# Labor, Health and Human Services, and Education: FY2020 Appropriations > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/crs%3AR46492 ## Record - **Collection:** Congressional research report - **Document type:** CRS Report - **Published:** August 20, 2020 - **Citation:** R46492 ## Text Labor, Health and Human Services, and Education: FY2020 Appropriations August 20, 2020 Congressional Research Service https://crsreports.congress.gov R46492 SUMMARY Labor, Health and Human Services, and Education: FY2020 Appropriations This report offers an overview of actions taken by Congress and the President to provide FY2020 appropriations for accounts funded by the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS) appropriations bill. This bill includes all accounts funded through the annual appropriations process at the Department of Labor (DOL) and Department of Education (ED). It also provides annual appropriations for most agencies within the Department of Health and Human Services (HHS), with certain exceptions (e.g., the Food and Drug Administration is funded via the Agriculture bill). The LHHS bill also provides funds for more than a dozen related agencies, including the Social Security Administration (SSA). This report primarily focuses on regular FY2020 LHHS discretionary funding enacted during the annual appropriations process. The emergency supplemental funding that was subsequently enacted for FY2020 is generally not included in the budgetary figures discussed in the main body of the report. (These appropriations are addressed in the context of the FY2020 annual cycle in Appendix C.) Regular Appropriations FY2020 LHHS Omnibus: On December 19, 2019, the President signed into law the Further Consolidated Appropriations Act, 2020 (H.R. 1865; P.L. 116-94). This law contained full-year LHHS appropriations in Division A. Discretionary LHHS appropriations totaled $195.4 billion. This amount is 3.2% more than FY2019 enacted and 17.4% more than the FY2020 President’s budget request. The omnibus also provided $902.3 billion in mandatory funding, for a combined LHHS total of $1.098 trillion. The distribution of discretionary funding was as follows:  DOL: $12.4 billion, 2.4% more than FY2019.   HHS: $94.9 billion, 4.9% more than FY2019. ED: $72.8 billion, 1.8% more than FY2019.  Related Agencies: $15.4 billion, 0.3% more than FY2019. R46492 August 20, 2020 Jessica Tollestrup, Coordinator Specialist in Social Policy Karen E. Lynch, Coordinator Specialist in Social Policy David H. Bradley Specialist in Labor Economics Ada S. Cornell Senior Research Librarian William R. Morton Analyst in Income Security Angela Napili Senior Research Librarian Kyle D. Shohfi Analyst in Education Policy FY2020 LHHS Senate Action: The FY2020 LHHS bill did not receive subcommittee, full committee, or initial floor action in the Senate prior to its enactment. With regard to committee consideration, the Senate Appropriations Committee scheduled a markup for September 10, 2019, but that markup was indefinitely postponed. (The initial LHHS subcommittee allocation (S.Rept. 116-104) that was adopted by the Senate Appropriations Committee on September 12, 2019 is discussed in Appendix A.) Senator Blunt, Chair of the Senate LHHS Subcommittee subsequently released the text of a draft LHHS bill and accompanying committee report on September 18. FY2020 LHHS House Action: The House Appropriations Committee’s LHHS subcommittee approved its draft bill on April 30, 2019, by a voice vote. The full committee markup was held on May 8, 2019, and the bill was ordered to be reported that same day (30-23). The bill was subsequently reported to the House on May 15 (H.R. 2740, H.Rept. 116-62). As reported by the full committee, the bill would have provided $204.3 billion in discretionary LHHS funds, a 7.9% increase from FY2019 enacted levels. This amount would have been 22.7% more than the FY2020 President’s request. In addition, the House committee bill would have provided an estimated $902.3 billion in mandatory funding, for a combined total of $1.107 trillion for LHHS as a whole. The distribution of discretionary funding was as follows: Congressional Research Service Labor, Health and Human Services, and Education: FY2020 Appropriations  DOL: $13.3 billion, 9.9% more than FY2019.   HHS: $99.4 billion, 9.8% more than FY2019. ED: $75.9 billion, 6.3% more than FY2019.  Related Agencies: $15.7 billion, 2.7% more than FY2019. The House began consideration of the FY2020 LHHS bill the week of June 10. Of the 73 LHHS amendments offered, 64 were adopted and the remaining 9 were withdrawn or defeated. The House passed the LHHS omnibus by a vote of 226-203 on June 19. Because there is no publicly-available source that estimates the account-level budgetary effects of the amendments adopted to Division A, this report provides analysis of the House Committeereported version of the LHHS bill. For information on the LHHS amendments offered during floor consideration, see Appendix B. FY2020 President’s Budget Request: On March 11, 2019, the Trump Administration released the FY2020 President’s budget. The President requested $166.5 billion in discretionary funding for acc ounts funded by the LHHS bill, which would have been a decrease of 12.1% from FY2019 levels. In addition, the President requested $900.4 billion in annually appropriated mandatory funding, for a total of $1.067 trillion for LHHS as a whole. The distribution of discretionary funding was as follows:  DOL: $10.9 billion, 10.0% less than FY2019.    HHS: $78.1 billion, 13.7% less than FY2019. ED: $64.0 billion, 10.4% less than FY2019. Related Agencies: $13.5 billion, 11.8% less than FY2019. Supplemental Appropriations The legislative response to the global pandemic of Coronavirus Disease 2019 (COVID-19) has included the enactment of laws to provide authorities and FY2020 supplemental funding to prevent, prepare for, and respond to the pandemic. As of the date of this report, discretionary LHHS supplemental appropriations for COVID-19 response have been enacted in four supplemental appropriations measures:     Title I, Division B, of the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA, P.L. 116-139), enacted on April 24, 2020, provided $100 billion in supplemental LHHS funds. Title VIII, Division B, of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act, P.L. 116-136), enacted on March 27, 2020, provided $172.1 billion in supplemental LHHS funds. Title V, Division A, of the Families First Coronavirus Response Act (FFCRA, P.L. 116-127), enacted on March 18, 2020, provided $1.25 billion in supplemental LHHS funds. Title III, Division A, of the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123), enacted on March 6, 2020, provided approximately $6.4 billion in supplemental LHHS funds. In addition, Title IX of the United States-Mexico-Canada Agreement Implementation Act (USMCA, P.L. 116113), enacted on January 29, 2020, provided $210 million in discretionary LHHS supplemental appropriations to implement the agreement. See Appendix C of this report for an analysis of the supplemental discretionary LHHS appropriations provided in these acts. For a detailed discussion of the LHHS COVID-19 response funding, see CRS Report R46353, COVID19: Overview of FY2020 LHHS Supplemental Appropriations. Congressional Research Service Labor, Health and Human Services, and Education: FY2020 Appropriations Contents Introduction ................................................................................................................... 1 Report Roadmap and Useful Terminology........................................................................... 1 Scope of the Report ................................................................................................... 2 Important Budget Concepts ......................................................................................... 2 Mandatory vs. Discretionary Budget Authority ......................................................... 2 Total Budget Authority Provided in the Bill vs. Total Budget Authority Available in the Fiscal Year ............................................................................................... 3 Status of FY2020 LHHS Appropriations ............................................................................. 4 FY2020 Supplemental Appropriations .......................................................................... 4 Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA, Title I, Division B, H.R. 266; P.L. 116-139) ........................................................... 4 Coronavirus Aid, Relief, and Economic Security Act (CARES Act, Title VIII, Divis ion B, H.R. 748; P.L. 116-136) ..................................................................... 5 Families First Coronavirus Response Act (FFCRA, Title V, Division A, H.R. 6201; P.L. 116-127)............................................................................................ 5 Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Title III, Division A, H.R. 6074; P.L. 116-123)...................................................... 6 United States-Mexico-Canada Agreement Supplemental Appropriations Act, 2019 (USMCA, Title IX, H.R. 5430; P.L. 116-113)......................................................... 6 FY2020 Annual LHHS Appropriations ......................................................................... 7 FY2020 LHHS Omnibus (Division A, Further Consolidated Appropriations Act, 2020, H.R. 1865; P.L. 116-94) ............................................................................. 7 FY2020 Continuing Resolutions (Division A, P.L. 116-59; Division A, P.L. 11669) .................................................................................................................. 8 Earlier Congressional Action on an LHHS Bill ......................................................... 9 FY2020 President’s Budget Request........................................................................... 10 Conclusion of the FY2019 Appropriations Process ....................................................... 10 Summary of FY2020 LHHS Appropriations ...................................................................... 11 Department of Labor (DOL) ........................................................................................... 14 About DOL ............................................................................................................ 15 FY2020 DOL Appropriations Overview ...................................................................... 15 Selected DOL Highlights .......................................................................................... 16 Employment and Training Administration (ETA) .................................................... 16 Bureau of Labor Statistics (BLS) .......................................................................... 17 Bureau of International Labor Affairs (ILAB) ......................................................... 18 Labor-Related General Provisions......................................................................... 18 Department of Health and Human Services (HHS) ............................................................. 21 About HHS............................................................................................................. 21 FY2020 HHS Appropriations Overview ...................................................................... 22 Special Public Health Funding Mechanisms................................................................. 24 Public Health Service Evaluation Tap .................................................................... 24 Prevention and Public Health Fund ....................................................................... 26 Selected HHS Highlights by Agency .......................................................................... 26 HRSA .............................................................................................................. 27 CDC................................................................................................................. 27 NIH.................................................................................................................. 28 Congressional Research Service Labor, Health and Human Services, and Education: FY2020 Appropriations SAMHSA ......................................................................................................... 29 AHRQ .............................................................................................................. 30 CMS ................................................................................................................ 30 ACF ................................................................................................................. 31 ACL................................................................................................................. 32 Restrictions Related to Certain Controversial Issues ...................................................... 32 Department of Education (ED) ........................................................................................ 39 About ED ............................................................................................................... 39 FY2020 ED Appropriations Overview ........................................................................ 40 Selected ED Highlights ............................................................................................ 41 School Improvement Programs............................................................................. 41 Student Financial Assistance ................................................................................ 42 Related Agencies .......................................................................................................... 44 FY2020 Related Agencies Appropriations Overview ..................................................... 45 Selected Related Agencies Highlights ......................................................................... 