoD and the Department of Veterans’ Affairs (VA) to provide sub-
ject matter expertise, as appropriate, as DoD provides updates and
continues to implement recommendations from the report aimed at
achieving representation of the demographic of the U.S. population
in clinical trials.
NCI Paylines.—Grant applications to NCI have increased by ap-
proximately 50 percent since 2013, outpacing available funding,
with requests for cancer research ten-fold greater than other Insti-
tutes and Centers. With such a high demand for NCI grants, only
a fraction of highly meritorious research proposals can be funded.
To support more awards and improve success rates, the Committee
provides an increase of $200,000,000 for NCI to prioritize com-
peting grants and to sustain commitments to continuing grants.
Pediatric Cancer Research.—NCI has supported research to ad-
vance significant achievements in childhood cancer diagnosis, pre-
vention, treatment, and quality of life improvements. Children that
are diagnosed with cancer deserve a fighting chance and effective
and less toxic therapies. Childhood cancers are rare, and they need
specialized treatments, not just lower dose treatments that adults
receive. The Committee urges NCI to continue this important work
to examine novel systems to better understand rare cancers, and
to support and accelerate the development of life-saving thera-
peutics for pediatric patients who often have no other options.
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
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search efforts with other Federal agencies, including DoD, as well
as private research foundations and advocacy groups.
Radiopharmaceutical Development.—Recognizing the promise of
radiotherapy treatments and other diagnostic uses, NCI has orga-
nized a Radiopharmaceutical Development Initiative (RDI), which
is a specialized infrastructure for the clinical evaluation of novel
theranostic radiopharmaceutical cancer therapies and which com-
plements academic and industry development of these agents with
early phase combination studies to test tolerability and early signs
of efficacy. While clinical trials for radiopharmaceuticals are pres-
ently ongoing, domestic production of such drugs relies on a very
small number of reactors, and the future loss of such reactors
would not only deal a significant blow to domestic patients due to
the short half-life of many of these drugs, but would also limit
NCI’s ability to continue to support and conduct this important re-
search. The Committee is aware of alternative technologies to
produce radionuclides by accelerators, such as the one located at
Brookhaven National Laboratory; however, some radionuclides can
be produced only in nuclear reactors. Therefore, the Committee re-
quests NIH, in conjunction with the Department of Energy, to pro-
vide an update in the fiscal year 2024 Congressional Justification
regarding the impact shortages of medical isotopes and radio-
pharmaceuticals have on the ability to conduct cancer research.
Rare Blood Cancers and Germline Mutations.—The Committee
commends NCI for collaborating with NHGRI in running natural
history studies of patients with germline mutations and their fami-
lies, which frequently lead to blood cancers including acute myeloid
leukemia (AML). More research on how genetic dispositions, such
as RUNX1 familial platelet disorder (RUNX1–FPD), lead to rare
blood cancers will ultimately support the discovery of treatments
that could prevent malignancy through advances in early detection
and early treatment for all blood cancers. Interest in this field has
grown significantly in recent years, and the Committee strongly
urges NCI to initiate new and expanded funding opportunities re-
lated to germline predispositions to rare blood cancers. The Com-
mittee is pleased to hear that NCI will soon be launching a preci-
sion medicine clinical trial for AML and myelodysplastic syndromes
and requests an update in the fiscal year 2024 Congressional Jus-
tification.
Rare Cancer Equity.—Nearly half a million Americans are diag-
nosed with a rare form of cancer every year. Rare cancers could ac-
count for hundreds, if not thousands, of distinct forms of cancer.
The Committee encourages NCI to continue research to better un-
derstand the molecular drivers of all cancers, including through
molecular characterization and molecular diagnostics for patients.
The Committee also encourages NCI to continue to support re-
search on cancer subtypes, which could benefit rare cancers.
NATIONAL HEART, LUNG, AND BLOOD INSTITUTE (NHLBI)
Appropriation, fiscal year 2022 ......................................................... $3,808,494,000
Budget request, fiscal year 2023 ....................................................... 3,822,961,000
Committee Recommendation ............................................................. 3,943,702,000
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Change from enacted level ......................................................... +135,208,000
Change from budget request ...................................................... +120,741,000
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105
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 Educational Materials.—The Com-
mittee is concerned that certain FDA guidance in the educational
materials provided in the blood donor questionnaire are inappro-
priate and misguided. The recommendations for deferral should not
hinge on a person’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 evaluate
the need for additional research studies to inform the FDA on re-
moving or replacing the recommended deferment of blood for men
who have had sex with men in the last three months.
Community Engagement Alliance (CEAL) Against COVID–19
Disparities Initiative.—The Committee continues to support the
CEAL initiative, which connects researchers with community orga-
nizations and leaders to conduct outreach and increase participa-
tion of people from underrepresented communities in clinical trials
for COVID–19 treatments, vaccines, and ongoing COVID–19 re-
lated research needs.
COVID–19-Associated Illnesses.—The Committee recognizes the
growing burden of COVID-associated critical illnesses, including
sepsis and pneumonia. The Committee encourages NIH to accel-
erate research into sepsis, pneumonia, and acute lung injury.
Duchenne and Becker Muscular Dystrophy.—Now that life ex-
pectancy for Duchenne patients has increased, there is a need for
more research related to clinical care and long-term cardiac im-
pacts. Furthermore, there is a paucity of data on Becker patients
to understand cardiac implications long term. The Committee urges
NHLBI to work with NINDS to explore research collaborations to
follow patients throughout the lifespan to fully clinically charac-
terize cardiac muscle function and better establish the relationship
between cardiac muscle function and the impact of its progressive
deterioration on both lifespan and quality of life.
