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                                                       Calendar No. 290

106th Congress                                                   Report
  1st Session                    SENATE                         106-166

======================================================================



 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION AND 
               RELATED AGENCIES APPROPRIATION BILL, 2000

                                _______
                                

               September 29, 1999.--Ordered to be printed

                                _______


   Mr. Specter, from the Committee on Appropriations, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 1650]

    The Committee on Appropriations reports the bill (S. 1650) 
making appropriations for Departments of Labor, Health and 
Human Services, and Education and related agencies for the 
fiscal year ending September 30, 2000, and for other purposes, 
reports favorably thereon and recommends that the bill do pass.



Amount of budget authority

Total bill as reported to Senate........................$324,157,991,000
Amount of adjusted appropriations, 1999................. 300,627,424,000
Budget estimates, 2000.................................. 325,069,040,000
The bill as reported to the Senate:
    Over the adjusted appropriations for 1999........... +23,530,567,000
    Under the budget estimates for 2000.................    -911,049,000


                                C O N T E N T S

                              ----------                              
                                                                   Page
Budget estimates.................................................     4
Title I--Department of Labor:
    Employment and Training Administration.......................    16
    Pension and Welfare Benefits Administration..................    37
    Pension Benefit Guaranty Corporation.........................    37
    Employment Standards Administration..........................    38
    Occupational Safety and Health Administration................    40
    Mine Safety and Health Administration........................    42
    Bureau of Labor Statistics...................................    43
    Departmental management......................................    44
    Assistant Secretary for Veterans' Employment and Training....    47
Title II--Department of Health and Human Services:
    Health Resources and Services Administration.................    49
    Centers for Disease Control and Prevention...................    79
    National Institutes of Health................................   109
    Substance Abuse and Mental Health Services Administration....   183
    Agency for Health Care Policy and Research...................   194
    Health Care Financing Administration.........................   197
    Administration for Children and Families.....................   209
    Administration on Aging......................................   224
    Office of the Secretary......................................   228
Title III--Department of Education:
    Education reform.............................................   248
    Education for the Disadvantaged..............................   258
    Impact aid...................................................   262
    School improvement programs..................................   264
    Reading excellence...........................................   272
    Indian education.............................................   272
    Bilingual and immigrant education............................   273
    Special education............................................   274
    Rehabilitation services and disability research..............   277
    Special institutions for persons with disabilities:
        American Printing House for the Blind....................   283
        National Technical Institute for the Deaf................   283
        Gallaudet University.....................................   284
    Vocational education.........................................   284
    Adult education..............................................   286
    Student financial assistance.................................   287
    Federal family education loan program........................   289
    Higher education.............................................   290
    Howard University............................................   304
    College housing and academic facilities loans................   304
    Historically black college and university capital financing 
      program....................................................   304
    Education research, statistics, and improvement..............   305
Departmental management:
    Program administration.......................................   318
    Office for Civil Rights......................................   318
    Office of the Inspector General..............................   318
Title IV--Related agencies:
    Armed Forces Retirement Home.................................   320
    Corporation for National and Community Service...............   320
    Corporation for Public Broadcasting..........................   322
    Federal Mediation and Conciliation Service...................   323
    Federal Mine Safety and Health Review Commission.............   323
    Office of Library Services: Grants and Administration........   323
    Medicare Payment Advisory Commission.........................   326
    National Commission on Libraries and Information Science.....   326
    National Council on Disability...............................   327
    National Education Goals Panel...............................   327
    National Labor Relations Board...............................   327
    National Mediation Board.....................................   327
    Occupational Safety and Health Review Commission.............   328
    Railroad Retirement Board....................................   328
    Social Security Administration...............................   329
    U.S. Institute of Peace......................................   334
Title V--General provisions......................................   335
Budgetary impact of bill.........................................   336
Compliance with paragraph 7, rule XVI of the standing rules of 
  the Senate.....................................................   336
Compliance with paragraph 7(C), rule XXVI of the standing rules 
  of the Senate..................................................   337
Compliance with paragraph 12, rule XXVI of the standing rules of 
  the Sen- 
  ate............................................................   338
Comparative statement of new budget authority....................   343

       Summary of Budget Estimates and Committee Recommendations

    For fiscal year 2000, the Committee recommends total budget 
authority of $324,157,991,000 for the Departments of Labor, 
Health and Human Services, and Education, and Related Agencies. 
Of this amount, which includes subsequent year advances, 
$84,018,000,000 is current year general purpose discretionary 
funding.

