# Labor, Health and Human Services, and Education: FY2022 Appropriations > Briefs, arguments, decisions, and more. URL: https://www.frixlaw.com/law-library/documents/crs%3AR47029 ## Record - **Collection:** Congressional research report - **Document type:** CRS Report - **Published:** September 13, 2022 - **Citation:** R47029 ## Text Labor, Health and Human Services, and Education: FY2022 Appropriations Updated September 13, 2022 Congressional Research Service https://crsreports.congress.gov R47029 SUMMARY Labor, Health and Human Services, and Education: FY2022 Appropriations This report offers an overview of actions taken by Congress and the President to provide FY2022 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). R47029 September 13, 2022 Jessica Tollestrup, Coordinator Specialist in Social Policy Karen E. Lynch, Coordinator Specialist in Social Policy This report primarily focuses on regular FY2022 LHHS discretionary funding enacted during the annual appropriations process. Totals in the report tables do not include emergency-designated funds. Regular Appropriations FY2022 LHHS Omnibus: On March 15, 2022, the Consolidated Appropriations Act, 2022 (FY2022 LHHS omnibus; H.R. 2471) was signed into law by the President (P.L. 117-103). The FY2022 LHHS omnibus provided full-year appropriations for all 12 annual appropriations acts in Divisions A-L. Annual discretionary LHHS appropriations totaled $214.2 billion. This amount is 7.9% more than FY2021 enacted and 15.7% less than the FY2022 President’s budget request. The omnibus also provided $1.102 trillion in mandatory funding, for a combined LHHS total of $1.316 trillion. The distribution of discretionary funding was as follows:  DOL: $13.2 billion, 5.2% more than FY2021.  HHS: $108.6 billion, 12.0% more than FY2021.  ED: $76.4 billion, 3.9% more than FY2021.  Related Agencies: $16.0 billion, 3.3% more than FY2021. FY2022 LHHS Senate Action: The FY2022 LHHS bill did not receive subcommittee, full committee, or initial floor action in the Senate. Senator Leahy, Chair of the Senate Appropriations Committee, released a majority draft of the LHHS bill and accompanying draft report language on October 18, 2021. These draft numbers are not presented in this report. In addition, on October 25, Senator Murray, Chair of the Senate Appropriations LHHS Subcommittee, introduced an FY2022 LHHS bill (S. 3062). This bill was referred to the Senate Appropriations Committee. Because S. 3062 did not receive any congressional action, this report does not discuss this measure. FY2022 LHHS House Action: On July 15, 2021, the House Appropriations Committee voted to report the FY2022 LHHS appropriations bill, 33-25; the measure was subsequently reported to the House on July 19 (H.R. 4502; H.Rept. 117-96). The measure was approved in subcommittee, via voice vote, on July 12, 2021. As reported by the full committee, the bill would have provided $254.4 billion in discretionary LHHS funds, a 28.1% increase from FY2021 enacted levels. This amount was 0.2% more than the FY2022 President’s request. In addition, the House committee bill would have provided an estimated $1.102 trillion in mandatory funding, for a combined total of $1.356 trillion for LHHS as a whole. The distribution of discretionary funding was as follows:   DOL: $14.7 billion, 17.4% more than FY2021. HHS: $119.8 billion, 23.6% more than FY2021. Congressional Research Service  ED: $102.8 billion, 39.8% more than FY2021.  Related Agencies: $17.0 billion, 9.8% more than FY2021. The House version of LHHS appropriations was initially considered on the floor as part of a consolidated appropriations package and passed the House (219-208), as amended, on July 31, 2021 (Division A of H.R. 4502). Of the amendments offered, 47 were adopted and 9 were rejected. Because there is no publicly available source that estimates the account- or subaccount-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. FY2022 President’s Budget Request: The full FY2022 President’s budget request was submitted to Congress on May 28, 2021. (The President had previously submitted to Congress an outline of his discretionary funding priorities for FY2022 on April 9, 2021.) The President requested $254.0 billion in discretionary funding for accounts funded by the LHHS bill, which is an increase of 27.9% from FY2021 levels. In addition, the President requested $1.102 trillion in annually appropriated mandatory funding, for a total of $1.355 trillion for LHHS as a whole. The distribution of discretionary funding was as follows:  DOL: $14.3 billion, 14.2% more than FY2021.  HHS: $120.0 billion, 23.7% more than FY2021.  ED: $102.8 billion, 39.8% more than FY2021.  Related Agencies: $16.9 billion, 9.0% more than FY2021. Emergency-Designated Appropriations Over the course of FY2022, five laws were enacted providing FY2022 emergency-designated appropriations for accounts typically funded in the LHHS bill.      Division B of the Bipartisan Safer Communities Act (S. 2938; P.L. 117-159, June 25, 2022) provided a total of $1.6 billion in FY2022 for several programs within HHS and ED related to community mental and behavioral health services, pediatric health care, school attendance and engagement, and school-based mental health service; Title IV of the Additional Ukraine Supplemental Appropriations Act, 2022 (H.R. 7691; P.L. 117128, May 21, 2022) provided a total of $1.0 billion to HHS agencies, mostly for resettlement assistance for eligible Ukrainians in the United States; Division B of the Further Extending Government Funding Act (H.R. 6119; P.L. 117-70, December 3, 2021) provided a total of $1.3 billion for public health and support services for Afghan arrivals and refugees; Division J of the Infrastructure Investment and Jobs Act (H.R. 3684; P.L. 117-58, November 15, 2021) provided $100 million in FY2022 for the HHS Low Income Home Energy Assistance Program, and rescinded $353 million in previously enacted emergency funding from the Education Stabilization Fund; and Divisions A and C of the Extending Government Funding and Delivering Emergency Assistance Act (H.R. 5305; P.L. 117-43, September 30, 2021) provided a total of $4.2 billion for HHS spending related to shelter and support services for unaccompanied minors (Division A), and public health and support services for Afghan arrivals and refugees (Division C). Congressional Research Service Labor, Health and Human Services, and Education: FY2022 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 FY2022 LHHS Appropriations ........................................................................................ 4 FY2022 Emergency-Designated Appropriations ...................................................................... 4 FY2022 Annual LHHS Appropriations ..................................................................................... 5 FY2022 Consolidated Appropriations Act .......................................................................... 5 FY2022 Continuing Appropriations ................................................................................... 7 Prior Congressional Action on an LHHS Bill ..................................................................... 7 FY2022 President’s Budget Request......................................................................................... 9 FY2021 LHHS Omnibus (Division H, Consolidated Appropriations Act, 2021, H.R. 133; P.L. 116-260) .................................................................................................................. 9 Summary of FY2022 LHHS Appropriations .................................................................................. 11 Department of Labor (DOL) ......................................................................................................... 14 About DOL ............................................................................................................................. 15 FY2022 DOL Appropriations Overview ................................................................................. 15 Selected DOL Highlights ........................................................................................................ 16 Employment and Training Administration (ETA)............................................................. 16 Employment Service ......................................................................................................... 17 Wage and Hour Division (WHD)...................................................................................... 17 Bureau of Labor Statistics (BLS) ...................................................................................... 18 Bureau of International Labor Affairs (ILAB) .................................................................. 18 Labor-Related General Provisions .................................................................................... 18 Department of Health and Human Services (HHS)....................................................................... 22 About HHS .............................................................................................................................. 22 FY2022 HHS Appropriations Overview ................................................................................. 23 Special Public Health Funding Mechanisms ........................................................................... 25 Public Health Service Evaluation Tap............................................................................... 25 Prevention and Public Health Fund .................................................................................. 27 Selected HHS Highlights by Agency ...................................................................................... 28 HRSA ................................................................................................................................ 28 CDC .................................................................................................................................. 28 NIH ................................................................................................................................... 30 SAMHSA .......................................................................................................................... 31 AHRQ ............................................................................................................................... 31 CMS .................................................................................................................................. 32 ACF ................................................................................................................................... 32 ACL .................................................................................................................................. 