Developing gene therapies to treat Duchenne muscular dystrophy
is a complex and multifaceted process. The Committee encourages
NIH to support research aimed at gene therapy safety utilizing
viral vectors and support the development of less immunogenetic
non-viral delivery systems. The Committee also supports further
NIH investment in the development of more sensitive outcome
measures and biomarkers for both Duchenne and Becker.
Harmful Algal Blooms.—The Committee strongly encourages
NHLBI to support research to address the human health concerns
of cyanotoxin exposure from harmful algal blooms and emergent
chemicals of concern, and particularly the need for research di-
rected on health issues relating to aerosolized exposure to water
contaminated with HABS and ECC toxins. This research could take
advantage of unique laboratory facilities at the Nation’s national
laboratories and prioritize new preventative, diagnostic, and thera-
peutic strategies to combat the harmful health effects of airborne
HAB and ECC toxin exposure, especially in vulnerable, at-risk pop-
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Health Disparities Research.—The COVID–19 pandemic has
highlighted and exacerbated health disparities in the U.S. The
Committee includes an increase of $15,000,000 for leveraging les-
sons learned by NHLBI to support research related to identifying
and reducing health disparities.
Kleine-Levin Syndrome (KLS).—The Committee commends NIH
for its December 2021 publication of the Sleep Research Plan. The
Committee recommends the inclusion of KLS, a complex neuro-
logical disorder characterized by long, recurring episodes of exces-
sive sleep and derealization, as a sleep disorder requiring attention
and study in the next publication of the Sleep Research Plan. The
cause of KLS is still unknown, and there are no known treatments.
Because KLS shares symptoms with other sleep disorders and
mental health conditions, the Committee encourages NIH to ex-
pand its support for research about KLS, which could provide the
KLS community and many others with critical information and an-
swers.
Long-Term Impact of COVID–19.—The Committee notes with
concern that an estimated ten percent of individuals who have re-
covered from COVID–19 are experiencing longer term health con-
sequences, including residual lung damage. More studies are need-
ed to understand if such changes resolve or are permanent. The
Committee urges NHLBI to prioritize research into the under-
standing, treatment, and prevention of post-COVID respiratory
conditions, particularly among minority populations disproportion-
ately impacted by COVID–19.
Lung Health Research.—The Committee recognizes that, over the
past year, lung failure was the number one cause of death in the
U.S. More than one million Americans have died as a direct result
from a respiratory pandemic. Even prior to emergence of SARS
CoV–2, deaths from chronic obstructive pulmonary disease were al-
ready the third leading cause of death in the world, and pneumonia
was the leading cause of death worldwide among children under
the age of five. The risks to lung health are only increasing as glob-
al air quality deteriorates from dust and particle pollution among
other factors. All of these exposures drive lung inflammation and
ultimately made COVID–19 more devastating as well. Further-
more, the Nation’s capability to address acute lung injury or acute
respiratory distress syndrome (ARDS) has been demonstrated to be
deeply inadequate.
The Committee supports the activities of NHLBI’s lung health
research program, which supports mechanisms of lung injury and
repair as well as clinical intervention trials addressing both acute
and chronic lung diseases. These investments will help to identify
the biological pathways of lung injury to find ways to help the lung
recover from injury.
Mitral Valve Prolapse (MVP) Research.—The Committee encour-
ages NHLBI to advance technological imaging and precision medi-
cine to generate data on individuals with valvular disease, identify
individuals who are at high risk of sudden cardiac death as a result
of valvular heart disease, develop prediction models for high-risk
patients, and enable interventions and treatment plans to keep
these patients healthy throughout their lives.
National Chronic Obstructive Pulmonary Disease (COPD) Action
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Plan.—The Committee notes NHLBI’s role in crafting the National
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COPD Action Plan and encourages NHLBI to continue this impor-
tant work by supporting additional research activities and collabo-
rating with other PHS agencies to facilitate implementation of the
plan’s recommendations.
National Commission on Lymphatic Diseases.—The Committee
requests an update on the establishment of a National Commission
on Lymphatic Diseases and strongly encourages the Director to en-
gage with relevant Institutes, Centers, and external stakeholders
to demonstrate key progress within 90 days of the enactment of
this Act.
NIH Sleep Research Plan.—The Committee commends the Na-
tional Center on Sleep Disorders Research (NCSDR) for the release
of the NIH Sleep Research Plan and supports the full implementa-
tion of the Plan. The Committee specifically encourages strong con-
sideration of the Plan’s proposal for multi-center studies and clin-
ical trials.
Pulmonary Fibrosis (PF).—Many PF patients wait more than a
year for diagnosis after symptom onset, and patients with some
types of PF have a life expectancy of only 3–5 years. The Com-
mittee urges NHLBI to support research into biomarkers that can
aid in earlier, safer diagnosis of pulmonary fibrosis, as well as tools
that can help predict which patients will experience disease pro-
gression. The Committee also encourages NHLBI to support the de-
velopment of novel outcome measures for clinical trials in pul-
monary fibrosis, such as imaging, and to continue to fund research
involving early phase clinical assessment of novel drugs and per-
sonalized approaches to therapies. The Committee requests an up-
date on PF research in the fiscal year 2024 Congressional Justifica-
tion.