                           allocation ceiling

    Consistent with Congressional Budget Office scorekeeping, 
the recommendations result in full use of the $83,593,000,000 
in general purpose discretionary budget authority pursuant to 
section 302(b) of the Congressional Budget Act of 1974, as 
amended. In addition, the recommendations include $405,000,000 
in budget authority for the Social Security Administration to 
conduct continuing disability reviews provided consistent with 
Public Law 104-124 and Public Law 104-193 and $20,000,000 for 
adoption incentive programs conducted by the Administration on 
Children and Families, provided consistent with Public Law 95-
266.

                      Overview and Bill Highlights

    The Labor, HHS and Education and Related Agencies bill 
constitutes the largest of the 13 federal appropriations bills 
being considered by Congress this year. It is the product of 
extensive deliberations, driven by the realization that no task 
before Congress is more important than safeguarding and 
improving the health and well-being of all Americans. This bill 
is made up of over 300 programs, spanning three federal 
Departments and numerous related agencies. But the bill is more 
than its component parts. Virtually every element of this bill 
reflects the traditional ideal of democracy: That every citizen 
deserves protection from illness and want; the right to a basic 
education and job skills training; and an equal opportunity to 
reach one's highest potential.
    This bill at the same time provides a safety net of social 
protections for the needy while stimulating advances in human 
achievement and the life sciences. At its core, this bill 
embodies those defining principles by which any free society 
must be guided: compassion for the less fortunate; respect for 
family and loved ones; acceptance of personal responsibility 
for one's actions; character development; and the avoidance of 
destructive behavior.

                         Highlights of the Bill

    Youth violence prevention initiative.--Building on last 
year's efforts, the Committee bill includes $850,000,000 for 
currently authorized programs within the Departments of Labor, 
HHS and Education. The initiative will focus resources on 
activities that identify, prevent and help cope with violence 
among youth.
    Youth employment and training.--The Committee bill provides 
$1,375,965,000 for programs to provide training and work 
experience to youths. This amount includes $1,000,965,000 for 
youth employment and training, $250,000,000 for youth 
opportunity grants, and $110,000,000 for school-to-work.
    Job Corps.--The Committee recommendation includes 
$1,347,191,000 for the Job Corps, an increase of $37,977,000 
over the 1999 level.
    Worker protection.--The Committee bill includes 
$1,318,201,000 to ensure the health and safety of workers, 
including $388,142,000 for the Occupational Safety and Health 
Administration and $230,873,000 for the Mine Safety and Health 
Administration. The recommendation is an increase of 
$141,454,000 over the 1999 level.
    National Institutes of Health.--A total of $17,613,470,000 
is recommended to fund biomedical research at the 25 Institutes 
and centers that comprise the NIH. This represents an increase 
of $2,000,000,000 over the fiscal year 1999 level.
    AIDS.--The Committee bill includes $4,432,699,000 for AIDS 
research, prevention, and services. This includes 
$1,610,500,000 for Ryan White programs, an increase of 
$199,649,000, $662,276,000 for AIDS prevention programs at the 
Centers for Disease Control and Prevention, and $85,000,000 for 
global and minority AIDS activities within the Public Health 
and Social Services Fund. The Committee recommendation includes 
$50,000,000 for benefit payments authorized by the Ricky Ray 
Hemophilia Trust Fund Act.
    Bioterrorism initiative.--The Committee bill includes 
$224,340,000 to fund efforts to address bioterrorism threats.
    Women's health.--The Committee bill provides $15,495,000 