33 Restrictions Related to Certain Controversial Issues .............................................................. 34 Department of Education (ED) ...................................................................................................... 41 About ED ................................................................................................................................ 41 Congressional Research Service Labor, Health and Human Services, and Education: FY2022 Appropriations FY2022 ED Appropriations Overview .................................................................................... 42 Selected ED Highlights ........................................................................................................... 43 Education for the Disadvantaged ...................................................................................... 43 Safe Schools and Citizenship Education........................................................................... 44 Higher Education .............................................................................................................. 44 Related Agencies ........................................................................................................................... 47 FY2022 Related Agencies Appropriations Overview ............................................................. 47 Selected Related Agencies Highlights..................................................................................... 48 SSA Limitation on Administrative Expenses (LAE) ........................................................ 49 Corporation for National and Community Service ........................................................... 49 National Labor Relations Board (NLRB) ......................................................................... 49 Figures Figure 1. FY2022 Enacted LHHS Appropriations .......................................................................... 6 Figure 2. FY2022 Enacted LHHS Appropriations by Title ........................................................... 14 Figure 3. FY2022 Enacted HHS Appropriations by Agency......................................................... 25 Tables Table 1. Status of Full-Year LHHS Appropriations Legislation, FY2022 ....................................... 5 Table 2. LHHS Appropriations Overview by Bill Title, FY2021-FY2022 ................................... 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 ........................................................................... 35 Table 7. HHS Discretionary Appropriations for Selected Programs or Activities, by Agency .................................................................................................................................. 38 Table 8. ED Appropriations Overview .......................................................................................... 42 Table 9. Detailed ED Appropriations ............................................................................................ 45 Table 10. Related Agencies Appropriations Overview .................................................................. 48 Table 11. Detailed Related Agencies Appropriations .................................................................... 50 Table A-1. LHHS Discretionary FY2021 and FY2022 Enacted Levels, and FY2022 House 302(b) Suballocations ..................................................................................................... 56 Table A-2. LHHS Appropriations Overview, by Bill Title: FY2021-FY2022............................... 57 Table B-1. LHHS House Floor Amendments Offered to H.R. 4502 ............................................. 60 Appendixes Appendix A. Budget Enforcement Activities ................................................................................ 52 Appendix B. House Floor Amendments Offered to Division A of H.R. 4502 .............................. 60 Congressional Research Service Labor, Health and Human Services, and Education: FY2022 Appropriations Contacts Author Information........................................................................................................................ 65 Congressional Research Service Labor, Health and Human Services, and Education: FY2022 Appropriations Introduction This report provides an overview of FY2022 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). Scope of the Report: Emergency Funding and Mandatory Funding Related to COVID-19 This report primarily focuses on regular FY2022 LHHS discretionary funding enacted during the annual appropriations process. The emergency discretionary funding that was enacted for FY2021 or FY2022 is generally not included in the budgetary figures discussed or table totals presented in the main body of the report. (Such spending is presented below the table totals and is in addition to regular appropriations.) In addition, during FY2021, mandatory appropriations were enacted for certain LHHS-related accounts for COVID-19 pandemic response, including in the American Rescue Plan Act of 2021 (P.L. 117-2). These mandatory funds are also not included in this report. 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 the “Mandatory vs. Discretionary Budget Authority” section), 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 FY2022 appropriations and (for context) a review of the conclusion of the FY2021 appropriations process. This is followed by a high-level summary and analysis of appropriations for FY2022, compared to FY2021 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 FY2022 proposed Congressional Research Service 1 Labor, Health and Human Services, and Education: FY2022 Appropriations funding levels compared to FY2021. (Note that the distribution of funds is sometimes illustrated by figures, which in all cases are based on the FY2022 enacted levels.1) Appendix A provides a summary of budget enforcement activities for FY2022. This includes information on mandatory spending sequestration pursuant to the Budget Control Act of 2011 (BCA; P.L. 112-25), discretionary spending budget enforcement pursuant to the FY2022 budget resolution, the House LHHS subcommittee spending allocation, and current-year spending levels. This is followed by Appendix B, which provides an overview of the LHHS floor amendments that were offered in the House during its consideration of H.R. 4502. 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 Authority2 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 budget authority is provided in appropriations measures. 1 The dollars and percentages in each figure also are generally illustrative, except as noted, of the parallel distribution of funds enacted in FY2021 and proposed by the FY2022 President’s budget and in the FY2022 House committee bill. 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/GAO- Congressional Research Service 2 Labor, Health and Human Services, and Education: FY2022 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 FY2022 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 because discretionary funding receives the bulk of attention during the appropriations process. (While 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 05-734SP. (Terms of interest may include appropriated entitlement, direct spending, discretionary, entitlement authority, and mandatory.) 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. Congressional Research Service 3 Labor, Health and Human Services, and Education: FY2022 Appropriations 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 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, see Appendix A). 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. (Those scorekeeping adjustments are displayed at the bottom of Table 2.) Status of FY2022 LHHS Appropriations FY2022 Emergency-Designated Appropriations Over the course of FY2022, five bills were signed into law providing FY2022 emergencydesignated appropriations for accounts typically funded in the LHHS bill.    Division B of the Bipartisan Safer Communities Act (S. 2938, P.L. 117-159, June 25, 2022) provided a total of $1.6 billion in FY2022 for several purposes or programs within HHS and ED related to community mental and behavioral health services, pediatric health care, school attendance and engagement, and school-based mental health services.7 Title IV of the Additional Ukraine Supplemental Appropriations Act, 2022 (H.R. 7691, P.L. 117-128, May 21, 2022) provided $54 million to the CDC for medical support, screening, and related public health activities related to the situation in Ukraine, including for populations displaced from Ukraine, and $900 million to ACF for resettlement assistance for Ukrainian refugees, Ukrainian parolees, and other eligible Ukrainians in the United States. Division B of the Further Extending Government Funding Act (H.R. 6119; P.L. 117-70, December 3, 2021) contained the Additional Afghanistan Supplemental Appropriations Act, 2022, which provided $8 million to the CDC for medical support, screening, and related public health activities for Afghan arrivals and refugees, and $1.3 billion to ACF for resettlement assistance for Afghan arrivals and refugees.8 5 Such figures exclude advance appropriations for future years, but include advance appropriations from prior years that 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). 7 See Table 3 in CBO, cost estimate, “The Bipartisan Safer Communities Act would provide funding to encourage enactment of state laws aimed at controlling access to guns and to support a variety of other initiatives to enhance school safety, mental health programs, and violence prevention,” June 22, 2022, https://www.cbo.gov/system/files? file=2022-06/S2938.pdf. 8 See the summary of these provisions from the House Appropriations Committee majority staff, H.R. 6119, Further Extending Government Funding Act Section-by-Section Summary, https://appropriations.house.gov/sites/ democrats.appropriations.house.gov/files/ Further%20Extending%20Government%20Funding%20Act%20Summary.pdf. Congressional Research Service 4 Labor, Health and Human Services, and Education: FY2022 Appropriations  Division J of the Infrastructure Investment and Jobs Act (H.R. 3684; P.L. 117-58, November 15, 2021) provided $100 million in FY2022 for the HHS Low Income Home Energy Assistance Program,9 and rescinded $353 million in previously enacted emergency funding from the Education Stabilization Fund. Divisions A and C of the Extending Government Funding and Delivering Emergency Assistance Act (H.R. 5305; P.L. 117-43, September 30, 2021) provided $4.2 billion in emergency-designated funding, as follows:10  Division A, which contained the first CR for FY2022, provided $2.5 billion (§141) to the HHS Administration for Children and Families (ACF) for shelter and support services for unaccompanied minors referred to HHS, including funding to expand the capacity of state-licensed shelters.  