Pulmonary Hypertension.—The Committee continues to note the
relationship between the long-term effects of COVID–19 and pul-
monary hypertension. The Committee encourages NHLBI to in-
crease their collaboration with key stakeholders in advancing crit-
ical research priorities.
Sickle Cell Disease.—Sickle cell disease (SCD) is the most com-
mon inherited blood disorder in the U.S. The Committee commends
NIH, including NHLBI, for past research efforts aimed at devel-
oping more effective treatments and cures, but believes more can
be done. As such, the Committee encourages NIH to renew its focus
and continue to prioritize efforts by supporting extramural grants
for research projects that will support the development of a treat-
ment approach for SCD, research into potential cures, and provide
better outreach and education for health care providers. The Com-
mittee 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 and to
develop different innovative technologies and medicines to treat
and cure SCD. The Committee also encourages NHLBI to increase
its focus on disease modifying 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 en-
courages NHLBI to fund the training of more sickle cell disease cli-
nicians and researchers to maintain this essential workforce pipe-
line and to make advances on the transition from childhood med-
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Support for The Heart Truth Program.—For over a decade, ‘‘The
Heart Truth’’ program has worked to raise awareness about wom-
en’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
health care providers. Accordingly, the Committee encourages
NHLBI to robustly fund ‘‘The Heart Truth’’ program.
Thalassemia.—Donated blood has a relatively short shelf life and
is generally stored for only 42 days. However, stored blood begins
to degrade before the end of that 42-day period, with possible stiff-
ening of cell membranes as early as after 21 days. For patients in
need of emergency blood transfusions, that degradation may not be
significant; however, studies are needed to determine the impact of
older red blood cells on patients who require chronic transfusion,
such as those with thalassemia, especially in terms of iron loading
in the heart and internal organs. The Committee urges NHLBI to
establish research initiatives focused on this issue.
Valvular Heart Disease Research.—Many people in the U.S. have
heart valve defects or disease but do not have symptoms. For some,
the condition remains the same throughout their lives and does not
cause significant or life-threatening problems. Unfortunately, over
25,000 people die each year in the U.S. from heart valve disease,
primarily due to underdiagnosis and undertreatment of the condi-
tion. The Committee strongly supports more research into valvular
heart disease. Such research should focus on advances in techno-
logical imaging and precision medicine to generate data on individ-
uals with valvular heart disease, identify individuals who are at
high risk of sudden cardiac death, and develop prediction models
for high-risk patients, enabling interventions and treatment plans
to help keep these patients healthy throughout their lives. The
Committee thanks NHLBI for hosting a workshop on this issue.
NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH
(NIDCR)
Appropriation, fiscal year 2022 ......................................................... $501,231,000
Budget request, fiscal year 2023 ....................................................... 513,191,000
Committee Recommendation ............................................................. 526,051,000
Change from enacted level ......................................................... +24,820,000
Change from budget request ...................................................... +12,860,000
Mission.—The mission of NIDCR is to advance fundamental
knowledge about dental, oral, and craniofacial (DOC) health and
disease and translate these findings into prevention, early detec-
tion, and treatment strategies that improve overall health for all
individuals and communities across the lifespan.
Pain Management Research.—The Committee commends NIDCR
for supporting research related to pain and pain management, in-
cluding studies to develop safer, non-opioid pain medications and
interventions. The Committee includes an increase of $9,000,000
for NIDCR to support additional research in this area as described
in the fiscal year 2023 budget request.
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NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY
DISEASES (NIDDK)
Appropriation, fiscal year 2022 ......................................................... $2,203,926,000
Budget request, fiscal year 2023 ....................................................... 2,206,080,000
Committee Recommendation ............................................................. 2,283,489,000
Change from enacted level ......................................................... +79,563,000
Change from budget request ...................................................... +77,409,000
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.
Chronic Kidney Disease (CKD).—The Committee urges NIDDK to
continue support for kidney research. The Committee applauds re-
cent changes to clinical practice in the diagnosis of kidney disease
and concurs with recommendations for new markers for estimating
kidney function. NIDDK is encouraged to prioritize research into
endogenous filtration markers, activities that spur the adoption of
new equations for estimating GFR that do not include race as a
modifier, and interventions to eliminate racial and ethnic dispari-
ties. Finally, the Committee encourages NIDDK to continue invest-
ment in research that bridges existing deficits in CKD manage-
ment and treatments to reduce incidence and progression, in-
creases the number of CKD clinical trials and diversity of partici-
pants, improves the delivery of evidenced-base care in underrep-
resented populations, and improves patients’ quality of life. The
Committee requests an update on these priorities in the fiscal year
2024 Congressional Justification.
Dietary Supplements.—The Committee supports efforts by
NIDDK to monitor drug-induced liver injury. Recently, more than
20 percent of cases are reported to be caused by dietary supple-
ments. These products need to be analyzed for their label claims;
it is essential to identify the component that may cause liver in-
jury. It has been reported that more than 70 percent of products
analyzed do not meet label claims, and many of them are laced
with steroids and pharmaceuticals. The Committee continues to
support NIDDK research into dietary supplements.
Inflammatory Bowel Disease.—The CDC estimates that in 2015,
three million Americans were living with IBD, and the Global Bur-
den of Disease Study 2017 reported that IBD prevalence in the
U.S. increased by nearly 24 percent between 1990 and 2017. Many
patients may be undiagnosed until the disease has become severe,
and despite the therapeutic options on the market, some patients
remain without an effective treatment. The Committee continues to
support NIH in funding basic, translational, and clinical studies on
the diagnosis and treatment of IBD.
