H.R. 3747 would reauthorize Project ECHO (Extension for Community Healthcare Outcomes, a Department of Health and Human Services (HHS) grant program) through 2031 and add dementia care to the list of specialty care areas eligible for the program. The legislation also would clarify the definition of eligible health care organizations to include public or private nonprofit entities. Project ECHO’s grants are used to evaluate, develop, and expand technology-enabled collaborative learning models to improve retention of providers and increase access to health care in rural, underserved, and tribal communities. HHS allocated about $3.8 million for those purposes in 2025.
The legislation would authorize the appropriation of $10 million annually for Project ECHO over the 2027‑2031 period. Based on historical spending patterns and assuming appropriation of the authorized amounts, CBO estimates that implementing H.R. 3747 would increase spending subject to appropriation by $39 million over the 2026-2031 period and by $9 million after 2031.
The estimated budgetary effects of the legislation are shown in Table 1. The costs of the legislation fall within budget function 550 (health).
Table 1.
Estimated Budgetary Effects of H.R. 3747
By Fiscal Year, Millions of Dollars
2026
2027
2028
2029
2030
2031
2026-2031
Increases in Spending Subject to Appropriation
Authorization
0
10
10
10
10
10
50
Estimated Outlays
0
4
8
9
9
9
39
The CBO staff contact for this estimate is Meghan Salaga. The estimate was reviewed by Chad Chirico, Director of Budget Analysis.