Division C, which contained the Afghanistan Supplemental Appropriations Act, 2022, provided $1.7 billion to ACF for resettlement assistance for Afghan arrivals and refugees, and $21.5 million to the HHS Centers for Disease Control and Prevention (CDC) for medical support, screening, and related public health activities for Afghan arrivals and refugees.  FY2022 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, FY2022 Subcommittee Approval House 7/12/21 voice vote Senate - Resolution of House and Senate Differences Full Committee Approval House H.R. 4502 H.Rept. 117-96 7/15/21 33-25 Senate - House Initial Passage Senate Initial Passage H.R. 4502, Division A 7/29/21 219-208 Conf. Report - House Final Passage Senate Final Passage H.R. 2471, Division H 3/9/22 361-69 H.R. 2471, Division H 3/10/22 68-31 Public Law P.L. 117103 3/15/22 Source: CRS Appropriations Status Table. FY2022 Consolidated Appropriations Act On March 15, 2022, the Consolidated Appropriations Act, 2022 (FY2022 LHHS omnibus; H.R. 2471) was signed into law by the President (P.L. 117-103). The FY2022 omnibus provided full9 Division J of P.L. 117-58 further provided to the Low Income Home Energy Assistance Program advance appropriations of $100 million for each of FY2023 through FY2026, for a total of $500 million for the program with all fiscal years taken into account. 10 See the summary of these provisions from House Appropriations Committee majority staff, H.R. 5305, Extending Government Funding and Delivering Emergency Assistance Act: Section-by-Section Summary, https://appropriations.house.gov/sites/democrats.appropriations.house.gov/files/documents/Summary_0.pdf. Congressional Research Service 5 Labor, Health and Human Services, and Education: FY2022 Appropriations year appropriations for all 12 annual appropriations acts in Divisions A-L.11 (Full-year LHHS appropriations were enacted in Division H.) Prior to its enactment, the final version of the measure was approved by the House on March 9. (The vote to approve the portion that contained LHHS appropriations was 260-171.)12 The bill was approved by the Senate (68-31) on March 10. See Figure 1 for a breakdown of FY2022 discretionary and mandatory LHHS appropriations enacted in the FY2022 LHHS omnibus.13 Annual discretionary LHHS appropriations totaled $214.2 billion. This amount is 7.9% more than FY2021 enacted and 15.7% less than the FY2022 President’s budget request. The omnibus also provided $1.102 trillion in mandatory funding, for a combined LHHS total of $1.316 trillion. Figure 1. FY2022 Enacted LHHS Appropriations Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2022 LHHS omnibus (P.L. 117-103), available in the Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2668-H2915. Enacted totals for FY2022 do not include emergency-designated appropriations. 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 the 21st Century Cures Act (P.L. 114-255), as amended. 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 11 The FY2022 omnibus was originally intended to carry additional supplemental appropriations related to the COVID- 19 pandemic in Division M, but Division M was omitted prior to floor consideration. 12 The special rule, H.Res. 973, provided for the consideration of an amendment consisting of the FY2022 omnibus (as contained in House Rules Committee Print 117-35) to the Senate amendment to H.R. 2471. H.Res. 973 also provided for the House to adopt the amendment in two votes: the first on Divisions B, C, F, X, Z, titles 2 and 3 of division N, and the second on the remaining divisions and titles. The House adopted Divisions B, C, F, X, Z, titles 2 and 3 of division N by a vote of 361-69, and adopted the remaining divisions and titles by a vote of 260-171. The subsequent motion that the House agree to the Senate amendment with an amendment was agreed to by a voice vote. 13 While the percentages in this figure were calculated based on amounts in the FY2022 LHHS omnibus, they are generally also illustrative—within a few percentage points—of the share of mandatory and discretionary funds in FY2021 and under the FY2022 President’s budget and the FY2022 House committee bill. Congressional Research Service 6 Labor, Health and Human Services, and Education: FY2022 Appropriations 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. FY2022 Continuing Appropriations Between the start of FY2022 and the enactment of full-year annual appropriations, FY2022 LHHS appropriations were provided by a series of CRs. The first CR was signed into law on September 30, 2021 (Division A of H.R. 5305; P.L. 117-43). The measure had previously been introduced by the House Appropriations Committee chair, Representative DeLauro, on September 21, and was passed by the House that same day, 220-211. On September 30, the Senate took up and passed the measure with an amendment, 65-35,14 which was subsequently agreed to by the House, 254-175. The first CR provided continuing appropriations for all 12 annual appropriations acts (including LHHS) through December 3, 2021. In general, the CR funded discretionary programs at the same rate and under the same conditions as in FY2021 (§101) and annually appropriated entitlements at their current law levels (§111).15 It also included several anomalies that are specific to LHHS accounts or related activities (§§138-149). A second CR was enacted extending the provisions of the first CR with some additional anomalies (for LHHS, see Section 162) through February 18, 2022 (Division A of H.R. 6119; P.L. 117-70, December 3, 2021). The measure had previously been introduced by Representative DeLauro on December 2, and passed the House (221-212) and the Senate (69-28) that same day. A third CR was enacted extending the provisions on the second CR with some additional anomalies (none of which were LHHS-related) through March 11, 2022 (Division A of H.R. 6617; P.L. 117-86, February 18, 2022). The measure had been previously introduced by Representative DeLauro on February 7. It passed the House (272-182) on February 8 and the Senate (65-27) on February 17. A fourth CR was enacted extending the provisions of the third CR with some additional anomalies (not LHHS-related) through March 15, 2022 (H.J.Res 75; P.L. 117-95, March 11, 2022). The measure had been previously introduced by Representative DeLauro on March 8. It passed the House (voice vote) on March 8 and the Senate (voice vote) on March 10. Prior Congressional Action on an LHHS Bill FY2022 LHHS Action in the Senate The FY2022 LHHS bill did not receive subcommittee, full committee, or initial floor action in the Senate. Senator Leahy, Chair of the Senate Appropriations Committee, released a majority draft of the LHHS bill and accompanying draft report language on October 18, 2021. According to the chair, the purpose of this release was to further negotiations toward enacting all 12 annual appropriations bills prior to when the CR was to expire on December 3.16 These draft numbers are not presented in this report. 14 No substantive changes were made by the Senate amendment to the CR provisions in Division A of H.R. 5305. 15 For an estimate of the discretionary appropriations contained in Division A of H.R. 5305, see Table 1-H and 1-S in Congressional Budget Office (CBO) Estimate for H.R. 5305, the Extending Government Funding and Delivering Emergency Assistance Act as Passed by the House of Representatives on September 21, 2021, https://www.cbo.gov/ system/files/2021-09/57491-CBO-Estimate-for-HR5305.pdf. 16 The text of the Senate majority draft LHHS bill and accompanying committee report is linked to the press release, Congressional Research Service 7 Labor, Health and Human Services, and Education: FY2022 Appropriations In addition, on October 25, Senator Murray, Chair of the Senate Appropriations LHHS Subcommittee, introduced an FY2022 LHHS bill (S. 3062). This bill was referred to the Senate Appropriations Committee.17 Because S. 3062 did not receive any congressional action, this report does not discuss this measure. FY2022 LHHS Action in the House (Division A, H.R. 2740) The House LHHS subcommittee approved the draft LHHS bill on July 12, 2021, by a voice vote. On July 15, 2021, the House Appropriations Committee voted (33-25) to report the LHHS bill; the measure was subsequently reported to the House on July 19 (H.R. 4502; H.Rept. 117-96). As reported by the full committee, the bill would provide $254.4 billion in discretionary LHHS funds, a 28.1% increase from FY2021 enacted levels. This amount would be 0.2% more than the FY2022 President’s request. In addition, the House committee bill would provide an estimated $1.102 trillion in mandatory funding, for a combined total of $1.356 trillion for LHHS as a whole. (Note that these totals are based only on amounts of non-emergency appropriations that would have been provided by the House committee bill and do not include emergency-designated funds, which are in addition to the regular annual appropriations.) Later in July, LHHS appropriations were initially considered on the House floor as part of a consolidated appropriations package and passed the House (219-208), as amended, on July 29, 2021 (Division A of H.R. 4502). This package would provide appropriations for six other appropriations acts in addition to LHHS.18 Floor action was regulated by the terms of a special rule (H.Res. 555). A total of 56 amendments to the LHHS title of the bill were made in order for consideration on the floor.19 This rule also provided the authority for the chair of the Appropriations Committee or her designee to offer any of the amendments made in order en bloc (i.e., in groups of amendments to be disposed of together).20 All but two LHHS amendments were considered in this manner.21 When counted as 56 separate amendments, 47 were adopted and 9 were rejected. Because there is no publicly available source that estimates the account- or subaccount-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. “Chairman Leahy Releases Remaining Nine Senate Appropriations Bills,” October 18, 2021, https://www.appropriations.senate.gov/news/majority/chairman-leahy-releases-remaining-nine-senate-appropriationsbills. See also “Shelby: Democrats’ Partisan Bills Threaten FY22 Appropriations Process,” October 18, 2021, https://www.appropriations.senate.gov/news/shelby-democrats-partisan-bills-threaten-fy22-appropriations-process. 17 The text of S. 3062 as introduced was generally the same as the draft LHHS bill released by the chair of the Senate Appropriations Committee on October 18, discussed above. 18 Those appropriations acts were Agriculture and Rural Development, Energy and Water Development, Financial Services and General Government, Interior and Environment, Military Construction and Veterans Affairs, and Transportation and Housing and Urban Development. 