Interstitial Cystitis.—The Committee notes the progress of inter-
stitial cystitis research through the Multidisciplinary Approach to
the Study of Chronic Pelvic Pain program and encourages NIDDK
and stakeholders to continue collaboration on a scientific workshop
to examine mechanisms for scientific opportunity. The Committee
requests an update on the progress of the conference in the fiscal
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year 2024 Congressional Justification.
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Pain Management Research.—The Committee commends NIDDK
for supporting research related to pain and pain management, in-
cluding studies to develop interventions to reduce opioid use in peo-
ple on hemodialysis. The Committee includes an increase of
$10,000,000 for NIDDK to support additional research in this area
as described in the fiscal year 2023 budget request.
Polycystic Kidney Disease (PKD).—The Committee commends
NIDDK for its continued commitment to PKD Research and Trans-
lation Centers and the Pediatric Centers of Excellence in Nephrol-
ogy, which improve our understanding of the causes of autosomal
dominant PKD and autosomal recessive PKD. The Committee con-
tinues to encourage NIDDK to fund innovative, high-impact PKD
research and promote the development of new therapeutic strate-
gies.
NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
(NINDS)
Appropriation, fiscal year 2022 ......................................................... $2,611,370,000
Budget request, fiscal year 2023 ....................................................... 2,768,043,000
Committee Recommendation ............................................................. 2,833,590,000
Change from enacted level ......................................................... +222,220,000
Change from budget request ...................................................... +65,547,000
The Committee recommendation includes $2,608,590,000 in dis-
cretionary appropriations and $225,000,000 made available in the
Cures Act.
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).—The Committee recognizes
the devastating toll that ALS takes on those affected by the disease
and their loved ones. ALS causes progressive and cumulative phys-
ical disabilities in patients, and leads to death due to respiratory
muscle failure. The Committee strongly urges NINDS to expand
support for research on ALS, including but not limited to its
causes, diagnosis, and treatment. The Committee directs NIH to
provide an update on NIH-supported research related to ALS in
the fiscal year 2024 Congressional Justification.
Brain Aneurysm Research.—The Committee remains concerned
that an estimated one out of every 50 individuals in the U.S. has
a brain aneurysm and an estimated 30,000 Americans suffer a
brain aneurysm rupture each year, with little or no warning. Rup-
tured brain aneurysms are fatal in about 50 percent of cases. The
Committee continues to be concerned about the lack of research fo-
cused on prevention and early detection of brain aneurysms and
encourages NIH to expand its support for research in this area.
BRAIN Initiative.—The Committee directs NIH to transfer
$225,000,000 from the NIH Innovation Account to NINDS to sup-
port the BRAIN Initiative. These funds were authorized in the
Cures Act. This collaborative effort is revolutionizing the under-
standing of how neural components and their dynamic interactions
result in complex behaviors, cognition, and disease, while accel-
erating the development of transformative tools to explore the
brain in unprecedented ways, making information previously be-
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Cerebral Palsy.—The Committee encourages NIH to continue to
prioritize and invest in research on cerebral palsy (CP) including
the establishment of a cerebral palsy Notice of Special Interest
(NOSI) to significantly strengthen and accelerate progress toward
CP research priorities across the lifespan. Cerebral palsy research
should focus on basic and translational discoveries, as well as im-
plementation, observational, and clinical studies aimed at early de-
tection and intervention, comparative effectiveness, and functional
outcomes. While some progress has been made in the under-
standing of CP, the most common lifelong physical disability, large
gaps remain that must be addressed to improve outcomes and
treatment for the cerebral palsy population and their families, im-
pacting quality of life and reducing medical costs. Similarly, to ad-
dress the racial and socioeconomic health equity challenges experi-
enced by the cerebral palsy population, it is imperative that greater
investment is made to address disparities in access to interventions
and stakeholder engagement. The Committee encourages NIH to
support greater investment in research focused on the areas in
need of growth, as outlined in the Strategic Plan on Cerebral Palsy
Research directed by the Joint Explanatory Statement accom-
panying the fiscal year 2022 Appropriations Act, including research
on lifespan issues to address the needs of transition-age youth and
adults with cerebral palsy, and research to support the develop-
ment and delivery of new and improved screening tools, treatments
and interventions.
The Committee also encourages NIH to consider a
neuroplasticity workshop and research opportunities focusing on
the motor and health benefits of physical activity specifically for in-
dividuals with CP across all gross motor functional classification
levels, which is vital to help prevent chronic disease and premature
aging.
Dystonia.—The Committee requests an update in the fiscal year
2024 Congressional Justification on the status of the implementa-
tion of the recommendations from the NINDS workshop Defining
Emergent Opportunities in Dystonia Research that was held in
2018.
Lyme Disease.—The Committee recognizes that there have been
only a small number of clinical trials involving Lyme disease,
which lacks a gold standard test, and that those trials have in-
volved a relatively small number of patients. For other diseases,
high quality multi-site trials involving robust number of well-char-
acterized patients have been considered essential to facilitate ad-
vancements in the development of more effective treatments and
improved outcomes. Because of the clear neurological dysfunction of
Lyme disease and the existence of the Network for Excellence in
Neuroscience Clinical Trials, the Committee encourages NINDS to
evaluate how it may contribute to improvements in tools to manage
Lyme disease.
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.
Opioid, Stimulant, and Pain Management Research.—The Com-
mittee includes no less than the fiscal year 2022 enacted level
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(HEAL) Initiative, which is a trans-NIH effort to accelerate sci-
entific discovery related to prevention and treatment of opioid use
disorder and improving pain management. The Committee also in-
cludes an additional $11,500,000 in NINDS to support related re-
search on pain and pain management, as described in the fiscal
year 2023 budget request.