46 SSA Limitation on Administrative Expenses (LAE) ................................................. 46 Corporation for National and Community Service ................................................... 46 National Labor Relations Board (NLRB) ............................................................... 47 Figures Figure 1. FY2020 Enacted LHHS Appropriations................................................................. 8 Figure 2. FY2020 Enacted LHHS Appropriations by Title ................................................... 14 Figure 3. FY2020 Enacted HHS Appropriations by Agency ................................................. 24 Tables Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2020 .................................. 7 Table 2. LHHS Appropriations Overview by Bill Title, FY2019-FY2020............................... 12 Table 3. DOL Appropriations Overview............................................................................ 16 Table 4. Detailed DOL Appropriations.............................................................................. 19 Table 5. HHS Appropriations Overview............................................................................ 23 Table 6. HHS Appropriations Totals by Agency ................................................................. 33 Table 7. HHS Discretionary Appropriations for Selected Programs or Activities, by Agency................................................................................................................. 36 Table 8. ED Appropriations Overview .............................................................................. 40 Table 9. Detailed ED Appropriations ................................................................................ 43 Table 10. Related Agencies Appropriations Overview ......................................................... 45 Table 11. Detailed Related Agencies Appropriations ........................................................... 47 Table A-1. FY2020 LHHS Discretionary House and Senate Initial 302(b) Suballocations, FY2020 Enacted Levels, and FY2019 Enacted Levels...................................................... 54 Table A-2. LHHS Appropriations Overview, by Bill Title: FY2019-FY2020........................... 55 Table B-1. House Floor Amendments Offered to H.R. 2740 ................................................. 57 Congressional Research Service Labor, Health and Human Services, and Education: FY2020 Appropriations Table C-1. Summary of Enacted FY2020 Discretionary Regular and Supplemental Appropriations ........................................................................................................... 65 Appendixes Appendix A. Budget Enforcement Activities ..................................................................... 50 Appendix B. House Floor Amendments Offered to H.R. 2740 .............................................. 57 Appendix C. Enacted FY2020 LHHS Supplemental Appropriations...................................... 63 Contacts Author Information ....................................................................................................... 66 Congressional Research Service Labor, Health and Human Services, and Education: FY2020 Appropriations Introduction This report provides an overview of FY2020 appropriations actions for accounts traditionally funded in the appropriations bill for the Departments of Labor, Health and Human Services, and Education, and Related Agencies (LHHS). This bill provides discretionary and mandatory appropriations to three federal departments: the Department of Labor (DOL), the Department of Health and Human Services (HHS), and the Department of Education (ED). In addition, the bill provides annual appropriations for more than a dozen related agencies, including the Social Security Administration (SSA). FY2020 Supplemental Appropriations This report primarily focuses on regular FY2020 LHHS discretionary funding enacted during the annual appropriations process. The emergency supplemental funding that was subsequently enacted for FY2020 is generally not included in the budgetary figures discussed in the main body of the report. (These appropriations are addressed in the context of the FY2020 annual cycle in Appendix C.) Discretionary funds represent less than one-fifth of the total funds appropriated in the annual LHHS bill. Nevertheless, the LHHS bill is typically the largest single source of discretionary funds for domestic nondefense federal programs among the various appropriations bills. (The Department of Defense bill is the largest source of discretionary funds among all federal programs.) Because the appropriations process both provides and controls discretionary funding (concepts discussed further in “Mandatory vs. Discretionary Budget Authority”), the bulk of this report is focused on these funds. The LHHS bill typically is one of the more controversial of the regular appropriations bills because of the size of its funding and the scope of its programs, as well as various related social policy issues addressed in the bill, such as restrictions on the use of federal funds for abortion and for research on human embryos, stem cells, and gun violence. Congressional clients may consult the LHHS experts list in CRS Report R42638, Appropriations: CRS Experts, for information on which analysts to contact at the Congressional Research Service (CRS) with questions on specific agencies and programs funded in the LHHS bill. Report Roadmap and Useful Terminology This report is divided into several sections. The opening section provides an explanation of the scope of the LHHS bill (and hence, the scope of this report) and an introduction to important terminology and concepts that carry throughout the report. Next is a series of sections describing major congressional actions on FY2020 appropriations and (for context) a review of the conclusion of the FY2019 appropriations process. This is followed by a high-level summary and analysis of enacted and proposed appropriations for FY2020, compared to FY2019 funding levels. The body of the report concludes with overview sections for each of the major titles of the bill: DOL, HHS, ED, and Related Agencies (RA). These sections provide selected highlights from FY2020 enacted and proposed funding levels compared to FY2019. (Note that the distribution of funds is sometimes illustrated by figures, which in all cases are based on the FY2020 enacted version of the LHHS bill. 1 ) Appendix A provides a summary of budget enforcement activities for FY2020. This includes information on the Budget Control Act of 2011 (BCA; P.L. 112-25) and sequestration, budget 1 T he dollars and percentages in each figure also are generally illustrative, except as noted, of the parallel distribution of funds enacted in FY2019 and proposed by the FY2020 President’s budget, and the House committee -reported and the Senate-passed bills. Congressional Research Service 1 Labor, Health and Human Services, and Education: FY2020 Appropriations enforcement in the absence of an FY2020 budget resolution, subcommittee spending allocations, and current-year spending levels. This is followed by Appendix B, which provides an overview of the LHHS-related floor amendments that were offered in the House during its consideration of H.R. 2740. Appendix C provides an analysis of the supplemental discretionary LHHS appropriations enacted for FY2020. For a detailed discussion of the FY2020 supplemental LHHS COVID-19 response funding, see CRS Report R46353, COVID-19: Overview of FY2020 LHHS Supplemental Appropriations. Scope of the Report This report focuses on appropriations to agencies and accounts that are subject to the jurisdiction of the Labor, Health and Human Services, Education, and Related Agencies subcommittees of the House and Senate appropriations committees (i.e., accounts traditionally funded via the LHHS bill). Department “totals” provided in this report do not include funding for accounts or agencies that are traditionally funded by appropriations bills under the jurisdiction of other subcommittees. The LHHS bill provides appropriations for the following federal departments and agencies:  the Department of Labor;  most agencies at the Department of Health and Human Services, except for the Food and Drug Administration (funded through the Agriculture appropriations bill), the Indian Health Service (funded through the Interior-Environment appropriations bill), and the Agency for Toxic Substances and Disease Registry (also funded through the Interior-Environment appropriations bill);   the Department of Education; and more than a dozen related agencies, including the Social Security Administration, the Corporation for National and Community Service, the Corporation for Public Broadcasting, the Institute of Museum and Library Services, the National Labor Relations Board, and the Railroad Retirement Board. Note also that funding totals displayed in this report do not reflect amounts provided outside of the annual appropriations process. Certain direct spending programs, such as Social Security and parts of Medicare, receive funding directly from their authorizing statutes; such funds are not reflected in the totals provided in this report because they are not provided through the annual appropriations process (see related discussion in the “Important Budget Concepts” section). Important Budget Concepts Mandatory vs. Discretionary Budget Authority 2 The LHHS bill includes both discretionary and mandatory budget authority. While all discretionary spending is subject to the annual appropriations process, only a portion of mandatory spending is provided in appropriations measures. 2 For definitions of these and other budget terms, see U.S. Government Accountability Office (GAO), A Glossary of Terms Used in the Federal Budget Process, GAO-05-734SP, September 1, 2005, http://www.gao.gov/products/GAO05-734SP. (T erms of interest may include appropriated entitlement, direct spending, discretionary, entitlement authority, and mandatory.) Congressional Research Service 2 Labor, Health and Human Services, and Education: FY2020 Appropriations Mandatory programs funded through the annual appropriations process are commonly referred to as appropriated entitlements. In general, appropriators have little control over the amounts provided for appropriated entitlements; rather, the authorizing statute controls the program parameters (e.g., eligibility rules, benefit levels) that entitle certain recipients to payments. If Congress does not appropriate the money necessary to meet these commitments, entitled recipients (e.g., individuals, states, or other entities) may have legal recourse. 3 Most mandatory spending is not provided through the annual appropriations process, but rather through budget authority provided by the program’s authorizing statute (e.g., Social Security benefits payments). The funding amounts in this report do not include budget authority provided outside of the appropriations process. Instead, the amounts reflect only those funds, discretionary and mandatory, that are provided through appropriations acts. As displayed in this report, mandatory amounts for the FY2020 President’s budget submission reflect current-law (or current services) estimates; they generally do not include the President’s proposed changes to a mandatory spending program’s authorizing statute that might affect total spending. (In general, such proposals are excluded from this report, as they typically would be enacted in authorizing legislation.) The report focuses most closely on discretionary funding. This is because discretionary funding receives the bulk of attention during the appropriations process. (As noted earlier, although the LHHS bill includes more mandatory funding than discretionary funding, the appropriators generally have less flexibility in adjusting mandatory funding levels than discretionary funding levels.) Mandatory and discretionary spending is subject to budget enforcement processes that include sequestration. In general, sequestration involves largely across-the-board reductions that are made to certain categories of discretionary or mandatory spending. However, the conditions that trigger sequestration, and how it is carried out, differ for each type of spending. This is discussed further in Appendix A. Total Budget Authority Provided in the Bill vs. Total Budget Authority Available in the Fiscal Year Budget authority is the amount of money a federal agency is legally authorized to commit or spend. Appropriations bills may include budget authority that becomes available in the current fiscal year, in future fiscal years, or some combination. Amounts that become available in future fiscal years are typically referred to as advance appropriations. Unless otherwise specified, appropriations levels displayed in this report refer to the total amount of budget authority provided in an appropriations bill (i.e., “total in the bill”), regardless of the year in which the funding becomes available. 4 In some cases, the report breaks out current-year appropriations (i.e., the amount of budget authority available for obligation in a given fiscal year, regardless of the year in which it was first appropriated). 5 3 Sometimes appropriations measures include amendments to laws authorizing mandatory spending programs and thereby change the amount of mandatory appropriations needed. Because such amendments are legislative in nature, they may violate parliamentary rules separating authorizations and appropriations. For more information, see CRS Report R42388, The Congressional Appropriations Process: An Introduction . 