19 For a list of these LHHS amendments (numbered 1-56) and the text of each that was made in order, see pages 8-13 and 30-38 of H.Rept. 117-109. 20 For further information about en bloc authority in the context of House floor consideration of appropriations measures, see CRS Report R46841, Changes in the House of Representatives’ Initial Consideration of Regular Appropriations Measures, 113th-116th Congresses. 21 For the en bloc amendments proposing changes to the LHHS division of the bill, see consideration of amendments en bloc nos. 1, 2, 3, and 4 in Congressional Record, daily edition, Vol. 167, No. 131 (July 27, 2021), pp. H4055-H4073. Congressional Research Service 8 Labor, Health and Human Services, and Education: FY2022 Appropriations FY2022 President’s Budget Request The President’s budget request for the upcoming fiscal year is due to be submitted to Congress by the first Monday in February. However, the FY2022 budget was submitted during a year in which a presidential transition occurred (on January 20, 2021). Recent Presidents have not submitted detailed budget proposals until April or May of their first year in office, although each has advised Congress regarding the general contours of their economic and budgetary policies in special messages submitted to Congress prior to that submission.22 This delay allows time to prepare a proposal that reflects the priorities of the new Administration. On April 9, President Biden submitted to Congress an outline of his discretionary funding priorities for FY2022.23 This preliminary document provided early highlights for numerous policy areas, including several funded in the LHHS bill. The full budget request was submitted on May 28, almost four months after its due date.24 The President requested $254.0 billion in discretionary funding for accounts funded by the LHHS bill, which is an increase of 27.9% from FY2021 levels. In addition, the President requested $1.102 trillion in annually appropriated mandatory funding, for a total of $1.355 trillion for LHHS as a whole. FY2021 LHHS Omnibus (Division H, Consolidated Appropriations Act, 2021, H.R. 133; P.L. 116-260) On December 27, 2020, the Consolidated Appropriations Act, 2021 was signed into law by the President (H.R. 133, P.L. 116-260). P.L. 116-260 provided full-year appropriations for all 12 annual appropriations acts in Divisions A-L, and supplemental appropriations for COVID-19 pandemic relief in Division M.25 (Full-year LHHS appropriations were enacted in Division H, referred to as “the FY2021 LHHS omnibus.”) Prior to its enactment, the final version of the measure was approved by the House on December 21. (The vote to approve the portion that contained LHHS appropriations was 359-53.26) It was approved by the Senate (92-6) later that same day. LHHS discretionary appropriations in the FY2021 LHHS omnibus totaled $198.5 billion. This amount was 1.6% more than FY2020 enacted and 11.0% more than the FY2021 President’s budget request. The omnibus also provided $980.0 billion in mandatory funding, for a combined LHHS total of $1.178 trillion. (Note that these totals are based only on amounts of non22 See CRS Insight IN11655, Budget Submission After a Presidential Transition: Contextualizing the Biden Administration’s FY2022 Request. 23 Office of Management and Budget (OMB), The President’s FY2022 Discretionary Request, April 9, 2021, https://www.whitehouse.gov/omb/fy-2022-discretionary-request/. 24 See https://www.whitehouse.gov/omb/budget/. 25 P.L. 116-260 also contained additional COVID-19 pandemic response provisions in Division N, but this division is considered authorizing legislation, rather than appropriations legislation, and is thus beyond the scope of this report. For further discussion, see the Congressional Budget Office cost estimate for Division N, released on January 14, 2021, at https://www.cbo.gov/system/files/2021-01/PL_116-260_div_N.pdf. In addition, Divisions O-FF of P.L. 116-260 contained miscellaneous authorizing provisions that are also beyond the scope of this report. 26 The special rule, H.Res. 1271, provided for the consideration of an amendment consisting of the final text for enactment (as contained in House Rules Committee Print 116-68) to the Senate amendment to H.R. 133. H.Res. 1271 also provided for the House to adopt the amendment in two votes: the first on Divisions B, C, E, and F, and the second on the remaining divisions. The House adopted Divisions B, C, E, and F by a vote of 327-85, and adopted the remaining divisions by a vote of 359-53. The subsequent motion that the House agree to the Senate amendment with an amendment was agreed to without objection. Congressional Research Service 9 Labor, Health and Human Services, and Education: FY2022 Appropriations emergency appropriations provided by the FY2021 LHHS omnibus and do not include emergency-designated or supplemental funds, which were provided in addition to the annual appropriations. Division H also enacted $1.6 billion in emergency-designated budget authority, of which $925 million was for DOL in Title I, and $638 million was for HHS in Title II, which is not reflected in the above figures, consistent with the conventions for displaying emergencydesignated budget authority in this report.) Congressional Research Service 10 Labor, Health and Human Services, and Education: FY2022 Appropriations Summary of FY2022 LHHS Appropriations Dollars and Percentages in this Report Amounts displayed in this report are typically rounded (e.g., to the nearest million), 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. For FY2022 enacted, amounts for HHS include $1.6 billion in regular discretionary appropriations enacted as part of the second continuing resolution for FY2022, P.L. 117-70, for the Unaccompanied Alien Children program. Throughout this report, the FY2022 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 Division A of H.R. 4502, as there is no publicly available source that estimates the account- and subaccount-level budgetary effects of the adopted amendments. However, information on the LHHS amendments offered during floor consideration can be found in Appendix B.) Amounts for the FY2021 Enacted, FY2022 Request, and FY2022 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2022 LHHS omnibus (P.L. 117-103), available in the Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2668-H2915. Amounts in the FY2021 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 117-96) accompanying H.R. 4502. The amounts shown for emergency-designated appropriations provided in Title II of P.L. 117-31, Divisions A and C of P.L. 117-43, Division J of P.L. 117-58, Division B of P.L. 117-70, Title IV of P.L. 117-128, and Division B of P.L. 117-159, are based on CRS analysis of the texts of those laws. In general, the enacted totals (“Total BA in the Bill”) in this report do not include emergency-designated appropriations. An exception to this rule is made in Table A-1, which includes FY2021 and FY2022 enacted emergency-designated funds in the “Adjusted Appropriations” totals, as scored by the Congressional Budget Office. In addition, as applicable, other tables in this report include, at the bottom, a separate line or lines for emergency-designated appropriations; these lines are shown for informational purposes and the amounts displayed are not included in the table totals. For consistency with source materials, amounts in this report generally do not reflect mandatory spending sequestration, where applicable, nor do they reflect any transfers or reprogramming of funds pursuant to executive authorities, except as noted.27 CRS calculations do, however, include LHHS funding provided to HHS pursuant to the 21st Century Cures Act (P.L. 114-255), as amended. The descriptions of the LHHS appropriations in this report frequently reference “report language,” which Congress may use to further specify funding or to communicate a range of directives to the agency. Each regular appropriations bill reported from committee is usually accompanied by a written committee report, and the final explanatory text may be used to reconcile any differences between those reports. For example, earlier report language may address certain issues in ways that are difficult to reconcile harmoniously with the final enacted text. In these instances, the explanatory text normally seeks to clarify how the affected agency is to proceed. On the other hand, if the original committee language is ultimately acceptable to congressional negotiators, the explanatory statement might be silent due to an expectation that the agency will follow the original directive. For further information, see CRS Report R44124, Appropriations Report Language: Overview of Components and Development. Table 2 displays FY2022 discretionary and mandatory LHHS budget authority proposed and enacted, by bill title, along with FY2021 enacted levels. The amounts shown in this table reflect 27 The general practice for CRS reports on the LHHS bill has been to reflect conventions used in source materials. These 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 comparability. 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]). The FY2017 version of this report differed from both of these prior practices, in that it reflected a smaller Congressional Research Service 11 Labor, Health and Human Services, and Education: FY2022 Appropriations 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-designated appropriations; those amounts are displayed separately at the bottom of the table and are in addition to regular appropriations. Table 2. LHHS Appropriations Overview by Bill Title, FY2021-FY2022 (total budget authority provided in the bill, in billions of dollars) FY2021 Enacted FY2022 Request FY2022 House Cmte. (H.R. 4502) 13.9 15.5 16.0 14.4 Discretionary 12.5 14.3 14.7 13.2 Mandatory 1.4 1.2 1.2 1.2 Title II: HHS 1,016.6 1,159.6 1,159.4 1,148.2 Discretionary 97.0 120.0 119.8 108.6 Mandatory 919.6 1,039.6 1,039.6 1,039.6 Title III: Education 77.2 106.5 106.5 80.1 Discretionary 73.5 102.8 102.8 76.4 Mandatory 3.7 3.7 3.7 3.7 70.8 73.8 74.0 73.0 Discretionary 15.5 16.9 17.0 16.0 Mandatory 55.3 57.0 57.0 57.0 Total BA in the Bill 1,178.5 1,355.5 1,355.9 1,315.7 Discretionary 198.5 254.0 254.4 214.2 Mandatory 980.0 1,101.5 1,101.5 1,101.5 P.L. 116-260, Division H 1.6 — — — P.L. 116-260, Division M 154.9 — — — P.L. 117-31, Title II 0.0a — — — P.L. 117-43, Divisions A and C — — — 4.2 P.L. 117-58, Division J — — — 0.1 P.L. 117-70, Division B — — — 1.3 P.L. 117-128, Title IV — — — 1.0 P.L. 117-159, Division B — — — 3.0 Bill Title Title I: Labor Title IV: Related Agencies FY2022 Enacted Emergency Funding (not in above totals) 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). The FY2018-FY2021 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. For FY2022, the source materials used for this report continue this most recent approach. Congressional Research Service 12 Labor, Health and Human Services, and Education: FY2022 Appropriations FY2021 Enacted FY2022 Request FY2022 House Cmte. (H.R. 4502) Advances for Future Years (provided in current bill)b 197.6 210.7 210.8 210.7 Advances from Prior Years (for use in current year)b 189.0 197.6 197.6 197.6 Additional Scorekeeping Adjustmentsc -22.8 -25.4 -14.7 -15.0 Bill Title FY2022 Enacted Memoranda (non-emergency funds only): Source: Amounts in this table for the FY2021 Enacted, FY2022 Request, and FY2022 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2022 LHHS omnibus (P.L. 117-103), available in the Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2668-H2915. Amounts in the FY2021 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 117-96) accompanying H.R. 4502. Enacted totals (“Total BA in the Bill”) for FY2021 or FY2022 do not include emergency-designated appropriations. 