Parkinson’s Disease (PD).—The Committee commends NINDS for
taking critical steps in identifying priority research recommenda-
tions to advance research on PD, which impacts between 500,000
and 1,500,000 Americans and is the second most prevalent
neurodegenerative disease in the U.S. The Committee recognizes
that NINDS is prioritizing public health concerns with severe gaps
in unmet medical needs and supports the research recommenda-
tions set forth by the NINDS planning strategy to bring us closer
to better treatments and a cure for PD. The Committee also en-
courages NINDS to submit an update on its progress on imple-
menting these recommendations in the fiscal year 2024 Congres-
sional Justification.
Parkinson’s Disease and Dementia.—The Committee recognizes
that although PD is often thought of only as a movement disorder,
most PD patients also develop dementia. Common symptoms in-
clude difficulty with problem solving and speed of thinking, mem-
ory, and other cognitive skills. Because people with PD usually de-
velop these symptoms several years after their diagnosis, PD rep-
resents an under-explored opportunity to study the onset and pro-
gression of dementia. Therefore, the Committee strongly urges NIA
and NINDS to put a higher priority on PD, both before and after
onset of dementia, within their overall dementia research port-
folios. The Committee requests an update on these activities in the
fiscal year 2024 Congressional Justification.
Prion Research and Brain Health.—The Committee supports the
efforts of NINDS to support research across the spectrum of
neurodegenerative disease, including through the BRAIN Initiative
and the Alzheimer’s disease research portfolio. The Committee en-
courages NINDS to support enhanced research on the processes
whereby misfolded proteins (prions) are replicated in the brain.
Such proteins are critically implicated in numerous
neurodegenerative diseases, many of which are both lethal and in-
curable. The Committee also encourages NINDS to enhance its
focus on the identification of genetic and other biomarkers for dis-
orders that involve misfolded proteins, such as traumatic brain in-
jury, ALS, Huntington’s disease, Parkinson’s disease, and Alz-
heimer’s disease, and the development of related diagnostic tools
and therapies.
NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES (NIAID)
Appropriation, fiscal year 2022 ......................................................... $6,322,728,000
Budget request, fiscal year 2023 ....................................................... 6,268,313,000
Committee Recommendation ............................................................. 6,642,608,000
Change from enacted level ......................................................... +319,880,000
Change from budget request ...................................................... +374,295,000
Mission.—The NIAID mission is to conduct and support basic
and applied research to better understand, treat, and ultimately
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Antimicrobial Resistance.—The Committee includes $560,000,000
to support antimicrobial resistance research, $20,000,000 above the
fiscal year 2022 enacted level. Increased funding would support the
training of new investigators; strengthen clinical trial infrastruc-
ture to boost preparedness; enhance basic, translational, and clin-
ical research on mechanisms of resistance, therapeutics, vaccines
and diagnostics; and support the development of a clinical trials
network to reduce barriers to research on difficult-to-treat infec-
tions.
Celiac Disease.—The Committee supports research to improve
the quality of life for patients with celiac disease, efforts to find the
cause of the disease, and efforts to find a cure. The Committee
commends NIH for issuing a Notice of Special Interest to spur ad-
ditional research on the study of celiac disease. Today, the only
known treatment for this disease is a gluten-free diet; however, re-
cent public and private sector research confirms that such a ‘‘treat-
ment’’ is insufficient for many who suffer from celiac disease. The
Committee urges NIH to support focused research on the study of
celiac disease; to better coordinate existing research; and, to focus
new research efforts toward causation, diagnosis, management,
treatment, and, ultimately, a cure of this disease. The Committee
thanks NIH for establishing a Research Condition, Disease Cat-
egorization (RCDC) for celiac disease.
Cellular Immunity.—To better understand diseases like COVID–
19, the Committee is aware of the enormous value in assessing cel-
lular immunity, in addition to antibodies, which may help us an-
swer questions about the efficacy of vaccines, the need for boosters,
and the degree to which they prime the body to protect against fu-
ture variants, as well as the role of cellular immune response
diagnostics. With more comprehensive immune response data, the
Committee understands that it may be possible to identify features
of immune responses to viruses like SARS–CoV–2 that make some
people more susceptible to severe disease, long COVID, and reinfec-
tion. The Committee believes enhanced cellular immunity assess-
ment will help to generate deeper insights into the immune re-
sponse, and may help identify new strategies to improve counter-
measures, including cellular immune response diagnostics, for
SARS–CoV–2 and other potential pathogens in the future. The
Committee encourages NIAID to incorporate cellular immunity as-
sessment into the wide range of intramural and extramural
COVID–19 and other disease studies conducted and supported by
NIH, including but not limited to vaccine schedule studies and un-
derstanding post-acute sequalae of SARS–CoV–2 infection (PASC/
long COVID). The Committee requests that NIAID provide an up-
date on these efforts in the fiscal year 2024 Congressional Jus-
tification.
Centers for AIDS Research.—As part of the Ending the HIV Epi-
demic initiative, the Committee includes $71,000,000 for the long-
standing HIV research efforts of the Centers for AIDS Research
(CFARs) as well as CFAR activities and similar efforts to support
the EHE, the same as the fiscal year 2022 enacted level and the
fiscal year 2023 budget request. These Centers and related efforts
offer evidence-based practices on prevention and treatment to ini-
tiative partners and support for evaluating the initiative. The Com-
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areas with the highest prevalence and to develop targeted interven-
tions that address high-need communities.