4 Such figures include advance appropriations provided in the bill for future fiscal years, but do not include advance appropriations provided in prior years’ appropriations bills that become available in the current year. 5 Such figures exclude advance appropriations for future years, but include advance appropriations from prior years that Congressional Research Service 3 Labor, Health and Human Services, and Education: FY2020 Appropriations As the annual appropriations process unfolds, the amount of current-year budget authority is measured against 302(b) allocation ceilings (budget enforcement caps for appropriations subcommittees that traditionally emerge following the budget resolution process). The process of measuring appropriations against these spending ceilings takes into account scorekeeping adjustments, which are made by the Congressional Budget Office (CBO) to reflect conventions and special instructions of Congress.6 Unless otherwise specified, appropriations levels displayed in this report do not reflect additional scorekeeping adjustments. Status of FY2020 LHHS Appropriations FY2020 Supplemental Appropriations The legislative response to the global pandemic of Coronavirus Disease 2019 (COVID-19) has included the enactment of laws to provide authorities and supplemental funding to prevent, prepare for, and respond to the pandemic. As of the date of this report, LHHS supplemental appropriations for COVID-19 response have been enacted in four separate supplemental appropriations measures, discussed below. These are discussed in detail in CRS Report R46353, COVID-19: Overview of FY2020 LHHS Supplemental Appropriations. In addition, supplemental discretionary LHHS appropriations to implement the United StatesMexico-Canada Agreement were enacted prior to the COVID-19 outbreak. See Appendix C for an analysis of the discretionary LHHS appropriations provided in these acts. Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA, Title I, Division B, H.R. 266; P.L. 116-139) In April 2020, Congress and the President came to an agreement on a fourth COVID-19 supplemental appropriations act. Among other provisions, this act provided additional supplemental appropriations to HHS for the Provider Relief Fund and to support COVID-19 testing. 7 The legislative vehicle that was used for the agreement was H.R. 266, an unrelated appropriations bill that had been passed previously by the House. On April 21, 2020, the measure was laid before the Senate by unanimous consent and passed with a substitute amendment by voice vote. The House adopted the Senate version of the proposal on April 23 by a vote of 388-5. 8 The President signed the bill into law (P.L. 116-139) the following day. 9 The bill provided $100 billion in supplemental LHHS funds for programs and activities at HHS. become available in the given fiscal year. 6 For more information on scorekeeping, see CRS Report 98-560, Baselines and Scorekeeping in the Federal Budget Process. See also a discussion of key scorekeeping guidelines included in the joint explanatory statement accompanying the conference report to the Balanced Budget Act of 1997 ( H.Rept. 105-217, pp. 1007-1014). T he CARES and PPPHCEA supplemental measures each provided funding for a “Provider Relief Fund” to assist health care providers and facilities affected by the COVID-19 pandemic. For more information on the new fund, see HHS, “CARES Act Provider Relief Fund” (the name given to t his fund by HHS), April 22, 2020, https://www.hhs.gov/ provider-relief/index.html. 7 8 House Committee on Appropriations, H.R. 622, Paycheck Protection Program and Health Care Enhancement Act Division B – Additional Emergency Appropriations for Coronavirus Response, April 21, 2020, https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/ Interim%20Emergency%20Package%20Funds%20Hospitals%2C%20Health%20Workers%20and%20Testing.pdf. 9 See CRS Report R46325, Fourth COVID-19 Relief Package (P.L. 116-139): In Brief. Congressional Research Service 4 Labor, Health and Human Services, and Education: FY2020 Appropriations Coronavirus Aid, Relief, and Economic Security Act (CARES Act, Title VIII, Division B, H.R. 748; P.L. 116-136) On March 17, 2020, the Administration released a second request for FY2020 supplemental appropriations of $45.8 billion for COVID-19 response, of which $11.1 billion was for LHHS accounts and activities. 10 Over the next several days, Congress and the Administration negotiated the scope and scale of this legislative response, leading to enactment of a third COVID-19 response measure. The legislative vehicle that was ultimately chosen for this package was H.R. 748, an unrelated measure that had been passed previously by the House. 11 Prior to when a deal was reached between Congress and the Administration, the Senate voted on March 22 (47-47) and March 23 (49-46) not to invoke cloture on the motion to proceed to H.R. 748. 12 The measure was ultimately laid before the Senate by unanimous consent and passed with a substitute amendment by a vote of 96-0 on March 25. The House subsequently took up the Senate amendment on March 27, and agreed to it by a voice vote. The bill was signed into law (P.L. 116-136) by the President that same day. 13 Among other provisions, the bill provided $172.1 billion in supplemental LHHS funds for various programs and activities at DOL, HHS, ED, and four LHHS related agencies (the Corporation for Public Broadcasting, the Institute of Museum and Library Services, the Railroad Retirement Board, and the Social Security Administration). Families First Coronavirus Response Act (FFCRA, Title V, Division A, H.R. 6201; P.L. 116-127) A second COVID-19 response measure was developed by Congress and the Administration soon after the first (P.L. 116-123) was enacted. Initially, H.R. 6201 was introduced by the Chair of the House Appropriations Committee on March 11, 2020. 14 The House amended and passed the measure by a vote of 363-40 on March 14, but further alterations to the final legislative package were negotiated over the next two days. 15 On March 16, the House (by unanimous consent) 10 With regard to LHHS, the letter also explained that the Administration was seeking to amend its FY2 021 budget request for CDC and NIH to provide them additional budgetary resources and authorities. Letter from Russell T . Vought, Acting Director, Office of Management and Budget (OMB), to Vice President Michael Pence, March 17, 2020, https://www.whitehouse.gov/wp-content/uploads/2020/03/Letter-regarding-additional-funding-to-support-theUnited-States-response-to-COVID-19-3.17.2020.pdf. 11 Prior to when H.R. 748 was determined to be the vehicle for the third COVID-19 response measure, the Senate Majority Leader, Senator McConnell, introduced a proposal on March 19, 2020, that did not include supplemental emergency-designated discretionary appropriations (S. 3548). Four days later, on March 23, 2020, the House Appropriations Committee Chair introduced a proposal (H.R. 6379) that did include supplemental appropriations (including for LHHS). 12 T he Senate Appropriations Committee released a summary of the supplemental appropriations in the measure (Senate Appropriations Committee, $340 Billion Surge in Emergency Funding to Combat Coronavirus Outbreak, March 25, 2020, https://www.appropriations.senate.gov/imo/media/doc/ Coronavirus%20Supplemental%20Appropriations%20Summary_FINAL.pdf .) 13 CRS reports on the CARES Act are available on Congress.gov at https://www.congress.gov/bill/116th-congress/ house-bill/748 and https://www.congress.gov/bill/116th-congress/senate-bill/3548. 14 For a summary of the measure, see House Appropriations Comm ittee, H.R. 6201, FAMILIES FIRST CORONAVIRUS RESPONSE ACT, Title-By-Title Summary, March 11, 2020, https://appropriations.house.gov/sites/ democrats.appropriations.house.gov/files/Families%20First%20Summary%20FINAL.pdf. 15 For background, see John Bresnahan and Marianne Levine, “ Senate to take up coronavirus package after House passes revised bill,” Politico, March 16, 2020, https://www.politico.com/news/2020/03/16/senate-coronavirusemergency-package-131465. See also “DIRECT ING T HE CLERK OF T HE HOUSE OF REPRESENT AT IVES T O Congressional Research Service 5 Labor, Health and Human Services, and Education: FY2020 Appropriations considered and agreed to a resolution (H.Res. 904) that directed the Clerk to make changes to the legislation when preparing the final, official version of the House-passed bill (engrossment). The engrossed version was sent to the Senate and ultimately passed without amendment by a vote of 90-8 on March 18. The President signed the bill into law (P.L. 116-127) the same day. 16 The bill provided $1.25 billion in supplemental LHHS funds for programs and activities at HHS. Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (Title III, Division A, H.R. 6074; P.L. 116-123) On February 24, 2020, the Trump Administration sent Congress a request for supplemental appropriations of $1.25 billion for the Public Health and Social Services Emergency Fund (PHSSEF) at HHS. 17 The request letter included a number of other proposals, largely but not exclusively related to re-purposing existing funds toward response efforts. All told, the Administration estimated needing to allocate approximately $2.5 billion toward COVID-19 response efforts. (For the most part, amounts for other LHHS aspects of the request generally were unspecified in the publicly released request letter.) 18 Several days after the Administration’s request, the Chair of the House Appropriations Committee introduced H.R. 6074 on March 4, 2020. The measure passed the House that same day by a vote of 415-2, passed the Senate on March 5 by a vote of 96-1, and was signed into law (P.L. 116-123) on March 6. 19 The bill provided approximately $6.4 billion in supplemental LHHS funds for accounts and activities at HHS. United States-Mexico-Canada Agreement Supplemental Appropriations Act, 2019 (USMCA, Title IX, H.R. 5430; P.L. 116-113) The United States-Mexico-Canada Agreement (USMCA) was a trade agreement that was introduced by the House Majority Leader, Representative Hoyer, on December 13, 2019 (H.R. 5430). The measure was passed by the House on December 19, 2019, by a vote of 385-41, and the Senate on January 16, 2020, by a vote of 89-10. The bill was signed into law on January 29, 2020 (P.L. 116-113). Supplemental discretionary appropriations carried in Title IX provided $210 million to the Department of Labor to implement the agreement. 20 MAKE CORRECT IONS IN T HE ENGROSSMENT OF H.R. 6201,” Congressional Record, daily edition, vol. 166, no. 50 (March 16, 2020), pp. H1698-H1707. 16 CRS Reports on FFCRA are available on Congress.gov at https://www.congress.gov/bill/116th-congress/house-bill/ 6201. 17 T he PHSSEF is an account used by the HHS Secretary for one-time or short-term funding such as emergency supplemental appropriations, and for some ongoing public health preparedness activities. 18 Letter from Russell T . Vought, Acting Director, Office of Management and Budget (OMB), to Vice President Michael Pence, February 24, 2020, https://www.whitehouse.gov/wp-content/uploads/2020/02/CoronavirusSupplemental-Request-Letter-Final.pdf. 19 A summary of provisions is provided in CRS Report R46285, Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116 -123): First Coronavirus Supplemental. 20 See CBO, “Estimate for H.R. 5430, the United States-Mexico-Canada Agreement Implementation Act, as introduced on December 13, 2019, December 16, 2020, https://www.cbo.gov/system/files/2019-12/hr5430.pdf. Congressional Research Service 6 Labor, Health and Human Services, and Education: FY2020 Appropriations FY2020 Annual LHHS Appropriations Table 1 provides a timeline of major legislative actions for full-year LHHS proposals, which are discussed in greater detail below Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2020 Subcommittee Approval House Senate Resolution of House and Senate Differences Full Committee Approval House 4/30/19 H.R. 2740 voice vote H.Rept. 116-62 5/15/19 Senate House Initial Passage Senate Initial Passage Conf. Report House Final Passage Senate Final Passage H.R. 2740, Division A H.R. 1865, H.R. 1865, Division A Division A 6/19/19 12/17/19 12/19/19 226-203 297-120 71-23 Public Law P.L. 116-94 12/20/19 30-23 Source: CRS Appropriations Status Table. FY2020 LHHS Omnibus (Division A, Further Consolidated Appropriations Act, 2020, H.R. 1865; P.L. 116-94) About one week prior to when the second FY2020 continuing resolution (CR) was scheduled to expire, the House, Senate, and Trump Administration announced that it had reached a deal that would fund all 12 appropriations bills in two legislative packages (H.R. 1158 and H.R. 1865); LHHS was funded in Division A of H.R. 1865. The Further Consolidated Appropriations Act, 2020 was agreed to by the House (297-120) on December 17, 2019, and by the Senate (71-23) on December 19. The bill was signed into law on December 20 (P.L. 116-94). LHHS discretionary appropriations in the FY2020 LHHS omnibus totaled $195.4 billion. This amount is 3.2% more than FY2019 enacted and 17.4% more than the FY2020 President’s budget request. The omnibus also provided $902.3 billion in mandatory funding, for a combined LHHS total of $1.098 trillion. (Note that these totals are based only on amounts provided by the FY2020 LHHS omnibus and do not include the supplemental funds, which were provided in addition to the annual appropriations.) See Figure 1 for a breakdown of FY2020 discretionary and mandatory LHHS appropriations. 21 21 While the percentages in this figure were calculated based on amounts in the FY20 20 LHHS omnibus, they are generally also illustrative—within a few percentage points—of the share of mandatory and discretionary funds in FY2019 and under the various FY2020 proposals (e.g., President’s budget and the House-committee bill). Congressional Research Service 7 Labor, Health and Human Services, and Education: FY2020 Appropriations Figure 1. FY2020 Enacted LHHS Appropriations Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2020 LHHS omnibus (P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11061-H11161. Enacted totals for FY2020 do not include emergency-designated appropriations provided by P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21 st Century Cures Act (P.L. 114-255). Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all budget authority appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. FY2020 Continuing Resolutions (Division A, P.L. 116-59; Division A, P.L. 11669) FY2020 LHHS appropriations were provided by two continuing resolutions (CRs) until the enactment of the LHHS omnibus (P.L. 116-94) on December 20, 2019. 