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. 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. P.L. 117-31 provided $25 million in supplemental appropriations for the Refugee and Entrant Assistance account at HHS for specified purposes related to Afghan special immigrants, which rounds to $0.0 in billions (the unit of measure used in this table). b. 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 a given fiscal year is as follows: Total BA in the Bill, minus Advances for Future Years, plus Advances from Prior Years. FY2022 advance appropriations enacted in prior fiscal years are listed in the FY2022 Request and FY2022 House Cmte. columns. c. Totals in this table have generally not been adjusted for scorekeeping. (To adjust for scorekeeping, add this line to the total budget authority.) Figure 2 displays discretionary and mandatory LHHS funding levels enacted for FY2022, by bill title. (While the dollars and percentages discussed in this section were calculated based on the FY2022 enacted amounts, they are generally also illustrative—within several percentage points— of the share of funds directed to each bill title in FY2021, and under the FY2022 President’s budget and House committee bill.) As this figure demonstrates, HHS accounts for the largest share of total FY2022 LHHS appropriations: $1.148 trillion, or 87.3%. 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 6.1% and 5.5%, 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, 1.1%. Congressional Research Service 13 Labor, Health and Human Services, and Education: FY2022 Appropriations 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 (50.7%), while ED accounts for a relatively larger share (35.7%). Together, these two departments represent the majority (86.4%) of discretionary LHHS appropriations. DOL and the Related Agencies account for the remaining discretionary funds, at 6.2% and 7.5% of the total, respectively. Figure 2. FY2022 Enacted LHHS Appropriations by Title (budget authority in billions of dollars unless otherwise indicated) Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2022 LHHS omnibus (P.L. 117-103), available in the Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2668-H2915. Enacted totals for FY2022 do not include emergency-designated appropriations. 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 the 21st Century Cures Act (P.L. 114-255), as amended. 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 (e.g., to the nearest million), 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: FY2022 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).29 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)28 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. FY2022 DOL Appropriations Overview Table 3 displays FY2022 enacted and proposed funding levels for DOL, along with FY2021 levels. The totals in this table do not include emergency supplemental appropriations. Those amounts are displayed separately, along with the law in which they were enacted, at the bottom of the table and are in addition to regular appropriations. (Although not technically supplemental appropriations, the bottom of the table also includes emergency-designated discretionary funding proposed or enacted in annual LHHS measures.) Discretionary funds represent the majority of DOL appropriations, accounting for 90% or more of FY2021 and FY2022 enacted levels. The FY2022 LHHS omnibus increased discretionary appropriations for DOL by $653 million (+5.2%) compared to the FY2021 LHHS omnibus. Relative to the FY2021 LHHS omnibus, discretionary DOL appropriations would have increased 28 Departmental Management includes the DOL salaries and expenses, Veterans Employment and Training Service (VETS), IT Modernization, and the Office of the Inspector General. 29 The Pension Benefit Guaranty Corporation (PBGC) is funded primarily through insurance premiums and related fees from companies covered by the PBGC. For further information, see CRS In Focus IF10492, An Overview of the Pension Benefit Guaranty Corporation (PBGC). Congressional Research Service 15 Labor, Health and Human Services, and Education: FY2022 Appropriations by $2.2 billion (+17.4%) under the FY2022 House committee bill and $1.8 billion (14.3%) under the FY2022 President’s budget request. Table 3. DOL Appropriations Overview (in billions of dollars) FY2021 Enacted FY2022 Request FY2022 House Cmte. (H.R. 4502) Discretionary 12.5 14.3 14.7 13.2 Mandatory 1.4 1.2 1.2 1.2 13.9 15.5 16.0 14.4 0.9 — — — Funding Total BA in the Bill FY2022 Enacted Emergency Funding (not in above totals) P.L. 116-260, Division H Source: Amounts in this table for the FY2021 Enacted, FY2022 Request, and FY2022 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2022 LHHS omnibus (P.L. 117-103), available in the Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2668-H2915. Amounts in the FY2021 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 117-96) accompanying H.R. 4502. Enacted totals (“Total BA in the Bill”) for FY2021 or FY2022 do not include emergency-designated appropriations. 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. 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. Selected DOL Highlights The following sections present highlights from FY2022 enacted and proposed appropriations compared to FY2021 enacted appropriations for selected DOL accounts and programs. 30 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 statute, the Workforce Innovation and Opportunity Act (WIOA, P.L. 113-128). The WIOA, which replaced the Workforce Investment Act, was enacted in July 2014 and authorized appropriations for its programs and activities from FY2015 through FY2020. Authorization of appropriations for WIOA programs and activities expired at the end of FY2020 but was extended through FY2021 by the FY2021 LHHS omnibus (P.L. 116-260, Division H, Title I) and through FY2022 by the FY2022 LHHS omnibus (P.L. 117-103, Division H, Title I). 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 30 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: FY2022 Appropriations Dislocated Workers. While the FY2022 LHHS omnibus provided a $34 million increase (+1.2%) for the three WIOA state formula grant programs compared to FY2021, the FY2022 President’s budget would have provided $174 million more (+6.1%) and the House committee bill would have increased funding by $250 million (+8.8%), compared to FY2021 enacted levels. The FY2022 LHHS omnibus provided $301 million for the Dislocated Workers Activities National Reserve (DWA National Reserve), an increase of $20 million (+7.1%) compared to the FY2021 enacted level. The House committee bill would have increased funding for the DWA National Reserve by $155 million (+55.2%), whereas the FY2022 President’s budget would have increased funding for the DWA National Reserve by $100 million (+35.6%), compared to the FY2021 LHHS omnibus. In addition, the FY2022 LHHS omnibus maintained a provision in that account (which originated in the FY2018 omnibus) directing $45 million from the DWA National Reserve toward training and employment assistance for workers dislocated in both the Appalachian, lower Mississippi, and Northern Border Regional Commission regions. Finally, the FY2022 LHHS omnibus maintained a provision that originated in the FY2020 omnibus directing $50 million from the DWA National Reserve to be used in developing, offering, or improving career training programs at community colleges. The FY2022 LHHS omnibus provided $235 million for the Apprenticeship Grant program, which was $50 million (+27.0%) more than the level enacted in FY2021. The House committee bill and the FY2022 President’s budget would have increased the level of funding for the Apprenticeship Grant program by $100 million (+54.1%) compared to the FY2021 enacted level. Finally, under the pilot and demonstration authority in WIOA (Section 169), the FY2022 House committee bill and the FY2022 President’s budget would have provided new funding for a National Youth Employment Program ($50 million) and a Veterans Clean Energy Training program ($20 million). These did not ultimately receive funding in the FY2022 LHHS omnibus. Employment Service The FY2022 LHHS omnibus provided $700 million for the Employment Service (ES), which was an increase of $8 million (+1.1%) compared to the FY2021 LHHS omnibus. The FY2022 House committee bill would have provided $771 million for the ES, which would have been an increase of $79 million (+11.4%) compared to the FY2021 LHHS omnibus and $50 million (+6.9%) more than requested in the FY2022 President’s budget. The ES is a joint federal-state partnership that funds staff to provide career counseling, job search services, and administration of the work test for the UI system. The FY2022 House committee bill included a provision to prohibit DOL from using any funds provided in the FY2022 LHHS appropriations bill to implement or enforce a 2020 final rule allowing the use of non-merit-staff employees to deliver Employment Service services.31 This provision was not included in the FY2022 LHHS omnibus. Wage and Hour Division (WHD) The FY2022 LHHS omnibus provided $251 million for the WHD, an increase of $5 million (+2.0%) compared to the FY2021 LHHS omnibus. The FY2022 House committee bill would have provided $300 million for WHD, an increase of $54 million (+22.0%) compared to the FY2021 enacted level and $24 million (+8.5%) more than the FY2022 President’s budget. The WHD is responsible for enforcing the Fair Labor Standards Act (FLSA), the Davis-Bacon Act (DBA), the Family and Medical Leave Act (FMLA), and other labor standards statutes. The FY2022 explanatory statement accompanying the FY2022 LHHS omnibus included a 31 See Section 114 and H.Rept. 117-96, p. 24, for further information. Congressional Research Service 17 Labor, Health and Human Services, and Education: FY2022 Appropriations requirement for the WHD to