Centers for Research and Emerging Infectious Diseases.—The
Committee recognizes the importance of the connection between
animal health and its impacts on human health. The NIH Centers
for Research on Emerging Infectious Diseases, a global network of
researchers dedicated to investigating how and why viruses emerge
from animals to cause disease in humans, has been established by
NIAID to investigate how and where viruses and other pathogens
can emerge from wildlife and spill over to cause disease in people.
The Committee commends the work of this program and supports
its continuation.
Consortium of Food Allergy Research (CoFAR).—The Committee
recognizes the serious issue of food allergies, which affect approxi-
mately eight percent of children and ten percent of adults in the
U.S. The Committee commends the ongoing work of NIAID in sup-
porting a total of 17 clinical sites for this critical research, includ-
ing seven sites as part of the CoFAR. The Committee includes
$12,100,000, an increase of $3,000,000, for CoFAR to expand its
clinical research network to add new centers of excellence in food
allergy clinical care and to select such centers from those with
proven expertise in food allergy research.
Health Disparities Research.—The Committee includes an in-
crease of $10,000,000 for NIAID to support research related to
identifying and reducing health disparities as described in the fis-
cal year 2023 budget request.
Hereditary Angioedema (HAE).—The Committee recognizes
NIAID for its ongoing stewardship of the HAE research portfolio,
including advancements that have taken HAE from a debilitating
and fatal condition to a manageable chronic disease. The Com-
mittee notes the potential of gene therapy and other cutting-edge
research to further improve health outcomes for HAE patients and
encourages NIAID to maintain its commitment to the HAE re-
search.
Late-Stage Antifungal Research and Development.—Fungal dis-
eases, like Valley fever, pose a threat to public health, including
life-threatening drug resistant infections. The Committee supports
research to further the research and development of novel anti-
fungal therapies for multi-drug resistant pathogens to minimize
their impact on public health.
Next-Generation Vaccine Platforms.—The Committee notes that
many current vaccines protect from disease but do not always pre-
vent the spreading of pathogens. When this occurs, protected peo-
ple might not experience symptoms but are still infectious. Next-
generation viral vectors, designed to target specific tissue like
mucosal sites or specific immune cells, offer new abilities to induce
the desired immune responses and protect the necessary tissues.
This will open novel opportunities to prevent diseases and trans-
mission. The Committee encourages NIAID to maintain a balanced
portfolio of vaccine platform approaches to include next-generation
viral vectors, particularly in vaccine centers that have experience
in developing viral vectors covering multiple virus-based vaccine
platforms and that have established collaborations with high con-
tainment laboratories (e.g., BSL–3 and BSL–4) for preclinical stud-
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Primary Immunodeficiencies (PI) Research.—The Committee ap-
plauds NIH for recognizing the need for research on primary
immunodeficiencies and other related conditions by issuing a No-
tice of Special Interest for research on inborn errors of immunity/
primary immunodeficiencies. The Committee encourages NIH to
fund as many meritorious proposals as possible and to consider
building upon the notice by issuing a targeted funding announce-
ment focused on research topics of significance to the PI research
and patient communities.
Regional Biocontainment Laboratories (RBLs).—The Committee
provides $52,000,000 to be evenly divided among the 12 RBLs to
support efforts to prevent, prepare for, and respond to infectious
disease outbreaks, including, but not limited to: (1) conducting re-
search on developing new antiviral compounds, vaccines, and point
of care tests; (2) conducting research on prophylactic methods to
prevent infections; (3) supporting operations costs and purchase of
equipment to speed drug discovery and testing; and (4) training
new researchers in biosafety level 3 practices. The Committee rec-
ognizes the need for RBLs to be able to utilize funding for all four
of the aforementioned areas. The Committee urges NIAID to iden-
tify appropriate grant mechanisms that will allow RBLs to access
funding to support these four critical areas.
Tick-Borne Disease Research.—The Committee is supportive of
the NIH Strategic Plan for Tickborne Disease Research published
in 2019. The Committee encourages NIAID to increase efforts to
understand causes of the increase in tick-borne diseases, to support
research on tick-borne tularemia (Francisella tularensis), and to de-
termine whether information learned on ways that ticks respond to
bacterial infections offer avenues to thwart tick infections in hu-
mans.
Universal Influenza Vaccine.—The Committee includes no less
than $260,000,000, an increase of $15,000,000 over the fiscal year
2022 level and the same as the fiscal year 2023 budget request, to
support basic, translational, and clinical research to develop a uni-
versal influenza vaccine that provides robust, long-lasting protec-
tion against multiple subtypes of flu, rather 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 requests an update on these
efforts within 60 days of enactment of this Act.
NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES (NIGMS)
Appropriation, fiscal year 2022 ......................................................... $3,092,373,000
Budget request, fiscal year 2023 ....................................................... 3,097,557,000
Committee Recommendation ............................................................. 3,200,157,000
Change from enacted level ......................................................... +107,784,000
Change from budget request ...................................................... +102,600,000
The Committee recommendation includes $1,779,457,000 in dis-
cretionary appropriations and $1,420,700,000 in PHS Act section
241 evaluation set-aside transfers.
Mission.—NIGMS supports basic research that increases our un-
derstanding of biological processes and lays the foundation for ad-
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Health Disparities Research.—The Committee includes an in-
crease of $10,000,000 for NIGMS to support research and activities
related to identifying and reducing health disparities as described
in the fiscal year 2023 budget request.