22 The first CR (Division A of H.R. 4378; P.L. 116-59) was enacted on September 27, 2019. The CR provided continuing appropriations for all 12 annual appropriations acts (including LHHS) through November 21, 2019. In general, the CR funded discretionary programs at the same rate and under the same conditions as in FY2019 (§ 101) and annually appropriated entitlements at their current law levels (§111). It also included several anomalies that were specific to LHHS accounts or activities (§§137-139). 23 The second CR (Division A of H.R. 3055; P.L. 116-69) was enacted on November 21, 2019. This law extended the prior FY2020 CR through December 20, 2019. (None of the few additional anomalies added by Division A were LHHS-specific.) 22 For an overview of CRs, see CRS Report R42647, Continuing Resolutions: Overview of Components and Practices. 23 For further information on the continuing appropriations provided by P.L. 116-59, see CRS Report R45982, Overview of Continuing Appropriations for FY2020 (P.L. 116 -59). Congressional Research Service 8 Labor, Health and Human Services, and Education: FY2020 Appropriations Earlier Congressional Action on an LHHS Bill FY2020 LHHS Action in the Senate (Division A, H.R. 2740) The FY2020 LHHS bill did not receive subcommittee, full committee, or initial floor consideration in the Senate prior to its enactment. With regard to committee consideration, the Senate Appropriations Committee scheduled a markup for September 10, 2019, but that markup was indefinitely postponed prior to when it was to occur. 24 (The initial LHHS subcommittee allocation (S.Rept. 116-104) that was adopted by the Senate Appropriations Committee on September 12, 2019 is discussed in Appendix A.) Senator Blunt, Chair of the Senate LHHS Subcommittee subsequently released the text of a draft LHHS bill and accompanying committee report on September 18. 25 The Senate Majority Leader, Senator McConnell, presented cloture on the motion to proceed to H.R. 2740, the House-passed version of the LHHS bill, on September 16. The Senate voted not to invoke cloture (51-44) on September 18. Cloture was not invoked a second time (51-41) on October 31. FY2020 LHHS Action in the House (Division A, H.R. 2740) The House Appropriations Committee’s LHHS subcommittee approved its draft bill on April 30, 2019, by a voice vote. The full committee markup was held on May 8 and the bill was ordered to be reported that same day (30-23). The bill was subsequently reported to the House on May 15 (H.R. 2740, H.Rept. 116-62). This is the earliest the LHHS bill (including its predecessor under prior jurisdictional arrangements) has been reported to the House since the current budget process was first implemented in FY1976. The FY2020 LHHS bill and FY2020 Military Construction, Veterans Affairs, and Related Agencies Appropriations bill (H.R. 2745) were the first to be reported to the House during the FY2020 cycle. The last time LHHS was the first bill reported by the House Appropriations Committee was FY1980, though in that year the bill was one of three reported on the same day. As reported by the full committee, the bill would have provided $204.3 billion in discretionary LHHS funds, a 7.9% increase from FY2019 enacted levels. This amount would have been 22.7% more than the FY2020 President’s request. In addition, the House committee bill would have provided an estimated $902.3 billion in mandatory funding, for a combined total of $1.107 trillion for LHHS as a whole. The House began consideration of the FY2020 LHHS bill the week of June 10. To do this, the House took up the FY2020 LHHS bill reported from committee (H.R. 2740) and amended it into a four-bill omnibus, with LHHS appropriations in Division A. 26 Of the 73 LHHS amendments 24 Senate Appropriations Committee, “Appropriations Schedule for the Week of September 9, 2019,” September 6, 2019, https://www.appropriations.senate.gov/newsroom/press-releases/appropriations-schedule-for-the-week-ofseptember-9-2019. 25 See Senate Appropriations Committee, “Blunt Releases FY2020 Labor, HHS, & Education Appropriations Bill,” September 18, 2019, https://www.appropriations.senate.gov/news/fy2020-labor-hhs-and-education-appropriations-billreleased. 26 T he four appropriations acts that received floor consideration via H.R. 2740 were LHHS (Division A); Department of Defense (Division B); Energy and Water Development and Related Agencies (Division C); and Department of State, Foreign Operations, and Related Programs (Division D). T wo special rules were adopted that affected the consideration of LHHS appropriations in Division A: H.Res. 431 and H.Res. 436. Congressional Research Service 9 Labor, Health and Human Services, and Education: FY2020 Appropriations offered to Division A, 64 were adopted and the remaining 9 were withdrawn or defeated. The House passed the LHHS omnibus by a vote of 226-203 on June 19. Because there is no publiclyavailable source that estimates the account-level budgetary effects of the amendments adopted to Division A, this report provides analysis of the House Committee-reported version of the LHHS bill. For information on the LHHS amendments offered during floor consideration, see Appendix B. FY2020 President’s Budget Request On March 11, 2019, the Trump Administration released the initial FY2020 President’s budget. 27 The President requested $166.5 billion in discretionary funding for accounts funded by the LHHS bill, which would have been a decrease of 12.1% from FY2019 levels. In addition, the President requested $900.4 billion in annually appropriated mandatory funding, for a total of $1.067 trillion for LHHS as a whole. Conclusion of the FY2019 Appropriations Process During the 115th Congress, on September 28, 2018, the President signed into law the Department of Defense and Labor, Health and Human Services, and Education Appropriations Act, 2019 and Continuing Appropriations Act, 2019 (H.R. 6157, P.L. 115-245). This was the first occasion since the FY1997 appropriations cycle that full-year LHHS appropriations were enacted on or before the start of the fiscal year (October 1). The conference report (H.Rept. 115-952) was adopted by the Senate on September 18, and the House on September 26. The bill provided regular, full-year appropriations for the Department of Defense (Division A) and LHHS (Division B) appropriations acts. LHHS discretionary appropriations in the FY2019 omnibus totaled $189.4 billion. This amount was 1.5% more than FY2018 enacted and 8.9% more than the FY2019 President’s budget request. The omnibus also provided $869.8 billion in mandatory funding, for a combined LHHS total of $1.059 trillion. (Note that these totals are based only on amounts provided by the FY2019 LHHS omnibus and do not include the supplemental funds, which were provided in addition to the annual appropriations.)28 27 T he initial set of budget materials was released on March 11, 2019, and additional agency materials were released in the following weeks, including many on March 18, 2019. In addition, on May 13, the President submitted two budget amendments that would affect portions of the initial request , though these amendments did not affect the net budget authority totals proposed in the initial FY2020 request. T he LHHS budget amendments proposed authorizing (1) the HHS National Institute on Minority Health and Health Disparities to implement a reorganization plan and (2) certain funds in the HHS General Departmental Management account to be available for specified activities carried out by the Departmental Appeals Board. 28 For further information, see CRS Report R45869, Labor, Health and Human Services, and Education: FY2019 Appropriations. Congressional Research Service 10 Labor, Health and Human Services, and Education: FY2020 Appropriations Summary of FY2020 LHHS Appropriations Dollars and Percentages in this Report Amounts displayed in this report are typically rounded to the nearest million or billion (as labeled). Dollar and percentage changes discussed in the text are based on unrounded amounts. Unless otherwise specified, appropriations levels displayed in this report refer to the total amount of budget authority provided in an appropriations bill (i.e., “total in the bill”), regardless of the year in which the funding becomes available. Amounts for FY2019 Enacted, FY2020 Request, and FY2020 Enacted are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2020 LHHS omnibus ( P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11061 -H11161. Amounts for the FY2020 House Committee-reported bill are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-62) accompanying H.R. 2740. Throughout this report, the FY2020 House Appropriations Committee-reported LHHS bill is commonly referred to as the House “committee bill.” (This report does not contain estimates of the House-passed version of H.R. 2740, as there is no publiclyavailable source that estimates the account-level budgetary effects of the adopted amendments. However, information on the LHHS amendments offered during floor consideration can be found in Appendix B.) Enacted totals for FY2019 do not include emergency-designated appropriations provided by P.L. 116-20 or P.L. 116-26. Enacted totals for FY2020 do not include emergency-designated appropriations provided by P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. For informational purposes, FY2019 and FY2020 enacted supplemental amounts are displayed separately at the bottom of tables throughout the report and not summed. One exception to this rule is made in Table A-1, which includes FY2019 and FY2020 enacted supplemental funds in the “Adjusted Appropriations” totals, as scored by the Congressional Budget Office. In addition, further details on the FY2020 supplemental appropriations can be found in Appendix C. For consistency with source materials, the FY2019 and FY2020 numbers in this report generally do not reflect actual or anticipated postenactment budgetary adjustments, except as noted. 29 CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21 st Century Cures Act (P.L. 114-255). Table 2 displays FY2020 discretionary and mandatory LHHS budget authority provided or proposed, by bill title, along with FY2019 enacted levels. The amounts shown in this table reflect total budget authority provided in the annual LHHS bill (i.e., all funds appropriated in the bill, regardless of the fiscal year in which the funds become available), not total budget authority available for the current fiscal year. (For a comparable table showing current-year budget authority, see Table A-2. Note that the totals in this table do not include emergency supplemental appropriations; amounts provided in supplementals are displayed separately at the bottom of the table and are in addition to regular appropriations. For a discussion of the FY2020 supplemental appropriations displayed below the bill totals in Table 2, see Appendix C.) 29 T he general practice for CRS reports on the LHHS bill has been to reflect conventions used in source materials. T hese conventions have varied over the years. For instance, CRS reports on LHHS appropriations for FY2012-FY2015 generally relied on source materials that adjusted appropriations amounts in the prior -year column to reflect sequestration, reestimates of mandatory spending, transfers, reprogramming, and other adjustments for compar ability. However, the FY2016 version of this report broke from that practice due to differing display conventions in source documents, and did not reflect any such adjustments (except sequestration for the Prevention and Public Health Fund (PPHF)). T he FY2017 version of this report differed from both of these prior practices, in that it reflected a smaller subset of transfers (generally concentrated at the National Institutes of Health) and other adjustments for comparability (e.g., program moves from one account to another), but not reprogramming of funds or mandatory sequestration (except sequestration of the PPHF). T he FY2108 and FY2019 versions of this report, however, relied on source materials that generally did not reflect any transfers or other budgetary adjustments pursuant to administrative authorities except PPHF sequestration. T he source materials used for the FY2020 report version, and thus the numbers in this report, continue this most recent approach. Congressional Research Service 11 Labor, Health and Human Services, and Education: FY2020 Appropriations Table 2. LHHS Appropriations Overview by Bill Title, FY2019-FY2020 (Total budget authority provided in the bill, in billions of dollars) FY2019 Enacted FY2020 Request FY2020 House Cmte. (H.R. 2740) Title I: Labor 13.6 12.3 14.7 13.8 Discretionary 12.1 10.9 13.3 12.4 Mandatory 1.4 1.4 1.4 1.4 Title II: HHS 899.2 916.1 939.3 934.8 Discretionary 90.5 78.1 99.4 94.9 Mandatory 808.7 838.0 840.0 839.9 Title III: Education 75.0 67.6 79.5 76.4 Discretionary 71.4 64.0 75.9 72.8 Mandatory 3.5 3.6 3.6 3.6 71.5 70.9 73.1 72.7 Discretionary 15.3 13.5 15.7 15.4 Mandatory 56.2 57.3 57.3 57.3 Total BA in the Bill 1,059.2 1,066.9 1,106.6 1,097.7 Discretionary 189.4 166.5 204.3 195.4 Mandatory 869.8 900.4 902.3 902.3 P.L. 116-20 (emergency) 0.5 — — — P.L. 116-26 (emergency) 2.9 — — — P.L. 116-113 (emergency) — — — 0.2 P.L. 116-123 (emergency) — — — 6.4 P.L. 116-127 (emergency) — — — 1.3 P.L. 116-136 (emergency) — — — 172.1 P.L. 116-139 (emergency) — — — 100.0 186.7 188.3 189.1 189.1 183.3 186.2 186.7 186.7 -9.4 -24.8 -12.6 -10.5 Bill Title Title IV: Related Agencies FY2020 Enacted (P.L. 116-94) Memoranda (non-emergency funds only): Advances for Future Years (provided in current bill) a Advances from Prior Years (for use in current year) a Additional Scorekeeping Adjustmentsb Source: Amounts in this table for the FY2019 Enacted, FY2020 Request, and FY2020 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2020 LHHS omnibus (P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11061-H11161. Amounts in the FY2020 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-62) accompanying H.R. 2740. Enacted totals for FY2019 do not include emergency-designated appropriations provided by P.L. 116-20 or P.L. 116-26. Enacted totals for FY2020 do not include emergency-designated appropriations provided by P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. For consistency with source materials, amounts in this table generally Congressional Research Service 12 Labor, Health and Human Services, and Education: FY2020 Appropriations do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21 st Century Cures Act (P.L. 114-255). Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. No amounts are shown for Title V, because this title consists solely of general provisions. a. Totals in this table are based on budget authority provided in the bill (i.e., they exclude advance appropriations from prior bills and include advance appropriations from this bill made available in future years). The calculation for total budget authority available in the current year is as follows: Total BA in the Bill, minus Advances for Future Years, plus Advances from Prior Years. b. Totals in this table have generally not been adjusted for further scorekeeping. (To adjust for scorekeeping, add this line to the total budget authority.) Figure 2 displays the FY2020 enacted discretionary and mandatory LHHS funding levels, by bill title. (While the dollars and percentages discussed in this section were calculated based on the FY2020 enacted amounts, they are generally also illustrative—within several percentage points— of the share of funds directed to each bill title in FY2019 and under the other FY2020 proposals.) As this figure demonstrates, HHS accounts for the largest share of total FY2020 LHHS appropriations: $934.8 billion, or 85.2%. This is due to the large amount of mandatory funding included in the HHS appropriation, the majority of which is for Medicaid grants to states and payments to health care trust funds. After HHS, ED and the Related Agencies represent the nextlargest shares of total LHHS funding, accounting for 7.0% and 6.6%, respectively. (The majority of the ED appropriations each year are discretionary, while the bulk of funding for the Related Agencies goes toward mandatory payments and administrative costs of the Supplemental Security Income program at the Social Security Administration.) DOL accounts for the smallest share of total LHHS funds, 1.3%. The overall composition of LHHS funding is noticeably different when comparing only discretionary appropriations. HHS accounts for a comparatively smaller share of total discretionary appropriations (48.6%), while ED accounts for a relatively larger share (37.2%). Together, these two departments represent the majority (85.8%) of discretionary LHHS appropriations. DOL and the Related Agencies account for a roughly even split of the remaining 14.2% of discretionary LHHS funds. Congressional Research Service 13 Labor, Health and Human Services, and Education: FY2020 Appropriations Figure 2. FY2020 Enacted LHHS Appropriations by Title Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2020 LHHS omnibus ( P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11061 -H11161. Enacted totals for FY2020 do not include emergency-designated appropriations provided by P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to th e 21 st Century Cures Act (P.L. 114-255). Notes: Details may not add to totals due to rounding. Amounts in this figure (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prioryear appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. Department of Labor (DOL) Note that all amounts in this section are based on regular LHHS appropriations only. Amounts in this section do not include mandatory funds provided outside of the annual appropriations process (e.g., direct appropriations for Unemployment Insurance benefits payments). All amounts in this section are rounded to the nearest million or billion (as labeled). The dollar changes and percentage changes discussed in the text are based on unrounded amounts. For consistency with source materials, amounts do not reflect sequestration or reestimates of mandatory spending programs, where applicable. Congressional Research Service 14 Labor, Health and Human Services, and Education: FY2020 Appropriations About DOL DOL is a federal department comprised of multiple entities that provide services related to employment and training, worker protection, income security, and contract enforcement. Annual LHHS appropriations laws direct funding to all DOL entities (see the text box). 31 The DOL entities fall primarily into two main functional areas—workforce development and worker protection. First, there are several DOL entities that administer workforce employment DOL Entities Funded via the and training programs—such as the Workforce LHHS Appropriations Process Innovation and Opportunity Act (WIOA) state Employment and Training Administration (ETA) formula grant programs, Job Corps, and the Employee Benefits Security Administration (EBSA) Employment Service—that provide direct Wage and Hour Division (WHD) funding for employment activities or Office of Federal Contract Compliance Programs administration of income security programs (OFCCP) (e.g., for the Unemployment Insurance Office of Labor-Management Standards (OLMS) benefits program). Also included in this area is Office of Workers’ Compensation Programs (OWCP) the Veterans’ Employment and Training Occupational Safety and Health Administration (OSHA) Service (VETS), which provides employment Mine Safety and Health Administration (MSHA) services specifically for the veteran Bureau of Labor Statistics (BLS) population. Second, there are several agencies Office of Disability Employment Policy (ODEP) that provide various worker protection Departmental Management (DM) 30 services. For example, the Occupational Safety and Health Administration (OSHA), the Mine Safety and Health Administration (MSHA), and the Wage and Hour Division (WHD) provide different types of regulation and oversight of working conditions. DOL entities focused on worker protection provide services to ensure worker safety, adherence to wage and overtime laws, and contract compliance, among other duties. In addition to these two main functional areas, DOL’s Bureau of Labor Statistics (BLS) collects data and provides analysis on the labor market and related labor issues. FY2020 DOL Appropriations Overview Table 3 generally displays FY2020 discretionary and mandatory DOL budget authority provided or proposed, along with FY2019 enacted levels. The totals in this table do not include emergency supplemental appropriations; amounts provided in supplementals are displayed separately at the bottom of the table and are in addition to regular appropriations. For a discussion of the FY2020 supplemental appropriations displayed below the bill totals in Table 3, see Appendix C. The FY2020 LHHS omnibus increased discretionary appropriations for DOL by $291 million (+2.4%) compared to the FY2019 enacted levels. Discretionary DOL appropriations would have increased by $1.2 billion (+9.9%) under the FY2020 House committee bill, compared to FY2019, but would have decreased under the FY2020 President’s budget request by $1.2 billion (-10.0%). Of the total funding provided in the bill for DOL, roughly 90% is discretionary. 30 Departmental Management includes the DOL salaries and expenses, Veterans Employment and T raining Service (VET S), IT Modernization, and the Office of the Inspector General. 31 T he Pension Benefit Guaranty Corporation (PBGC) is funded primarily through insurance premiums and related fees from companies covered by the PBGC. Congressional Research Service 15 Labor, Health and Human Services, and Education: FY2020 Appropriations Table 3. DOL Appropriations Overview (Dollars in billions) Funding FY2019 Enacted FY2020 Request FY2020 House Cmte. (H.R. 2740) FY2020 Enacted (P.L. 116-94) Discretionary 12.1 10.9 13.3 12.4 Mandatory 1.4 1.4 1.4 1.4 Total BA in the Bill 13.6 12.3 14.7 13.8 P.L. 116-20 (emergency) 0.1 — — — P.L. 116-26 (emergency) — — — — P.L. 116-113 (emergency) — — — 0.2 P.L. 116-123 (emergency) — — — — P.L. 116-127 (emergency) — — — — P.L. 116-136 (emergency) — — — 0.4 P.L. 116-139 (emergency) — — — — Source: Amounts in this table for the FY2019 Enacted, FY2020 Request, and FY2020 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2020 LHHS omnibus (P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11061-H11161. Amounts in the FY2020 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-62) accompanying H.R. 2740. Enacted totals for FY2019 do not include emergency-designated appropriations provided by P.L. 116-20 or P.L. 116-26. Enacted totals for FY2020 do not include emergency-designated appropriations provided by P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. For consistency with source materials, amounts in this table generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senat e appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. Selected DOL Highlights The following sections present highlights from FY2020 enacted and proposed appropriations compared to FY2019 enacted appropriations for selected DOL accounts and programs.32 Table 4 displays funding for DOL programs and activities discussed in this section. Employment and Training Administration (ETA) ETA administers the primary federal workforce development law, the Workforce Innovation and Opportunity Act (WIOA, P.L. 113-128). The WIOA, which replaced the Workforce Investment Act, was signed into law in July 2014 and authorized appropriations for its programs through FY2020. WIOA’s provisions went into effect in FY2015 and FY2016. 32 DOL budget materials can be found at https://www.dol.gov/general/aboutdol#budget. Congressional Research Service 16 Labor, Health and Human Services, and Education: FY2020 Appropriations Title I of WIOA, which authorizes more than half of all funding for the programs authorized by the four titles of WIOA, includes three state formula grant programs serving Adults, Youth, and Dislocated Workers. While the FY2020 LHHS omnibus provided a $30 million increase (+1.1%) for the three WIOA state formula grant programs compared to FY2019, the President’s budget would have provided level funding and the House committee bill would have increased funding by $178 million (+6.4%), compared to FY2019 enacted levels. The FY2020 LHHS omnibus provided $271 million for the Dislocated Workers Activities National Reserve (DWA National Reserve), which was an increase of $50 million (+22.6%) compared to the FY2019 enacted level. The FY2020 President’s budget would have reduced funding for the DWA National Reserve by $86 million (-39.0%) but the House committee bill would have increased DWA National Reserve funding by $150 million (+67.9%), compared to the FY2019 enacted level. In addition, the FY2020 LHHS omnibus maintained a provision in that account (which originated in the FY2018 omnibus and was included in the FY2019 omnibus) directing $30 million from the DWA National Reserve toward training and employment assistance for workers dislocated in both the Appalachian and lower Mississippi regions. Finally, the FY2020 LHHS omnibus included a new provision directing $40 million from the DWA National Reserve to be used in developing, offering, or improving career training programs at community colleges. The FY2020 LHHS omnibus provided $175 million for the Apprenticeship Grant program, which is $15 million (+9.4%) more than the level enacted in FY2019. The FY2020 President’s budget would have maintained the same level of funding for the Apprenticeship Grant program as the FY2019 enacted level and the House committee bill would have increased funding by $90 million (+56.3%) compared to the FY2019 enacted level. Four ETA programs for which the FY2020 President’s budget proposed no funding—the Native Americans program, the Migrant and Seasonal Farmworkers program, the Community Service Employment for Older Americans (CSEOA) program, and the Workforce Data Quality Initiative—received FY2020 appropriations at roughly the same level as FY2019. Bureau of Labor Statistics (BLS) The FY2020 LHHS omnibus provided $655 million for BLS, which was an increase of $40 million (+6.5%) from the FY2019 enacted level and the same amount requested in the FY2020 President’s budget but $21 million (-3.1%) less than the amount proposed in the House committee bill. The FY2020 President’s budget indicates that the additional $40 million was requested, and should remain available until September 30, 2024, for necessary costs associated with the physical relocation of BLS headquarters to the Suitland Federal Complex. Similarly, the FY2020 LHHS omnibus directed BLS to use $27 million for costs associated with this move. As noted in the explanatory statement accompanying the FY2020 LHHS omnibus, the remainder of the increase ($13 million) is to be used to support an annual supplement to the Current Population Survey (CPS) to collect data on contingent workers every two years and other topics in the alternate years, to restore the production of labor market data in the Local Area Unemployment Statistics (LAUS) program for New England Minor Civil Divisions with populations less than 1,000, and to plan and develop a new National Longitudinal Survey of Youth (NLSY) c ohort. 