collect and report annually data on employer participation in the 14(c) program, which allows employers to pay workers with disabilities less than the prevailing federal minimum wage.32 Bureau of Labor Statistics (BLS) The FY2022 LHHS omnibus provided $688 million for BLS, an increase of $33 million (+5.0%) compared to the FY2021 LHHS omnibus, whereas the FY2022 House committee bill and the FY2022 President’s budget each proposed a $46 million increase (+7.0%) relative to FY2021. As noted in the explanatory statement accompanying the FY2022 LHHS omnibus, $28.5 million of the FY2022 appropriation is for costs associated with completing the physical relocation of BLS headquarters to the Suitland Federal Complex, which was initiated in FY2020.33 Similarly, the FY2022 House committee report indicated continued support for BLS to continue implementation of several data projects started in FY2020, including a BLS plan to increase spending on the new National Longitudinal Survey of Youth (NLSY) cohort to $14.5 million and for BLS to develop plans to increase the Job Openings and Labor Turnover Survey (JOLTS) sample and to release JOLTS on a monthly basis, rather than its current quarterly release.34 Bureau of International Labor Affairs (ILAB) The ILAB provides research, advocacy, technical assistance, and grants to promote workers’ rights in different parts of the world. The FY2022 LHHS omnibus provided $106 million for ILAB, which was an increase of $10 million (+10.4%) above the FY2021 enacted level. The FY2022 House committee bill would have increased funding for ILAB by $40 million (+41.5%) compared to the FY2021 LHHS omnibus, while the FY2022 President’s budget would have increased funding by $28 million (+28.7%) for ILAB. Language in the FY2022 explanatory statement accompanying the FY2022 LHHS omnibus requests ILAB to include the amounts spent on technical assistance grants to combat exploitative child labor and worker rights issues in future Congressional Budget Justifications.35 In addition, language in the FY2022 House committee report directs ILAB to place additional labor attachés in strategic countries to assist with promoting worker rights, such as freedom of association and collective bargaining.36 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 FY2022 LHHS omnibus. The FY2022 LHHS omnibus continued several provisions that have been included in at least one previous LHHS appropriations act, including provisions that 32 Congressional Record, March 9, 2022, Vol. 168, No. 42, Book IV, p. H2668. 33 Congressional Record, March 9, 2022, Vol. 168, No. 42, Book IV, p. H2668. 34 See H.Rept. 117-96, p. 36, for further information. 35 Congressional Record, March 9, 2022, Vol. 168, No. 42, Book IV, p. H2668. 36 H.Rept. 117-96, p. 38. Congressional Research Service 18 Labor, Health and Human Services, and Education: FY2022 Appropriations       exempted certain insurance claims adjusters from overtime protection for two years following a “major disaster” (included since FY2016);37 directed 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);38 authorized the Secretary of Labor to provide up to $2 million in “excess personal property” to apprenticeship programs to assist training apprentices (included since FY2018);39 authorized 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);40 authorized 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);41 and prohibited annual appropriations from being used to alter the Interagency Agreement between DOL and USDA or to close any Civilian Conservation Centers unless certain conditions are met (included since FY2020).42 Table 4. Detailed DOL Appropriations (in millions of dollars) Agency or Selected Program FY2021 Enacted FY2022 Request FY2022 House Cmte. (H.R. 4502) FY2022 Enacted ETA—Mandatorya 634 540 551 540 ETA—Discretionary 9,392 10,708 11,075 9,942 Training and Employment Services: 3,663 4,211 4,407 3,912 State Formula Grants: 2,845 3,019 3,095 2,879 Adult Activities Grants to States 863 900 923 871 Youth Activities Grants to States 921 964 989 933 1,062 1,155 1,184 1,076 Discretionary ETA Programs: Dislocated Worker Activities (DWA) Grants to States 37 See Division H, Title I, §108 of P.L. 117-103. 38 See Division H, Title I, §110 of P.L. 117-103. The 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. 39 See Division H, Title I, §112 of P.L. 117-103. 40 See Division H, Title I, §113 of P.L. 117-103. 41 See Division H, Title I, §114 of P.L. 117-103. 42 See Division H, Title I, §115 of P.L. 117-103. Congressional Research Service 19 Labor, Health and Human Services, and Education: FY2022 Appropriations Agency or Selected Program National Activities: FY2021 Enacted FY2022 House Cmte. (H.R. 4502) FY2022 Request FY2022 Enacted 818 1,192 1,312 1,033 DWA National Reserve 281 381 436 301 Native Americans 56 58 58 57 Migrant and Seasonal Farmworkers 94 97 97 95 YouthBuild 97 145 145 99 Reintegration of Ex-Offenders 100 150 150 102 6 6 7 6 Apprenticeship Grants 185 285 285 235 Community Projects 0 0 64 138 National Youth Employment Program 0 50 50 0 Veterans Clean Energy Training 0 20 20 0 1,749 1,755 1,830 1,749 Community Service Employment for Older Americans 405 405 450 405 State Unemployment Insurance and Employment Service Operations (SUI/ESO): 3,417 4,126 4,176 3,711 Unemployment Compensation 2,584 3,243 3,243 2,869 Employment Service 692 721 771 700 Foreign Labor Certification 78 94 94 80 One-Stop Career Centers 63 68 68 63 ETA Program Administration 159 212 212 164 Employee Benefits Security Administration 181 218 218 186 Pension Benefit Guaranty Corp, (PBGC) program level (non-add)b (465) (473) (473) (473) Wage and Hour Division 246 277 300 251 Office of Labor-Management Standards 44 52 44 46 Office of Federal Contract Compliance Programs 106 141 141 108 Office of Workers’ Compensation Programs—Mandatoryc 739 683 683 683 Office of Workers’ Compensation Programs—Discretionary 118 141 141 120 Occupational Safety & Health Administration 592 665 692 612 Mine Safety & Health Administration 380 447 405 384 Bureau of Labor Statistics 655 701 701 688 Workforce Data Quality Initiative Job Corps Congressional Research Service 20 Labor, Health and Human Services, and Education: FY2022 Appropriations Agency or Selected Program FY2021 Enacted FY2022 Request FY2022 House Cmte. (H.R. 4502) FY2022 Enacted Office of Disability Employment Policy 39 43 43 41 Departmental Management 784 933 961 812 Salaries and Expenses 349 440 457 368 96 124 136 106 Veterans Employment and Training 316 325 335 325 IT Modernization 27 37 37 28 Working Capital Fund 0 36 36 0 Office of the Inspector General 91 95 95 91 Total, DOL BA in the Bill 13,909 15,548 15,954 14,412 Subtotal, Mandatory 1,373 1,223 1,234 1,223 Subtotal, Discretionary 12,536 14,325 14,720 13,189 925 — — — Total, BA Available in Fiscal Year (current year from any bill) 13,909 15,551 15,957 14,415 Total, BA Advances for Future Years (provided in current bill) 1,786 1,783 1,783 1,783 Total, BA Advances from Prior Years (for use in current year) 1,786 1,786 1,786 1,786 International Labor Affairs (non-addd) Emergency Funding (not in above totals) P.L. 116-260, Division H Memoranda (non-emergency funds only) Source: Amounts in this table for the FY2021 Enacted, FY2022 Request, and FY2022 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2022 LHHS omnibus (P.L. 117-103), available in the Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2668-H2915. Amounts in the FY2022 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 117-96) accompanying H.R. 4502. Enacted totals (“Total BA in the Bill”) for FY2021 or FY2022 do not include emergency-designated appropriations. 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. 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. 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). b. 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 Expenses total. Congressional Research Service 21 Labor, Health and Human Services, and Education: FY2022 Appropriations 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 American Rescue Plan Act of 2021 [P.L. 117-2]). All amounts in this section are rounded (e.g., to the nearest million), 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 Agencies Funded via the HHS is a large federal department composed LHHS Appropriations Process of multiple agencies working to enhance the Health Resources and Services Administration (HRSA) health and well-being of Americans. Annual Centers for Disease Control and Prevention (CDC) LHHS appropriations laws direct funding to National Institutes of Health (NIH) most (but not all) HHS agencies (see text box Substance Abuse and Mental Health Services for HHS agencies supported by the LHHS Administration (SAMHSA) bill).43 For instance, the LHHS bill directs Agency for Healthcare Research and Quality (AHRQ) funding to five Public Health Service (PHS) Centers for Medicare & Medicaid Services (CMS) agencies: the Health Resources and Services Administration for Children and Families (ACF) Administration (HRSA), Centers for Disease Administration for Community Living (ACL) Control and Prevention (CDC), National Office of the Secretary (OS) Institutes of Health (NIH), Substance Abuse and Mental Health Services Administration (SAMHSA), and Agency for Healthcare Research and Quality (AHRQ).44 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,45 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 Affordable Care Act (ACA; P.L. 111-148). 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 43 Three HHS public health agencies receive annual funding from appropriations bills other than the LHHS bill: 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 (funded through the Interior-Environment appropriations bill). In addition, while the National Institutes of Health (NIH) receive the majority of their appropriations from the LHHS bill, one NIH institute (the National Institute of Environmental Health Sciences) receives appropriations from two bills: LHHS and the Interior-Environment bill. 44 For more information on HHS PHS agencies, see CRS Report R44916, Public Health Service Agencies: Overview and Funding (FY2016-FY2018). 45 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. Congressional Research Service 22 Labor, Health and Human Services, and Education: FY2022 Appropriations access to community supports for older Americans and people with disabilities. 