Institutional Development Awards (IDeA).—The Committee pro-
vides $423,076,000 for IDeA, $13,119,000 above the fiscal year
2022 enacted level. The program increases our Nation’s biomedical
research capability by improving research in States that have his-
torically been less successful in obtaining biomedical research fund-
ing. IDeA funds only merit-based, peer-reviewed research that
meets NIH research objectives in the 23 IDeA States and Puerto
Rico. NIH IDeA is comprised of these key initiatives: Centers of
Biomedical Research Excellence (COBRE) and IDeA Networks of
Biomedical Research Excellence (INBRE). The program aims to
strengthen an institution’s ability to support biomedical research,
enhance the competitiveness of investigators in securing research
funding, and enable clinical and translational research that ad-
dresses the needs of medically underserved communities.
COBRE is a proven successful method to increase the number of
new scientists at institutions in States eligible for IDeA awards.
The Committee recognizes the success of the COBRE program and
encourages NIH to continue working to increase the number of new
scientists at institutions in eligible IDeA States.
EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH
AND HUMAN DEVELOPMENT (NICHD)
Appropriation, fiscal year 2022 ......................................................... $1,683,009,000
Budget request, fiscal year 2023 ....................................................... 1,674,941,000
Committee Recommendation ............................................................. 1,756,630,000
Change from enacted level ......................................................... +73,621,000
Change from budget request ...................................................... +81,689,000
Mission.—NICHD’s mission is to lead research and training to
understand human development, improve reproductive health, en-
hance the lives of children and adolescents, and optimize abilities
for all.
Endometriosis Research.—The Committee urges NICHD to con-
tinue to expand basic, clinical, and translational research into the
mechanics of endometriosis, identify early diagnostic markers, and
develop new treatment methods.
Health Impacts on Children of Technology and Social Media
Use.—The Committee remains concerned about the impacts of tech-
nology use and media consumption on infant, children, and adoles-
cent development. The Committee appreciates NIH’s ongoing en-
gagement on this important topic and encourages NIH to prioritize
research into the cognitive, physical, and socioemotional impacts of
young people’s use of technologies as well as long-term develop-
mental effects on children’s social, communication, and creative
skills. The Committee also encourages NIH to study the repercus-
sions of increased use of digital media and technologies on suicidal
thoughts and ideation among children. The Committee asks NIH to
consider different forms of digital media and technologies, includ-
ing mobile devices, smart phones, tablets, computers, and virtual
reality tools, as well as social-media content, video games, and tele-
vision programming. The Committee includes no less than
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Impact of COVID–19 on Children.—The Committee includes no
less than $10,000,000, an increase of $2,500,000 above the fiscal
year 2022 enacted level, for NICHD to support additional research
into multisystem inflammatory syndrome in children (MIS–C) and
other ways in which COVID–19 affects children, as described in the
fiscal year 2023 budget request.
Impact of COVID–19 on Pregnant and Lactating Women.—The
Committee includes an increase of $3,000,000, the same as the fis-
cal year 2023 budget request, to support research on the effects of
COVID–19 on pregnancy, lactation, and postpartum health with a
focus on individuals from racial and ethnic minority groups.
IMPROVE Maternal Health Initiative.—The Committee includes
no less than $30,000,000 for the Implementing a Maternal Health
and Pregnancy Outcomes Vision for Everyone (IMPROVE) Initia-
tive, the same as the fiscal year 2022 enacted level and the fiscal
year 2023 budget request. The IMPROVE Initiative advances re-
search to reduce preventable causes of maternal deaths and im-
prove health for pregnant and postpartum individuals before, dur-
ing, and after delivery.
Learning Disabilities Research.—The Committee is increasingly
concerned with the decline in achievement for students with dis-
abilities and recognizes the need for continued research and im-
proved interventions, particularly in light of the COVID–19 crisis,
which has led to significant loss of in-person instruction for many
students. The Committee recognizes the importance of NICHD’s
funding of Learning Disabilities Research Centers and Learning
Disabilities Innovation Hubs, which are a source of Federal funding
available to researchers interested in exploring child development
and learning disabilities to conduct randomized control trials and
explore the relationships between different variables at work.
While learning disabilities do impact an individual’s education and
academic achievement, these disorders are brain-based, and so clin-
ical research using the latest technology and advances in neuro-
science is essential. To continue robust research into language,
reading development, learning disabilities, and disorders that ad-
versely affect the development of listening, speaking, reading, writ-
ing, and mathematics abilities, the Committee urges NICHD to
continue its investment in its Learning Disabilities Research Cen-
ters and Learning Disabilities Innovation Hubs.
Male Reproductive Health.—The Committee urges NICHD to con-
tinue to support research on male mechanisms of infertility. There
is a gap in the knowledge of how to diagnose and treat male infer-
tility, often resulting in women undergoing unnecessary treatments
due to undiagnosed or untreated male partner infertility. The Com-
mittee notes that NICHD has recently recognized the importance
of male reproduction in its strategic plan and included andrology
as a research priority. The Committee is concerned, however, that
none of the NICHD branches focus on male fertility, leaving a gap
in representation. The Committee encourages NICHD to consider
forming a distinct Male Fertility Health branch to prioritize re-
search in this area, including identifying new proteins and sperm
structures necessary for normal sperm function and, consequently,
for fertility and healthy embryo development.