33 33 Explanatory statement accompanying the FY2020 LHHS omnibus ( P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11063. Congressional Research Service 17 Labor, Health and Human Services, and Education: FY2020 Appropriations Bureau of International Labor Affairs (ILAB) The FY2020 LHHS omnibus provided $96 million for ILAB, which was an increase of $10 million (+11.6%) from the FY2019 enacted level. The House committee bill would have provided $122 million for ILAB, an increase of $36 million (+41.8%) over the FY2019 enacted level. The FY2020 President’s budget would have decreased funding by $68 million (-78.5%) for ILAB, which provides research, advocacy, technical assistance, and grants to promote workers’ rights in different parts of the world. Language in the FY2020 President’s budget indicated that the proposed reduction reflected a $59.8 million decrease to eliminate new grants and a $7.8 million decrease to reduce staff levels, with the remaining $19 million to be used on “efforts to make U.S. trade agreements fair for U.S. workers by monitoring and enforcing the labor provisions of free trade agreements (FTAs) and trade preference programs to ensure a fair global playing field for U.S. workers and businesses.”34 Labor-Related General Provisions Annual LHHS appropriations acts regularly contain general provisions related to certain labor issues. This section highlights selected DOL general provisions in the FY2020 LHHS omnibus. The FY2020 LHHS omnibus continued several provisions that have been included in at least one previous LHHS appropriations act, including provisions that      exempt certain insurance claims adjusters from overtime protection for two years following a “major disaster” (included since FY2016);35 direct the Secretary of Labor to accept private wage surveys as part of the process of determining prevailing wages in the H-2B program, even in instances in which relevant wage data are available from the Bureau of Labor Statistics (included since FY2016);36 authorize the Secretary of Labor to provide up to $2 million in “excess personal property” to apprenticeship programs to assist training apprentices (included since FY2018);37 authorize the Secretary of Labor to employ law enforcement officers or special agents to provide protection to the Secretary of Labor and certain other employees and family members at public events and in situations in which there is a “unique and articulable” threat of physical harm (included since FY2018); 38 and authorize the Secretary of Labor to dispose of or divest “by any means the Secretary determines appropriate” all or part of the real property on which the Treasure Island Job Corps Center is located (included since FY2018). 39 34 See https://www.dol.gov/sites/dolgov/files/general/budget/2020/CBJ-2020-V3-02.pdf, DM-38. 35 See Division A, T itle I, §108 of P.L. 116-94. 36 See Division A, T itle I, §110 of P.L. 116-94. T he H-2B program allows for the temporary employment of foreign workers in nonagricultural sectors and requires these workers to be paid the “prevailing wage” (i.e., the average wage paid to similar workers in the local area). Under DOL regulations, private employer surveys may be considered only if the employer meets certain conditions. 37 See Division A, T itle I, §112 of P.L. 116-94. 38 See Division A, T itle I, §113 of P.L. 116-94. 39 See Division A, T itle I, §114 of P.L. 116-94. Congressional Research Service 18 Labor, Health and Human Services, and Education: FY2020 Appropriations Table 4. Detailed DOL Appropriations (Dollars in millions) Agency or Selected Program FY2019 Enacted FY2020 Request FY2020 House Cmte. (H.R. 2740) FY2020 Enacted (P.L. 11694) ETA—Mandatory a 790 680 680 680 ETA—Discretionary 9,116 7,893 9,934 9,293 Training and Employment Services: 3,503 3,247 3,978 3,611 State Formula Grants: 2,790 2,790 2,967 2,820 Adult Activities Grants to States 846 846 900 855 Youth Activities Grants to States 903 903 964 913 1,041 1,041 1,103 1,052 713 458 1,010 791 DWA National Reserve 221 135 371 271 Native Americans 55 0 55 55 Migrant and Seasonal Farmworkers 89 0 99 92 YouthBuild 90 85 128 95 Reintegration of Ex-Offenders 93 78 100 98 Workforce Data Quality Initiative 6 0 8 6 160 160 250 175 1,719 1,016 1,869 1,744 400 0 464 405 3,336 3,476 3,466 3,375 2,528 2,663 2,630 2,553 Employment Service 683 683 702 690 Foreign Labor Certification 62 71 71 69 One-Stop Career Centers 63 59 63 63 ETA Program Administration 159 154 159 159 Employee Benefits Security Administration 181 194 183 181 Pension Benefit Guaranty Corp, (PBGC) program level (non-add)b (445) (453) (453) (453) Wage and Hour Division 229 233 298 242 Office of Labor-Management Standards 41 49 40 43 Office of Federal Contract Compliance Programs 103 104 120 106 Discretionary ETA Programs: Dislocated Worker Activities (DWA) Grants to States National Activities: Apprenticeship Grants Job Corps Community Service Employment for Older Americans State Unemployment Insurance and Employment Service Operations (SUI/ESO): Unemployment Compensation Congressional Research Service 19 Labor, Health and Human Services, and Education: FY2020 Appropriations Agency or Selected Program FY2019 Enacted FY2020 Request FY2020 House Cmte. (H.R. 2740) FY2020 Enacted (P.L. 11694) Office of Workers’ Compensation Programs— Mandatory c 642 695 695 695 Office of Workers’ Compensation Programs— Discretionary 118 118 121 118 Occupational Safety & Health Administration 558 558 661 582 Mine Safety & Health Administration 374 376 417 380 Bureau of Labor Statistics 615 655 676 655 Office of Disability Employment Policy 38 27 39 39 Departmental Management 751 700 832 776 Salaries and Expenses 338 267 383 348 86 19 122 96 Veterans Employment and Training 300 306 316 311 IT Modernization 23 37 37 25 Office of the Inspector General 89 90 96 91 Total, DOL BA in the Bill 13,555 12,280 14,696 13,789 Subtotal, Mandatory 1,432 1,375 1,375 1,375 Subtotal, Discretionary 12,123 10,905 13,322 12,414 P.L. 116-20 (emergency) 50 — — — P.L. 116-26 (emergency) — — — — P.L. 116-113 (emergency) — — — 210 P.L. 116-123 (emergency) — — — — P.L. 116-127 (emergency) — — — — P.L. 116-136 (emergency) — — — 360 P.L. 116-139 (emergency) — — — — Total, BA Available in Fiscal Year (current year from any bill) 13,556 12,366 14,696 13,789 Total, BA Advances for Future Years (provided in current bill) 1,786 1,700 1,786 1,786 Total, BA Advances from Prior Years (for use in current year) 1,787 1,786 1,786 1,786 International Labor Affairs (non-addd) Memoranda (non-emergency funds only) Source: Amounts in this table for the FY2019 Enacted, FY2020 Request, and FY2020 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2020 LHHS omnibus (P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11061-H11161. Amounts in the FY2020 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-62) accompanying H.R. 2740. Enacted totals for FY2019 do not include emergency-designated appropriations provided by P.L. 116-20 or P.L. 116-26. Enacted totals for FY2020 do not include emergency-designated appropriations provided by P.L. 116-113, P.L. 116-123, Congressional Research Service 20 Labor, Health and Human Services, and Education: FY2020 Appropriations P.L. 116-127, P.L. 116-136, or P.L. 116-139. For consistency with source materials, amounts in this table generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities. Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. a. b. Mandatory funding within ETA goes to Federal Unemployment Benefits and Allowances (FUBA) and Advances to the Unemployment Trust Fund (UTF), if any. FUBA funds Trade Adjustment Assistance for Workers (TAA). PBGC funding is provided outside the LHHS Appropriations Act. c. Mandatory programs in the Office of Workers’ Compensation Programs include Special Benefits (comprising the Federal Employees’ Compensation Benefits and the Longshore and Harbor Workers’ Benefits), Special Benefits for Disabled Coal Miners, Energy Employees Occupational Illness Compensation (Administrative Expenses), and the Black Lung Disability Trust Fund. d. The funding for International Labor Affairs is included in the Salaries and E xpenses total. Department of Health and Human Services (HHS) Note that all amounts in this section are based on regular LHHS appropriations only; they do not include funds for HHS agencies provided through other appropriations bills (e.g., funding for the Food and Drug Administration) or outside of the annual appropriations process (e.g., direct appropriations for Medicare or mandatory funds provided by authorizing laws, such as the Patient Protection and Affordable Care Act [ACA, P.L. 111-148]). 40 All amounts in this section are rounded to the nearest million or billion (as labeled). The dollar changes and percentage changes discussed in the text are based on unrounded amounts. For consistency with source materials, amounts do not reflect sequestration or re-estimates of mandatory spending programs, where applicable. About HHS HHS is a large federal department composed of multiple agencies working to enhance the health and well-being of Americans. Annual LHHS appropriations laws direct funding to most (but not all) HHS agencies (see text box for HHS agencies supported by the LHHS bill). 41 For instance, the LHHS bill directs funding to five Public Health Service (PHS) agencies: the Health Resources and Services Administration (HRSA), Centers for Disease HHS Agencies Funded via the LHHS Appropriations Process Health Resources and Services Administration (HRSA) Centers for Disease Control and Prevention (CDC) National Institutes of Health (NIH) Substance Abuse and Mental Health Services Administration (SAMHSA) Agency for Healthcare Research and Quality (AHRQ) Centers for Medicare & Medicaid Services (CMS) Administration for Children and Families (ACF) Administration for Community Living (ACL) Office of the Secretary (OS) 40 T he ACA was subsequently amended by the Health Care and Education Reconciliation Act ( P.L. 111-152). These two laws are collectively referred to as the ACA in this report. (Previous CRS reports on the Patient Protection and Affordable Care Act used the acronym PPACA to refer to the statute, but newer reports will use “ACA,” in conformance with the more widely used acronym for the law.) For information on funding directly appropriated by the ACA, see the tables in CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act (ACA). 41 T hree HHS public health agencies receive annual funding from appropriations bills other than the LHHS bill: the Congressional Research Service 21 Labor, Health and Human Services, and Education: FY2020 Appropriations Control and Prevention (CDC), National Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA), and Agency for Healthcare Research and Quality (AHRQ). 42 These public health agencies support diverse missions, ranging from the provision of health care services and supports (e.g., HRSA, SAMHSA), to the advancement of health care quality and medical research (e.g., AHRQ, NIH), to the prevention and control of infectious and chronic diseases (e.g., CDC). In addition, the LHHS bill provides funding for annually appropriated components of CMS, 43 which is the HHS agency responsible for the administration of Medicare, Medicaid, the State Children’s Health Insurance Program (CHIP), and consumer protections and private health insurance provisions of the ACA. The LHHS bill also provides funding for two HHS agencies focused primarily on the provision of social services: the Administration for Children and Families (ACF) and the Administration for Community Living (ACL). ACF’s mission is to promote the economic and social well-being of vulnerable children, youth, families, and communities. ACL was formed with a goal of increasing access to community supports for older Americans and people with disabilities. 44 The LHHS bill also provides funding for the HHS Office of the Secretary (OS), which encompasses a broad array of management, research, oversight, and emergency preparedness functions in support of the entire department. FY2020 HHS Appropriations Overview Table 5 displays enacted and proposed FY2020 funding levels for HHS, along with FY2019 levels. Note that the totals in this table do not include emergency supplemental appropriations; amounts provided in supplementals are displayed separately at the bottom of the table and are in addition to regular appropriations. For a discussion of the FY2020 supplemental appropriations displayed below the bill totals in Table 5, see Appendix C. In general, discretionary funds account for about 10% of HHS appropriations in the LHHS bill. Compared to the FY2019 funding levels, the FY2020 LHHS omnibus increased HHS discretionary appropriations by 4.9%. The House committee bill would have increased HHS discretionary appropriations to a greater degree, by 9.8%, while the President requested a 13.7% decrease in discretionary HHS funding. Food and Drug Administration (funded through the Agriculture appropriations bill), the Indian Health Service (funded through the Interior-Environment appropriations bill), and the Agency for T oxic Substances and Disease Registry (funded through the Interior-Environment appropriations bill). In addition, while the National Institutes of Health (NIH) receive the majority of their appropriations fro m the LHHS bill, one NIH institute (the National Institute of Environmental Health Sciences) receives appropriations from two bills: LHHS and the Interior -Environment bill. 42 For more information on HHS PHS agencies, see CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-FY2018). 43 Much of the funding for CMS activities is provided through mandatory appropriations in authorizing legislation, and thus is not subject to the annual appropriations process. 44 ACL was established in 2012 by consolidating the Administration on Aging, the Office of Disability, and the Administration on Developmental Disabilities (renamed the Administration on Intellectual and Developmental Disabilities) into one agency. See the HHS Secretary’s press release from April 16, 2012: http://www.hhs.gov/news/ press/2012pres/04/20120416a.html. For more information on the ACL, see http://www.hhs.gov/acl/. Congressional Research Service 22 Labor, Health and Human Services, and Education: FY2020 Appropriations Table 5. HHS Appropriations Overview (Dollars in billions) FY2019 Enacted FY2020 Request FY2020 House Cmte. (H.R. 2740) FY2020 Enacted (P.L. 116-94) Discretionary 90.5 78.1 99.4 94.9 Mandatory 808.7 838.0 840.0 839.9 Total BA in the Bill 899.2 916.1 939.3 934.8 P.L. 116-20 (emergency) 0.3 — — — P.L. 116-26 (emergency) 2.9 — — — P.L. 116-113 (emergency) — — — — P.L. 116-123 (emergency) — — — 6.4 P.L. 116-127 (emergency) — — — 1.3 P.L. 116-136 (emergency) — — — 140.4 P.L. 116-139 (emergency) — — — 100 Funding Source: Amounts in this table for the FY2019 Enacted, FY2020 Request, and FY2020 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2020 LHHS omnibus (P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11061-H11161. Amounts in the FY2020 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 116-62) accompanying H.R. 2740. Enacted totals for FY2019 do not include emergency-designated appropriations provided by P.L. 116-20 or P.L. 116-26. Enacted totals for FY2020 do not include emergency-designated appropriations provided by P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. For consistency with source materials, amounts in this table generally do not reflect mandatory spending sequestration, where applicable, nor do they generally reflect transfers or reprogramming of funds pursuant to executive authorities. CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21 st Century Cures Act (P.L. 114-255). Notes: BA = Budget Authority. Details may not add to totals due to rounding. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. Figure 3 provides an HHS agency-level breakdown of FY2020 enacted appropriations. As this figure demonstrates, annual HHS appropriations are dominated by mandatory funding, the majority of which goes to CMS to provide Medicaid benefits and payments to health care trust funds. When taking into account both mandatory and discretionary funding, CMS accounts for $828.3 billion, which is 88.6% of all enacted appropriations for HHS. NIH and ACF account for the next-largest shares of total HHS appropriations, receiving about 4.3% and 4.2% apiece. By contrast, when looking exclusively at discretionary appropriations, funding for CMS constitutes about 4.7% of FY2020 enacted HHS appropriations. Instead, the bulk of discretionary appropriations went to the PHS agencies, which account for 63.4% of discretionary appropriations provided for HHS. 45 NIH typically receives the largest share of all discretionary 45 For further information about PHS agency funding, see CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-FY2018). Congressional Research Service 23 Labor, Health and Human Services, and Education: FY2020 Appropriations funding among HHS agencies (42.2% in FY2020), with ACF accounting for the second-largest share (25.8% in FY2020). Figure 3. FY2020 Enacted HHS Appropriations by Agency Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2020 LHHS omnibus (P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11061 -H11161. Enacted totals for FY2020 do not include emergency-designated appropriations provided by P.L. 116-113, P.L. 116-123, P.L. 116-127, P.L. 116-136, or P.L. 116-139. For consistency with source materials, amounts in this figure generally do not reflect mandatory spending sequestration, where applicable, nor do they generally reflect transfers or reprogramming of funds pursuant to executive authorities. Notes: Details may not add to totals due to rounding. The bar representing the combined mandatory and discretionary total for CMS has been abbreviated due to space constraints. When taking into account both mandatory and discretionary funding, CMS receives over 20 times the funding appropriated to either ACF or NIH in the FY2019 LHHS omnibus. Amounts in this table (1) reflect all BA appropriated in the bill, regardless of the year in which funds become available (i.e., totals do not include advances from prior-year appropriations, but do include advances for subsequent years provided in this bill); (2) have generally not been adjusted to reflect scorekeeping; (3) comprise only those funds provided (or requested) for agencies and accounts subject to the jurisdiction of the LHHS subcommittees of the House and Senate appropriations committees; and (4) do not include appropriations that occur outside of appropriations bills. Special Public Health Funding Mechanisms Annual appropriations for HHS public health service agencies are best understood in the context of certain HHS-specific funding mechanisms: the Public Health Service Evaluation Set-Aside, and the Prevention and Public Health Fund (PPHF). In recent years, LHHS appropriations have used these funding mechanisms to direct additional support to certain programs and activities. Public Health Service Evaluation Tap The PHS Evaluation Set-Aside, also known as the PHS Evaluation Tap, is a unique feature of HHS appropriations. It is authorized by Section 241 of the Public Health Service Act (PHSA), and allows the Secretary of HHS, with the approval of appropriators, to redistribute a portion of eligible PHS agency appropriations across HHS for program evaluation purposes. Congressional Research Service 24 Labor, Health and Human Services, and Education: FY2020 Appropriations The PHSA limits the set-aside to not less than 0.2% and not more than 1% of eligible program appropriations. However, LHHS appropriations acts have commonly established a higher maximum percentage for the set-aside and have distributed specific amounts of “tap” funding to selected HHS programs. Since FY2010, and including in FY2020, this higher maximum set-aside level has been 2.5% of eligible appropriations. 46 (While the House committee bill would also have maintained the set-aside at 2.5%, the President’s budget proposed to increase the set-aside to 2.9%.) Display of Evaluation Tap Transfers Before FY2015, the PHS tap traditionally provided more than a dozen HHS programs By convention, tables in this report show only the amount of PHS Evaluation Tap funds received by an with funding beyond their annual agency (i.e., tables do not subtract the amount of the appropriations and, in some cases, was the evaluation tap from donor agencies’ appropriations). sole source of funding for a program or That is to say, tap amounts shown in the following activity. However, since FY2015 and tables are in addition to amounts shown for budget including in FY2020, LHHS appropriations authority, but the amounts shown for budget authority have not been adjusted to reflect potential “transferlaws have directed tap funds to a smaller out” of funds to the tap. number of programs or activities within three HHS agencies (NIH, SAMHSA, and OS) and have not provided any tap transfers to AHRQ, CDC, and HRSA. This has been particularly notable for AHRQ, which had been funded primarily through tap transfers from FY2003 to FY2014, but has received discretionary appropriations since then. 47 The House committee bill generally would have maintained the current distributional practice for FY2020, except that it would have also provided tap funding to AHRQ. The President’s budget proposed to expand the activities and agencies funded by the PHS tap to include the Public Health Scientific Services at the CDC, while simultaneously proposing to reduce or eliminate tap transfers to some other activities. Since FY2015, LHHS appropriations laws have directed the largest share of tap transfers to NIH. 48 The FY2020 LHHS omnibus provided $1.2 billion in tap transfers to NIH, an $84 million (+7.3%) increase over the FY2019 level. The FY2020 House committee bill proposed that the NIH transfers be continued at FY2019 levels ($1.1 billion), whereas the President’s request proposed that the transfer be reduced by $406 million (-35.4%). 46 See Section 204, Division B, P.L. 116-94 for the FY2020 maximum set -aside level. T he last time that an appropriations act set the PHS tap percentage at a level other than 2.5% was in FY2009, when it was 2.4% (see P.L. 111-8). T he FY2020 omnibus also retained a change to this provision, first included in the FY2014 omnibus, allowing tap transfers to be used for the “evaluation and the implementation” of programs funded in the HHS title of the LHHS appropriations act. Prior to FY2014, such provisions had restricted tap funds to the “evaluation of the implementation” of programs authorized under the Public Health Service Act. 47 Until FY2015, AHRQ had not received a discretionary appropriation in an annual appropriations act in more than a decade. FY2009 was the exception to this general pattern, as AHRQ received a supplemental appropriat ion from the American Recovery and Reinvestment Act that year. In recent years, AHRQ has also received some transfers from the Prevention and Public Health Fund and the Patient -Centered Outcomes Research T rust Fund, though these transfers were generally much smaller than the transfers AHRQ received from the tap. For more information, see CRS Report R44136, The Agency for Healthcare Research and Quality (AHRQ) Budget: Fact Sheet. 48 Prior to FY2015, NIH had traditionally been by far the largest net donor of tap funds, rather than a net recipient. T he joint explanatory statement accompanying the FY2015 omnibus explained this shift as being intended to ensure that tap transfers are a “net benefit to NIH rather than a liability” and noted that this change was in response to a growing concern at the loss of NIH funds to the tap. Joint Explanatory Statement, Proceedings and Debates of the 113 th Congress, Second Session, Congressional Record, vol. 160, no. 151, Book II, December 11, 2014, p. H9832. Congressional Research Service 25 Labor, Health and Human Services, and Education: FY2020 Appropriations Prevention and Public Health Fund Display of PPHF Transfers PPHF transfer amounts displayed in the HHS tables in this report are in addition to amounts shown for budget authority provided in the bill. For consistency with source materials, the amounts shown for PPHF transfers in these tables reflect the estimated effects of mandatory spending sequestration; this is not the case for other mandatory spending shown in this report (also for consistency with source materials). The ACA both authorized and appropriated mandatory funding to three funds to support programs and activities within the PHS agencies. 49 One of these, the Prevention and Public Health Fund (PPHF, ACA §4002, as amended), was given a permanent, annual appropriation that was intended to provide support each year to prevention, wellness, and related public health programs funded through HHS accounts. The ACA had appropriated $2 billion in mandatory funds to the PPHF for FY2020, but this amount was reduced by subsequent laws that decreased PPHF funding for FY2020 and other fiscal years. Under current law, the FY2020 appropriation was $950 million. 50 In addition, this appropriation was subject to a 5.9% reduction due to sequestration of nonexempt mandatory spending. (For more information on sequestration, see the budget enforcement discussion in Appendix A.) After sequestration, the total PPHF appropriation available for FY2020 was $894 million, an increase of $50 million relative to FY2019. Of this amount, the LHHS omnibus allocated $854 million to CDC, $12 million to SAMHSA, and $28 million to ACL. 51 PPHF funds are intended to supplement (sometimes quite substantially) the funding that selected programs receive through regular appropriations. Although the PPHF authority instructs the HHS Secretary to transfer amounts from the fund to HHS agencies, since FY2014 provisions in annual appropriations acts and accompanying reports have explicitly directed the distribution of PPHF funds and prohibited the Secretary from making further transfers for those years. 52 CDC commonly receives the largest share of annual PPHF funds. The amount provided to CDC for FY2020 and proposed by the House committee bill, $854 million, was a $50 million (+6.2%) increase relative to FY2019. The President’s request proposed increasing the PPHF funding transferred to CDC to $894 million (+11.1%). Selected HHS Highlights by Agency This section begins with a limited selection of FY2020 discretionary funding highlights by HHS agency. The discussion is largely based on the enacted and proposed appropriations levels for FY2020, compared to FY2019 enacted levels. 53 These summaries are followed by a brief overview of significant provisions from annual HHS appropriations laws that restrict spending in certain controversial areas, such as abortion and stem cell research. The section concludes with two tables (Table 6 and Table 7) presenting more detailed information on FY2019 enacted and FY2020 proposed and enacted funding levels for HHS. 49 For more information, see CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act (ACA). 50 42 U.S.C. 300u-11. 51 See explanatory statement accompanying the FY2020 LHHS omnibus (P.L. 116-94), available in the Congressional Record, vol. 165, no. 204, December 17, 2019, p. H11080, for allocations to specific agency programs and activities. 52 See Division A, §222, P.L. 116-94. 53 HHS budget materials can be found at http://www.hhs.gov/budget/. Congressional Research Service 26 Labor, Health and Human Services, and Education: FY2020 Appropriations HRSA The FY2020 LHHS omnibus provided $7.0 billion in discretionary budget authority for HRSA. This was $195 million (+2.8%) more than HRSA’s FY2019 discretionary funding level and $1.2 billion (+20.4%) more than the FY2020 President’s budget request. The explanatory statement accompanying the FY2020 LHHS omnibus provided $50 million for the first year of an initiative to reduce HIV transmission under the Primary Health Care account. These funds are to be used to increase the use of pre-exposure prophylaxis (PrEP) among high risk groups. 54 Under the Ryan White HIV/AIDS Program appropriation, there is an additional $70 million set aside for the HIV initiative, to be used in high-need jurisdictions to increasing viral suppression among people with HIV. The explanatory statement also allocates within the Rural Health account $6 million to be used to develop best practices for HIV treatment through telehealth. 