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. FY2022 HHS Appropriations Overview Table 5 displays enacted and proposed FY2022 funding levels for HHS, along with FY2021 levels. Note that the totals in this table do not include emergency-designated appropriations. Those amounts are displayed separately, along with the law in which they were enacted, at the bottom of the table and are in addition to regular appropriations.46 In general, discretionary funds account for about 10% of HHS appropriations in the LHHS bill. Compared to the FY2021 funding levels, the FY2022 LHHS omnibus increased HHS discretionary appropriations by 12.0%. Both the House committee bill and the President’s request would have increased HHS discretionary appropriations to a greater degree, by 23.6% and 23.7%, respectively. Table 5. HHS Appropriations Overview (in billions of dollars) FY2021 Enacted FY2022 Request FY2022 House Cmte. (H.R. 4502) Discretionary 97.0 120.0 119.8 108.6 Mandatory 919.6 1,039.6 1,039.6 1,039.6 1,016.6 1,159.6 1,159.4 1,148.2 P.L. 116-260, Division H 0.6 — — — P.L. 116-260, Division M 72.9 — — — P.L. 117-31, Title IIa 0.0 — — — P.L. 117-43, Divisions A and C — — — 4.2 P.L. 117-58, Division J — — — 0.5 P.L. 117-70, Division B — — — 1.3 P.L. 117-128, Title IV — — — 1.0 P.L. 117-159, Division B — — — 1.0 Funding Total BA in the Bill FY2022 Enacted Emergency Funding (not in above totals) Sources: Amounts in this table for the FY2021 Enacted, FY2022 Request, and FY2022 Enacted columns are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2022 LHHS omnibus (P.L. 117-103), available in the Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2668-H2915. Amounts in the FY2022 House Committee column are generally drawn from or calculated based on data contained in the committee report (H.Rept. 117-96) accompanying H.R. 4502. Enacted totals (“Total BA in the Bill”) for FY2021 and FY2022 do not include emergency-designated appropriations. For 46 For a discussion of the COVID-19-related FY2021 supplemental appropriations in Division M of P.L. 116-260, see CRS Report R46775, Overview of COVID-19 LHHS Supplemental Appropriations: FY2020 and FY2021. Congressional Research Service 23 Labor, Health and Human Services, and Education: FY2022 Appropriations 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 the 21 st Century Cures Act (P.L. 114-255), as amended. 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. P.L. 117-31 provided $25 million in supplemental appropriations for the Refugee and Entrant Assistance account at HHS for specified purposes related to Afghan special immigrants, which rounds to $0.0 in billions (the unit of measure used in this table). Figure 3 provides an HHS agency-level breakdown of FY2022 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 $1,027.1 billion, which is 89.5% of all enacted appropriations for HHS. ACF and NIH account for the next-largest shares of total HHS appropriations, receiving 4.0% and 3.8% apiece, respectively. By contrast, when looking exclusively at discretionary appropriations, funding for CMS constitutes about 4.5% of FY2022 enacted HHS appropriations. Instead, the bulk of discretionary appropriations went to the PHS agencies, which combined to account for 61.2% of discretionary appropriations provided for HHS. NIH typically receives the largest share of all discretionary funding among HHS agencies (40.2% in FY2022), with ACF accounting for the second-largest share (27.5% in FY2022). Congressional Research Service 24 Labor, Health and Human Services, and Education: FY2022 Appropriations Figure 3. FY2022 Enacted HHS Appropriations by Agency (budget authority in billions of dollars) Source: Amounts in this figure are generally drawn from or calculated based on data contained in the explanatory statement accompanying the FY2022 LHHS omnibus (P.L. 117-103), available in the Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2668-H2915. Enacted totals (“Total BA in the Bill”) for FY2022 do not include emergency-designated appropriations. 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 the 21st Century Cures Act (P.L. 114-255), as amended. 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 FY2022 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), Congressional Research Service 25 Labor, Health and Human Services, and Education: FY2022 Appropriations 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. The PHSA limits the set-aside to not less than 0.2% and not more than 1.0% 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 FY2022, this higher maximum set-aside level has been 2.5% of eligible appropriations.47 (Both the House committee bill and the President’s budget would have continued this 2.5% level.) Before FY2015, the PHS tap traditionally Display of Evaluation Tap Transfers 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 FY2022, 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.48 Since FY2015, LHHS appropriations laws have directed the largest share of tap transfers to NIH. The FY2022 LHHS omnibus directed $1.3 billion in tap funds to NIH, which was a small increase relative to FY2021 (+$38 million, 3.0%). The President’s budget and House committee bill would have kept the NIH transfers the same as FY2022. With regard to the OS, the FY2022 LHHS omnibus almost doubled the tap transfers to OS (+$64 million, 99.1%) to transition the Office of the National Coordinator for Health Information Technology to being solely funded by the PHS tap.49 Both the President’s budget and the House committee bill also proposed that funding transition, but would have increased the transfers to OS to a greater degree than what was ultimately enacted for FY2022—$106 million (+163.7%) and $97 million (+149.0%), respectively. The FY2022 LHHS omnibus, President’s budget, and House committee bill kept the tap transfers to SAMHSA the same amount as FY2021 ($134 million). In addition to the transfers to NIH, SAMHSA, and OS, the FY2022 House committee bill proposed that AHRQ receive $129 million in tap funding, slightly over half the amount that it proposed for AHRQ’s discretionary funding for FY2022 ($251 million), for a total of $380 47 See Section 204, Division H, P.L. 117-103 for the FY2022 maximum set-aside level. The 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). The FY2022 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. 48 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 appropriation 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 Trust 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. 49 Congressional Record, vol. 168, no. 42, book IV, March 9, 2022, pp. H2684. Congressional Research Service 26 Labor, Health and Human Services, and Education: FY2022 Appropriations million. The FY2022 President’s budget had requested that AHRQ receive a comparatively lesser amount of tap funding ($27 million), with a greater proportion of AHRQ’s funding in the LHHS bill being derived from discretionary appropriations ($353 million), for a total of $380 million. This proposed use of tap funds was rejected by the FY2022 LHHS omnibus. 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 President’s budget also proposed expanding the activities and agencies funded by the PHS tap to include the Public Health Scientific Services and Environmental Health at the CDC ($139 million), and Paralysis Resource Center, Limb Loss, and Traumatic Brain Injury at ACL ($17 million). The House committee bill and the FY2022 LHHS omnibus rejected those proposals. Prevention and Public Health Fund The ACA both authorized and appropriated mandatory funding to three funds to support programs and activities within the PHS agencies.50 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. PPHF funds are intended to supplement (sometimes quite substantially) the funding that selected programs receive through regular appropriations. The PPHF authority instructs the HHS Secretary to transfer amounts from the fund to HHS agencies. However, 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.51 The ACA had appropriated $2 billion in mandatory funds to the PPHF for FY2022, but this amount was reduced by subsequent laws that decreased PPHF funding for FY2022 and other fiscal years. Under current law, the FY2022 appropriation is $1 billion.52 This appropriation was subject to a 5.7% reduction due to sequestration of nonexempt mandatory spending. 53 (For more information on sequestration, see the budget enforcement discussion in Appendix A.) After sequestration, the total PPHF appropriation available for FY2022 was $943 million, an increase of $47 million relative to FY2021. Of this amount, the FY2022 LHHS omnibus allocated $903 million to CDC, $12 million to SAMHSA, and $28 million to ACL, the same amounts as proposed by the House committee bill and the President’s budget. CDC commonly receives the largest share of annual PPHF funds. The amount that was provided to CDC by the FY2022 LHHS omnibus, $903 million, was a $47 million (+5.5%) increase relative to FY2021. The amounts for SAMHSA and ACL were the same as FY2021. 50 For more information, see CRS Report R41301, Appropriations and Fund Transfers in the Affordable Care Act (ACA). 51 For the FY2022 LHHS omnibus, see Division H, §222, P.L. 117-103. 52 42 U.S.C. §300u-11. 53 OMB Report to the Congress on the BBEDCA 251A Sequestration for Fiscal Year 2022, May 28, 2021, p. 7 of 17, https://www.whitehouse.gov/wp-content/uploads/2021/05/BBEDCA_251A_Sequestration_Report_FY2022.pdf. Congressional Research Service 27 Labor, Health and Human Services, and Education: FY2022 Appropriations Selected HHS Highlights by Agency This section begins with a limited selection of FY2022 discretionary funding highlights by HHS agency. The discussion is largely based on the enacted and proposed appropriations levels for FY2022 compared to FY2021 enacted levels.54 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 FY2021 enacted and FY2022 proposed and enacted funding levels for HHS. HRSA The FY2022 LHHS omnibus provided $8.6 billion in discretionary budget authority for HRSA. This was $1.4 billion (+18.8%) more than HRSA’s FY2021 discretionary funding level and $741 million (+9.5%) more than the FY2022 President’s budget request. Under the Primary Health Care account, the Community Health Centers program received $1.7 billion, an increase of $65 million (+3.9%) relative to FY2021.55 The explanatory statement also recommended $122.3 million under that same account for the Ending the HIV Epidemic Initiative.56 Under the Ryan White HIV/AIDS Program appropriation, there is an additional $125 million set aside for this HIV initiative.57 The Maternal and Child Health Block Grant received $748 million, an increase of $35 million (+4.9%) relative to FY2021. Related to maternal health, the explanatory statement also set aside $12 million for the Alliance for Maternal Health Safety Bundles, which are “a set of targeted and evidence-based best practices that, when implemented, improve patient outcomes and reduce maternal mortality and severe maternal morbidity,”58 and $29 million for State Maternal Health Innovation Grants.59 The Rural Communities Opioid Response program received $135 million in the law, an increase of $25 million (+22.7%) relative to FY2021.60 CDC The FY2022 LHHS omnibus provided $7.5 billion in discretionary budget authority for CDC, which was $535 million (+7.7%) more than CDC’s FY2021 funding level. The FY2022 LHHS omnibus did not direct any PHS tap funds to the CDC, continuing the practice started in FY2015. The FY2022 LHHS omnibus supplemented discretionary CDC appropriations by directing $903 million in PPHF transfers to the CDC, which was $47 million (+5.5%) more than FY2021. Altogether, this combination of funding represented an increase of $582 million (+7.4%) from FY2021 in budget authority that is inclusive of directed transfers. 