Maternal-Fetal Medicine Units Network.—The Committee sup-
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the country that conduct clinical studies to improve maternal, fetal,
and neonatal health that ultimately improves the clinical practice
of obstetrics. Many Institutes at the NIH support at least one grant
or project related to pregnancy, which further improves maternal
and infant health outcomes and addresses maternal mortality.
Pelvic Floor Disorders.—Pelvic floor disorders, including urinary
incontinence, accidental bowel leakage, and pelvic organ prolapse,
negatively impact the quality of life of more than 25 million U.S.
women each year. There are socioeconomic disparities amongst
women suffering from pelvic floor disorders, with differences in
symptoms, knowledge, access to care, availability of treatments,
and treatment outcomes noted in patients from different back-
grounds. The Committee urges NICHD to prioritize research activi-
ties into underrepresented patient populations and pelvic floor dis-
orders. Such activities may include the development of educational
programs for general practitioners, the evaluation of effectiveness
of screening protocols for pelvic floor disorders in the primary care
setting, investigating medical literacy amongst minority women as
it pertains to pelvic floor disorders, as well as assessing socio-
economic and socio-cultural disease perspectives by designing quali-
tative studies using focus groups of women with varying socio-eco-
nomic, cultural, and ethnic backgrounds, evaluating current edu-
cational resources, determining gaps in patient knowledge, and de-
signing culture-specific educational materials and resources. The
Committee requests an update on this research in the fiscal year
2024 Congressional Justification.
Population Research.—The Committee congratulates NICHD for
leading efforts to promote research regarding the effects of COVID–
19 on child development and health disparities. The Committee en-
courages NICHD to sustain these research priorities through its
support of the Population Dynamics Research Centers Program and
population-representative longitudinal datasets, such as the Fragile
Families and Child Wellbeing Study, Baby’s First Years, Panel
Study of Income Dynamics Child Supplement Survey, and National
Longitudinal Survey of Youth. The Committee urges NICHD to en-
gage the population research field to develop informed frameworks
for conceptualizing and measuring social determinants of health,
including structural racism. The Committee also encourages
NICHD to support research exploring the direct and indirect effects
of COVID–19 on reproductive health, marriage, and divorce and to
expand research and data collection on mortality, especially during
adolescence and the transition to adulthood. Within 90 days of en-
actment of this Act, the Committee requests a report on the Insti-
tute’s efforts to address these priority areas.
Pregnancy Loss Research.—The Committee supports NIH re-
search into pregnancy loss and encourages NIH to expand and co-
ordinate research activities with respect to pregnancy loss.
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. The Committee encourages NIH to continue implementing
these recommendations to the extent appropriate and feasible
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under the legal authorities available to the Secretary.
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Sudden Infant Death Syndrome (SIDS).—The Committee urges
NICHD to strengthen support for research into the causes and pre-
vention of SIDS.
Trans-NIH Pediatric Research Consortium (N–PeRC).—The Com-
mittee is aware of the N–PeRC that was established in 2018 to bet-
ter coordinate pediatric research activities across multiple Insti-
tutes and Centers. The Committee supports the goals and objec-
tives of N–PeRC and requests that NIH update the Committee on
its activities and focus of multi-Institute or -Center pediatric re-
search projects implemented as a result of N–PeRC. Additionally,
the Committee requests a report in the fiscal year 2024 Congres-
sional Justification on how N–PeRC plans to encourage longitu-
dinal studies of the physical, mental, and behavioral health im-
pacts of COVID–19 on children, including multisystem inflam-
matory syndrome in children (MIS–C), as well as plans for N–
PeRC’s focus over the coming three years.
Uterine Fibroids.—The Committee encourages NIH to support
the activities outlined in the Stephanie Tubbs Jones Uterine Fi-
broid Research and Education Act of 2022 (H.R. 2007), as intro-
duced in the House, to support research related to uterine fibroids
etiology, prevention, diagnosis, disparities, and treatment.
NATIONAL EYE INSTITUTE (NEI)
Appropriation, fiscal year 2022 ......................................................... $863,918,000
Budget request, fiscal year 2023 ....................................................... 853,355,000
Committee Recommendation ............................................................. 891,186,000
Change from enacted level ......................................................... +27,268,000
Change from budget request ...................................................... +37,831,000
Mission.— The mission of the National Eye Institute is to elimi-
nate vision loss and improve quality of life through vision research.
Blepharospasm.—The Committee continues to encourage NEI to
expand research into blepharospasm, a form of dystonia, and re-
quests an update on collaborative efforts amongst stakeholders and
other Institutes and Centers in the fiscal year 2024 Congressional
Justification.
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES (NIEHS)
Appropriation, fiscal year 2022 ......................................................... $842,169,000
Budget request, fiscal year 2023 ....................................................... 932,056,000
Committee Recommendation ............................................................. 878,750,000
Change from enacted level ......................................................... +36,581,000
Change from budget request ...................................................... ¥53,306,000
Mission.—NIEHS’s mission is to discover how the environment
affects people in order to promote healthier lives.
The Committee includes an additional $10,000,000 for NIEHS to
support and coordinate research on the rise in and exacerbation of
a wide range of health conditions related to the environment,
which may include infectious disease, injury and trauma, and
chronic conditions such as asthma, mental health, and health dis-
parities. Such research may include evaluation of both preventive
and intervention strategies for such conditions.
Harmful Algal Blooms (HABs) Human Health Effects Research.—
Harmful algal blooms are occurring with increasing frequency and
severity across the country. While we know of the temporary phys-
ical discomfort caused by the toxic bacteria, we do not know if ex-
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