55 From amounts appropriated to the Health Workforce account, the explanatory statement directed $102 million (+36%) toward Behavioral Health Workforce Education and Training (BHWET). Within this amount, the explanatory statement allocated no less than $26.7 million to establish the Mental and Substance Use Disorder Workforce Training Demonstration, 56 no less than $10 million for experiential training for peer support specialists, 57 and no less than $12 million to establish the Loan Repayment Program for Substance Use Disorder Treatment Workforce.58 CDC The FY2020 LHHS omnibus provided $6.8 billion in discretionary budget authority for CDC, which was $362 million (+5.6%) more than CDC’s FY2019 funding level. The FY2020 LHHS omnibus did not direct any PHS tap funds to the CDC, continuing the practice started in FY2015. However, the FY2020 LHHS omnibus did supplement discretionary CDC appropriations with transfers from two additional sources. First, the FY2020 LHHS omnibus directed $854 million in PPHF transfers to the CDC, which was $50 million (+6.2%) more than FY2019. 59 Second, the FY2020 LHHS omnibus directed $225 million from the HHS Nonrecurring Expenses Fund (NEF)60 to the CDC Buildings and Facilities account to support infrastructure improvements for the CDC’s Chamblee Campus. 61 Funds transferred into the NEF are generally available to the 54 Congressional Record, December 17, 2019, Vol. 165, No. 204, Book III, p. H11063. 55 Ibid., p. H11064. 56 Authorized under Section 9022 of the 21 st Century Cures Act (P.L. 114-255) and described in Congressional Record, vol. 165, no. 204, December 17, 2019, p. H11064. See also H.Rept. 116-62, p. 45. 57 As described in Congressional Record, vol. 165, no. 204, December 17, 2019, p. H11064. See also H.Rept. 116-62, p. 45. 58 Authorized under Section 7071 of the SUPPORT for Patients and Communities Act ( P.L. 115-271) and described in Congressional Record, vol. 165, no. 204, December 17, 2019, p. H11064. See also H.Rept. 116-62, p. 45. 59 Congressional Record, December 17, 2019, Vol. 165, No. 204, Book III, p. H11065. 60 T he NEF was established by the Consolidated Appropriations Act of 2008 to enable the HHS Secretary to repurpose certain unobligated balances of expired discretionary funds appropriated to HHS from the General Fund ( P.L. 110-161, Division G, T itle II, §223). Most accounts in annual appropriations measures receive appropriations from the General Fund at the U.S. T reasury. T his term refers to all federal money not allocated by law to any other fund account, such as federal trust funds for Medicare. 61 See Division A, T itle II, §238 of P.L. 116-94. T he $225 million NEF transfer to the CDC Buildings and Facilities account was for one-time projects for the CDC’s Chamblee Campus, such as real property, equipment, construction, demolition, installation, renovation of facilities, and related infrastructure improvements. T he FY2020 LHHS omnibus separately appropriated $25 million to the CDC Buildings and Facilities account, but did not explicitly direct any of Congressional Research Service 27 Labor, Health and Human Services, and Education: FY2020 Appropriations Secretary for capital acquisitions across HHS, including facilities infrastructure and information technology. Until recently, it has not been common for LHHS appropriations acts to specify that particular projects are to be funded by the NEF, but there have been a few such cases since FY2017. 62 All told, this combination of funding represented an increase of $637 million (+8.7%) from FY2019. The President’s budget request would have decreased discretionary budget authority by $1.6 billion (-31.2%) relative to FY2019, while requesting that $423 million in tap funds be directed to the CDC. The President’s budget also requested $894 million in PPHF transfers, which would have been an $89 million (+11.1%) increase. However, the President’s budget did not request that any transfers from the NEF be directed to the CDC. All told, this combination of funding would have represented a decrease of $751 million (-10.2%) from FY2019. Most programmatic accounts, except Immunization and Respiratory Diseases and Public Health Preparedness and Response, received increases relative to FY2019. Notable increases were provided for (1) the HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases (STDs), and Tuberculosis Prevention account, which was funded at an increased level of $1.274 billion (+13.2% above FY2019), including funding for a new initiative to prevent new HIV infections ($140 million), 63 and (2) the Public Health and Scientific Services account, funded at $555 million (+10.1%), which contained a new initiative on public health data modernization ($50 million). 64 The explanatory statement contained a number of new activities under the Injury Prevention and Control account, which was funded at $677 million (+4.4%), including funding for child sexual abuse prevention ($1 million), suicide prevention ($10 million), and adverse childhood experiences ($4 million). It also included specific funding for a new Firearm Injury and Mortality Prevention Research program ($12.5 million). 65 NIH The FY2020 LHHS omnibus provided $40.2 billion in discretionary budget authority for NIH. This was $2.3 billion (+6.0%) more than FY2019 and $6.8 billion (+20.4%) more than the President’s FY2020 budget request. The FY2020 LHHS omnibus also directed $225 million from the HHS Nonrecurring Expenses Fund (NEF) 66 to the NIH Buildings and Facilities account to implement the recommendations in the 2019 National Academies of Sciences, Engineering, and these appropriations to the Chamblee project. T he $25 million appropriation to this account represents a $5 million decrease from FY2019 (-17%), when excluding the NEF funds reserved for the Chamblee project. 62 For instance, a continuing resolution for FY2017 (P.L. 114-254) authorized HHS to transfer up to $300 million (if certain conditions were met) from the NEF to the HHS Refugee and Entrant Assistance program dedicated to unaccompanied alien children. For more information, see CRS Report R44723, Overview of Further Continuing Appropriations for FY2017 (H.R. 2028). In addition, the FY2018 omnibus provision directing $240 million in NEF funds to the construction of a new CDC laboratory. T he explanatory statement identifies several other priorities for NEF projects (Congressional Record, March 22, 2018, Vol. 164, No. 50, Book III, p. H2705.) 63 Congressional Record, December 17, 2019, Vol. 165, No. 204, Book III, p. H11065. 64 Ibid, p. H11066. T he explanatory statement notes that these funds are intended to support the initiative as outlined in an early committee report. For those details, see pp. 71 -72 in H.Rept. 116-62. 65 Ibid, p. H11067. When taking account of the $12.5 million in NIH funding that was reserved for the same purpose, the total provided for Firearm Injury and Mortality Prevention Research was $25 million. 66 T he NEF was established by the Consolidated Appropriations Act of 2008 to enable the HHS Secretary to repurpose certain unobligated balances of expired discretionary funds appropriated to HHS from the General Fund ( P.L. 110-161, Division G, T itle II, §223). Most accounts in annual appropriations measures receive appropriations from the General Fund at the U.S. T reasury. T his term refers to all federal money not allocated by law to any other fund account, such as federal trust funds for Medicare. Congressional Research Service 28 Labor, Health and Human Services, and Education: FY2020 Appropriations Medicine report Managing the NIH Bethesda Campus’ Capital Assets in a Highly Competitive Global Biomedical Research Environment. 67 In addition, the FY2020 LHHS omnibus directed $1.2 billion in PHS tap transfers to NIH, an increase of $84 million (+7.3%) from FY2019. The entirety of the PHS tap transfer was provided to the National Institute of General Medical Sciences (NIGMS), and was paired with a discretionary appropriation of $1.7 billion. The NIGMS discretionary appropriation was $20 million (-1.1%) less than FY2019, but when combined with the tap transfer, total funding for NIGMS increased by $64 million (+2.2%) from FY2019. In line with recent practice, the explanatory statement on the FY2020 LHHS omnibus directed NIH to reserve a specific dollar amount for a number of purposes, for example, $2.82 billion for Alzheimer’s disease research, referring to it as an increase of $350 million from FY2019. 68 It also included a new reservation of funds for Firearm Injury and Mortality Prevention Research ($12.5 million). 69 Reserving a specific dollar amount for a particular disease or area of research at NIH is a relatively new practice and constitutes a significant departure from past precedent. 70 The FY2020 LHHS omnibus appropriated $492 million to the NIH Innovation Account pursuant to the 21st Century Cures Act (Cures Act; P.L. 114-255), which was equal to the amount authorized to be appropriated in that act. The explanatory statement also reiterated the purposes authorized in the Cures Act, directing that NIH transfer $195 million to the National Cancer Institute to support cancer research, and $70 million each to the National Institute of Neurological Disorders and Stroke and the National Institute of Mental Health to support the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative. The remaining $157 million was divided between the Precision Medicine Initiative ($149 million) and regenerative medicine research ($8 million). 71 SAMHSA The FY2020 LHHS omnibus provided $5.7 billion in discretionary budget authority for SAMHSA. This amount was $140 million (+2.5%) more than SAMHSA’s FY2019 funding level and $202 million (+3.6%) more than the President’s FY2020 budget request. The FY2020 LHHS omnibus also directed $134 million in PHS evaluation tap funding and $12 million in PPHF funding to SAMHSA, which was the same amount as FY2019. 67 See Division A, T itle II, §237 of P.L. 116-94. For further details, see Congressional Record, December 17, 2019, Vol. 165, No. 204, Book III, p. H11074. 68 Ibid., p. H11070. For a list of specified funding levels in the explanatory statement accompanying the LHHS omnibus, see T able A-2 in CRS Report R43341, National Institutes of Health (NIH) Funding: FY1995-FY2021. 69 Ibid., p. H11072. When taking account of the $12.5 million in CDC funding that was reserved for the same purpose, the total provided for Firearm Injury and Mortality Prevention Research was $25 million. 70 As recently as December 2014, the explanatory statement on the FY2015 omnibus stipulated, “In keeping with longstanding practice, the agreement does not recommend a specific amount of NIH funding for this purpose [Alzheimer’s disease] or for any other individual disease. Doing so would establish a dangerous precedent that could politicize the NIH peer review system. Nevertheless, in recognition that Alzheimer’s disease poses a serious threat to the Nation’s long-term health and economic stability, the agreement expects that a significant portion of the recommended increase for NIA should be directed to research on Alzheimer’s. T he exact amount should be determined by scientific opportunity of additional research on this disease and the quality of grant applications that are submitted for Alzheimer’s relative to those submitted for other diseases.” See Congressional Record, daily edition, vol. 160, no. 151, Book II (December 11, 2014), p. H9832. 71 Congressional Record, December 17, 2019, Vol. 165, No. 204, Bo ok III, p. H11068. Congressional Research Service 29 Labor, Health and Human Services, and Education: FY2020 Appropriations The FY2020 LHHS omnibus included an increase of $50 million (+33.3%) from FY2019 for Certified Community Behavioral Health Centers. Under the explanatory statement accompanying the FY2020 LHHS omnibus, funding for Mental Health Programs of Regional and National Significance (PRNS) received an increase of $65 million (+16.9%) and Substance Abuse Treatment PRNS received an increase of $19 million (+4.1%) from FY2019. 72 Some of the increases in PRNS funding are for programs created by the SUPPORT Act (P.L. 115-271), such as Comprehensive Opioid Recovery Centers ($2 million), Emergency Department Alternatives to Opioids ($5 million), Peer Support Technical Assistance Center ($1 million), and Treatment, Recovery, and Workforce Support ($4 million). 73 The State Opioid Response Program continued to be funded at $1.5 billion, the same amount as FY2019. AHRQ The FY2020 LHHS omnibus provided $338 million in discretionary budget authority to AHRQ. This was the same as the FY2019 level. The FY2020 LHHS omnibus did not direct any PHS tap transfers to AHRQ, which is in keeping with practices since FY2015 but contrasts with earlier years (FY2003-FY2014) in which AHRQ had been funded primarily with tap transfers.74 (The House committee bill proposed $18 million in tap transfers for AHRQ, but this proposal was not enacted.) The FY2020 LHHS omnibus continued to fund AHRQ as its own operating division, declining the President’s proposal to consolidate AHRQ into NIH. The FY2020 President’s budget had requested zero funding for AHRQ, proposing instead to continue funding many of AHRQ’s activities through a new National Institute for Research on Safety and Quality (NIRSQ) in the NIH. 75 CMS The FY2020 LHHS omnibus provided $4.5 billion in discretionary budget authority for CMS. This was $21 million (+0.5%) more than FY2019 and $84 million (+1.9%) more than the FY2019 President’s budget request. The LHHS omnibus appropriated $786 million for the CMS Health Care Fraud and Abuse Control (HCFAC) account, 2.7% more than FY2019, and slightly less (0.8%) than the FY2020 President’s request. Of the total amount appropriated for HCFAC, $475 million was effectively exempt from the discretionary budget caps. (See Appendix A for an explanation of the LHHS budget cap exemptions.) 72 As described in the explanatory statement accompanying the LHHS omnibus ( Congressional Record, vol. 165, no. 204, December 17, 2019, pp. H11074-H11075, and pp. H11116-H11117). 73 Ibid., p. H11075. 74 In addition to funds provided through the annual appropriations process, AHRQ is also scheduled in FY2020 to receive a transfer of certain mandatory funds that were authorized and appropriated to the Patient-Centered Outcomes Research T rust [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/documents/crs%3AR46492. 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