for programs focused on the advancement of women's health 
initiatives. The Committee recommends an additional 
$167,051,000 for breast and cervical cancer screening, an 
increase of $7,980,000 over the 1999 level.
    Infectious diseases.--The Committee bill provides 
$165,610,000 within the Centers for Disease Control and 
Prevention to combat the growing threat of infectious disease. 
The amount recommended is an increase of $27,974,000 over the 
fiscal year 1999 amount.
    Family planning.--The Committee bill recommends 
$222,432,000 for the family planning program, an increase of 
$7,500,000 over last year's appropriation. These funds support 
primary health care services at over 4,000 clinics nationwide.
    Child care and development block grant.--The Committee 
recommendation provides $1,182,672,000 for child care services, 
the same as last year's level.
    Community services block grant.--The Committee bill 
includes $500,000,000.
    Head Start.--The Committee recommendation includes 
$5,267,000,000 for the Head Start Program. This represents an 
increase of $608,483,000 over the 1999 enacted level.
    Low-income home energy assistance.--The Committee 
recommends $1,100,000,000 for heating and cooling assistance 
for low-income individuals and families as an advance 
appropriation for fiscal year 2001. Also included is bill 
language permitting up to $300,000,000 in funding to provide 
additional energy assistance during weather emergencies.
    Crime reduction.--The bill recommends $174,449,000 for 
violent crime reduction activities, including $102,300,000 for 
battered women's shelters.
    Drug abuse.--A total of $3,687,015,000 is included for drug 
abuse prevention, treatment, and research activities, an 
increase of $367,849,000 over the fiscal year 1999 level.
    Grants for disadvantaged children.--The Committee bill 
provides $8,052,397,000 for grants to disadvantaged children, 
$320,000,000 more than the 1999 level.
    Student financial aid.--The Committee recommends 
$9,498,000,000 for student financial assistance, including 
$934,000,000 for the Federal Work Study Program. The amount 
provided for the Pell Grant Program will allow the maximum 
grant to be raised to $3,325, an increase of $200 over the 1999 
amount.
    Higher education initiatives.--The Committee bill provides 
$1,404,631,000 for initiatives to provide greater opportunities 
for higher education, including $180,000,000 for GEAR UP, 
$10,000,000 for Learning Anytime Anywhere partnership grants, 
and $80,000,000 to improve teacher quality training.
    Education for individuals with disabilities.--The Committee 
bill provides $6,035,646,000 to ensure that all children have 
access to a free and appropriate education, and that all 
infants and toddlers with disabilities have access to early 
intervention services. This represents an increase of 
$911,500,000 over the 1999 level.
    Rehabilitation services.--The bill recommends 
$2,692,872,000 for rehabilitation services, an increase of 
$40,288,000 above the amount provided in 1999. These funds are 
essential for families with disabilities seeking employment.
    Services for older Americans.--For programs serving older 
Americans, the Committee recommendation totals $2,247,219,000 
including $440,200,000 for community service employment for 
older Americans, $310,082,000 for supportive services and 
centers, and $521,412,000 for senior nutrition programs. For 
the medical research activities of the National Institute on 
Aging, the Committee recommends $680,332,000, an increase of 
13.4 percent. The Committee recommendation includes $15,500,000 
for the Medicare insurance counseling program.
    Public broadcasting.--The Committee bill provides 
$350,000,000 to support public radio and television, an 
increase of $10,000,000 over the previous year's appropriation.
    Social Security Administration.--The Committee bill 
recommends $6,673,871,000, an increase of $247,871,000 over the 
1999 level.