54 HHS budget materials can be found at http://www.hhs.gov/budget/. 55 The Health Centers program also received significant additional FY2020 and FY2021 funding related to the COVID- 19 pandemic, totaling roughly $2 billion in discretionary funding, and $4 billion in mandatory funding. For a discussion of this funding, see CRS Report R46711, U.S. Public Health Service: COVID-19 Supplemental Appropriations in the 116th Congress. 56 Congressional Record, March 9, 2022, Vol. 168, No. 42, Book IV, p. H2669. 57 Ibid, p. H2670. This initiative also was supported by funds from other parts of HHS. For more information, see https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/funding. 58 Ibid, p. H2669. See H.Rept. 117-96 p. 57, for a description of this activity. 59 Ibid, p. H2670. 60 See Ibid, p. H2670, for a description of this activity. Congressional Research Service 28 Labor, Health and Human Services, and Education: FY2022 Appropriations The President’s FY2022 budget request would have increased discretionary budget authority by $1.5 billion (+21.4%) relative to FY2021, while also requesting that $139 million in tap funds be directed to the CDC. The President’s budget also requested $903 million in PPHF transfers, the same as enacted. All told, this combination of funding would have represented an increase of $1.7 billion (+21.5%) from FY2021. The FY2022 omnibus provided $1.1 billion (-11.5%) less than the FY2022 requested amount, inclusive of directed transfers. All but one programmatic account received an increase in discretionary budget authority relative to FY2021. The Immunization and Respiratory Diseases account was flat-funded in terms of discretionary budget authority only, but was increased by $47 million (+5.7%) when also accounting for PPHF transfers. Some notable increases included the HIV/AIDS, Viral Hepatitis, STI and TB Prevention account, which was funded at an increased level of $1.3 billion (+2.4% above FY2021), and included $195 million for CDC’s contribution the Ending HIV/AIDS Initiative;61 the Public Health Scientific Services account, which was funded at $652 million (+10.1%) above FY2021, and included $100 million for public health data modernization (+100% above FY2021 funding of $50 million).62 Discretionary funding for the CDC-Wide Activities and Program Support account was increased by $210 million (+169.9%). When also accounting for PPHF transfers, which were kept at the same level as FY2021 ($160 million), the program level for that account was increased by 74.1% relative to FY2021. Of the discretionary funding, $200 million was designated for public health infrastructure and capacity.63 With regard to the Injury Prevention and Control account, which received $715 million (+4.7% over FY2021), the explanatory statement included funding for several line items that were first included in FY2020, including child sexual abuse prevention ($2 million), suicide prevention ($20 million), and adverse childhood experiences (ACEs, $7 million).64 The explanatory statement also included specific funding for Firearm Injury and Mortality Prevention Research program ($12.5 million) and Opioid Overdose Prevention and Surveillance ($491 million).65 61 Congressional Record, vol. 168, no. 42, March 9, 2022, p. H2670. See also Centers for Disease Control and Prevention, “Ending the HIV Epidemic,” https://www.cdc.gov/endhiv/index.html. 62 Ibid, p. H2672. For FY2021, see Congressional Record, vol. 166, no. 218 (December 21, 2020), p. H8623. 63 P.L. 117-103, 136 STAT. 448. See also Congressional Record, vol. 168, no. 42, March 9, 2022, p. H2674. 64 Ibid., pp. H2672-H2673. For FY2021 enacted, see Congressional Record, vol. 166, no. 218 (December 21, 2020), p. H8623. 65 Ibid. 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. Congressional Research Service 29 Labor, Health and Human Services, and Education: FY2022 Appropriations NIH The FY2022 LHHS omnibus provided $43.7 billion in discretionary budget authority for NIH. This was $2.2 billion (+5.3%) more than FY2021, but $6.8 billion (-13.5%) less than the FY2022 President’s budget request. When adding the $1.0 billion appropriation for the new Advanced Research Projects Agency for Health (ARPA-H)—which the HHS Secretary has placed within NIH after enactment of FY2022 LHHS funding—the NIH’s FY2022 discretionary budget authority was $44.7 billion.66 ARPA-H was originally proposed as a part of President Biden’s FY2022 NIH budget request with proposed funding of $6.5 billion. The FY2022 enacted NIH discretionary budget authority, plus the ARPA-H transfer, was $5.8 billion (-11.5%) less than the President’s FY2022 budget request. All NIH Institute and Center (IC) accounts received increases in FY2022 relative to FY2021. Among the ICs, the National Institute of Minority Health and Health Disparities saw the largest percentage increase compared to FY2021 (+17.4%). In addition, the FY2022 LHHS omnibus directed $1.3 billion in PHS tap transfers to NIH, $38 million more than FY2021. 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 $1.8 billion. The NIGMS discretionary appropriation was $63 million (+3.7%) more than FY2021. When combined with the tap transfer, total funding for NIGMS increased by $101 million (+3.4%) from FY2021. The Buildings and Facilities account saw a $50 million increase (+25.0%) in discretionary budget authority relative to FY2021, but a decrease of $175 million (-41.2%) relative to FY2021 when accounting for the $225 million NEF transfer to that account in FY2021.67 In line with recent practice, the explanatory statement on the FY2022 LHHS omnibus directed NIH to reserve a specific dollar amount for a number of purposes, for example, an increase of $289 million for Alzheimer’s disease and related dementia research.68 It also included a reservation of funds for Firearm Injury and Mortality Prevention Research of $12.5 million, the same amount as in FY2020 and FY2021.69 Reserving a specific dollar amount for a particular 66 Although the FY2022 President’s budget and FY2022 House committee bill proposed that ARPA-H funding be appropriated to the NIH, the $1 billion in enacted funding for ARPA-H was ultimately appropriated to the HHS Office of the Secretary (OS). Those funds were subsequently transferred to the NIH when ARPA-H was placed within that operating division by the HHS Secretary. The enacted ARPA-H funding is displayed under the OS in Table 7 in keeping with how it was appropriated in the LHHS omnibus. For background on ARPA-H and its placement, see CRS Report R47074, Advanced Research Projects Agency for Health (ARPA-H): Congressional Action and Selected Policy Issues. 67 The 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, Title II, §223). Most accounts in annual appropriations measures receive appropriations from the General Fund at the U.S. Treasury. This term refers to all federal money not allocated by law to any other fund account, such as federal trust funds for Medicare. Funds transferred into the NEF are generally available to the 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, including in FY2021 where the LHHS omnibus directed $225 million from the NEF transfers to the NIH Buildings and Facilities account. 68 Congressional Record, vol. 168, no. 42 (March 9, 2022), p. H2676. For a list of specified funding levels in the explanatory statement accompanying the LHHS omnibus, see Table A-2 in CRS Report R43341, National Institutes of Health (NIH) Funding: FY1996-FY2023. 69 Ibid., p. H2678. 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 in FY2020, FY2021 and Congressional Research Service R47029 · VERSION 3 · UPDATED 30 Labor, Health and Human Services, and Education: FY2022 Appropriations disease or area of research at NIH is a relatively new practice that has expanded since 2015; still, most NIH funding is not designated for particular diseases or areas of research.70 SAMHSA The FY2022 LHHS omnibus provided $6.4 billion in discretionary budget authority for SAMHSA. This amount was $530 million (+9.0%) more than SAMHSA’s FY2021 funding level and $3.2 billion (-33.2%) less than the President’s FY2022 budget request. The FY2022 LHHS omnibus also directed $134 million in PHS evaluation tap funding and $12 million in PPHF funding to SAMHSA, which were the same amounts as FY2021. The additional funding provided to SAMHSA was spread across several programs in the explanatory statement. All accounts received discretionary budget authority increases relative to FY2021. The programs within the Mental Health Programs of Regional and National Significance (PRNS) received an increase of $112 million (+23.6%), including the increase of $78 million (+323.4%) to the Suicide Lifeline program to prepare for the launch of a new 988 number for suicide prevention.71 The programs within the Substance Abuse Treatment PRNS received an increase of $25 million (+5.0%) and the programs within the Substance Abuse Prevention PRNS received an increase of $10 million (+4.8%). There was also an increase in funding to the Certified Community Behavioral Health Clinics (CCBHCs)—$65 million (+26.0%) more than FY2021. The Community Mental Health Services Block Grant (MHBG) received an increase of $100 million (+13.6%) while the Substance Abuse Prevention and Treatment Block Grant (SABG) received an increase of $50 million (+2.8%) more than FY2021. The State Opioid Response (SOR) grant program received an increase of $25 million (+1.7%) compared to FY2021. AHRQ The FY2022 LHHS omnibus provided $350 million in discretionary budget authority to AHRQ. This amount was $12 million (+3.7%) more than AHRQ’s FY2021 funding level and $3 million (-0.7%) less than the President’s FY2022 budget request. The FY2022 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.72 (The President’s budget proposed $27 million, and the House bill proposed $129 FY2022. 70 Historically, Congress generally did not specify funding for certain research areas within NIH accounts through the appropriations process. For example, 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. The 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, vol. 160, no. 151 (December 11, 2014), p. H9832. 71 As described in the explanato [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%3AR47029. Public record. Not legal advice.