                  youth violence prevention initiative

    The shocking events surrounding the shootings at public 
schools serve to highlight a problem that is neither new nor 
predictable by way of demographics, region or economic 
standing. Violent behavior on the part of young people is no 
longer confined to inner-city street gangs. For all of the hope 
and inspiration our young people give us, we now find ourselves 
profoundly troubled by the behavior of some of the younger 
generation.
    An estimated 3 million crimes a year are committed in or 
near the nation's 85,000 public schools. During the 1996-97 
school year alone, one-fifth of public high schools and middle 
schools reported at least one violent crime incident, such as 
murder, rape or robbery; more than half reported less serious 
crimes. Homicide is now the third leading cause of death for 
children age 10 to 14. For more than a decade it has been the 
leading cause of death among minority youth between the ages of 
15 and 24. The trauma and anxiety that violence begets in our 
children most certainly interferes with their ability to learn 
and their teachers' ability to teach: an increasing number of 
school-aged children say they often fear for their own safety 
in and around their classroom.
    The Gun-Free Schools Act of 1994 requires states to pass 
laws mandating school districts to expel any student who brings 
a firearm to school. A recent study indicates that the number 
of students carrying weapons to school dropped from 26.1 
percent in 1991 to 18.3 percent in 1997. While this trend is 
encouraging, the prevalence of youth violence is still 
unacceptably high. Recent incidents clearly indicate that much 
more needs to be done. Some of the funds provided in this 
initiative will help state and local authorities to purchase 
metal detectors and hire security officers to reduce or 
eliminate the number of weapons brought into educational 
settings.
    Fault does not rest with one single factor. In another 
time, society might have turned to government for the answer. 
However, there is no easy solution, and total reliance on 
government would be a mistake. Youth violence has become a 
public health problem that requires a national effort. 
Certainly, our government at all levels--federal, state and 
local--must play a role. But we must also enlist the energies 
and resources of private organizations, businesses, families 
and the children themselves.
    The Committee is aware of the controversy regarding the 
media's role in influencing in youth violence. The Committee 
recognizes that some members of the entertainment industry have 
challenged the methodology of studies conducted over the past 3 
decades which have linked movies, television programs, song 
lyrics, and video games with violent behavior. The Committee 
believes that any studies that determine causative factors for 
youth violence should be based on sound methodology which 
yields statistically significant and replicable results. 
Despite disagreement over the media's role, the Committee is 
encouraged by historic efforts of various sectors of the 
entertainment industry to monitor and discipline themselves and 
to regulate content. The industry's self-imposed, voluntary 
ratings system is a step in the right direction. Further 
vigilance, however, is needed to ensure that media products are 
distributed responsibly, and that ratings systems are 
appropriate and informative so that parents are empowered to 
monitor their youths' consumption of movies, television 
programs, music and video games.
    Many familial, psychological, biological and environmental 
factors contribute to youths' propensity toward violence. The 
youth violence prevention initiative contained in this bill is 
built around these factors and seeks to be comprehensive and to 
eliminate the conditions which cultivate violence.
    Over the past several months, the Committee convened three 
lengthy meetings with the Deputy Attorney General; the Surgeon 
General; Assistant Secretary for Management and Budget, DHHS; 
Acting Deputy Assistant Secretary for Elementary and Secondary 
Education and the Director of Safe and Drug Free Schools; 
Assistant Secretary for Special Education; Commissioner, 
Administration for Children and Families; Director, National 
Institute of Mental Health; Director of Policy, Employment and 
Training Administration; Director of Program Development, 
Center for Mental Health Services, Substance Abuse and Mental 
Health Services Administration; Director, Division of Violence 
Prevention, National Center for Injury Prevention and Control, 
Centers for Disease Control; Assistant Surgeon General; Deputy 
Assistant Secretary for Health; Acting Director, Office of 
Victims of Crime, Department of Justice; Deputy Assistant 
Secretary for Employment and Training, Department of Labor; and 
the National Association of School Psychologists. These 
officials expressed their appreciation for the opportunity to 
discuss this issue with other agency administrators, and share 
their particular programs' approaches to preventing youth 
violence. The meeting participants enthusiastically endorsed a 
coordinated interagency approach to the youth violence problem, 
and discussed how best to efficiently collaborate with other 
agencies and organizations across the government and in the 
private sector.
    Based on those three meetings and staff follow up, the 
following action plan was developed.
    The Committee has reallocated from existing programs 
$850,800,000 for a youth violence prevention initiative. These 
funds together with increases included for the National 
Institute of Mental Health, National Institute of Drug Abuse, 
and the National Institute of Alcohol Abuse and Alcoholism will 
provide resources to address school violence issues in a 
comprehensive way. This coordinated approach will improve 
research, prevention, education and treatment strategies to 
address youth violence.
1. Office of the United States Surgeon General
    A. Coordination by the United States Surgeon General.--The 
Committee views youth violence as a public health problem, and 
therefore directs the United States Surgeon General to take the 
lead role in coordinating a federal initiative to prevent youth 
violence. The Office of the Surgeon General (OSG) within the 
Office of Public Health and Science shall be responsible for 
the development and oversight of cross-cutting initiatives 
within the Department of Health and Human Services and with 
other Federal Agencies to coordinate existing programs, some of 
which are outlined below, to reduce the incidence of youth 
violence in the United States. The Committee has included 
$4,000,000 directly to the OSG to help in this coordination 
effort. Sufficient funds have been included for a Surgeon 
General's report on youth violence. This report, to be 
coordinated by the OSG should review the biological, 
psychosocial and environmental determinants of violence, 
including a comprehensive analysis of the effects of the media, 
the internet, and video games on violent behavior and the 
effectiveness of preventive interventions for violent behavior, 
homicide, and suicide. The OSG shall have lead responsibility 
for this report and its implementation activities.
    B. Federal Coordinating Committee on the Prevention of 
Youth Violence.--The Committee also directs the Secretary of 
HHS to establish a Federal Coordinating Committee on the 
Prevention of Youth Violence. This Committee should be chaired 
by the Surgeon General and co-chaired by a representative from 
the OSG, within the Office of Public Health and Science, the 
Departments of Justice, Education and Labor to foster 
interdepartmental collaboration and implementation of programs 
and initiatives to prevent youth violence. The representative 
from the OSG within the Office of Public Health and Science 
shall report directly to the Surgeon General and shall 
coordinate this initiative.
    C. National Academic Centers of Excellence on Youth 
Violence Prevention.--The Committee has included $10,000,000 to 
support the establishment of ten National Centers of Excellence 
at academic health centers that will serve as national models 
for the prevention of youth violence. These Centers should: (1) 
develop and implement a multi-disciplinary research agenda on 
the risk and protective factors for youth violence, on the 
interaction of environmental and individual risk factors, and 
on preventive and therapeutic interventions; (2) develop and 
evaluate preventive interventions for youth violence, 
establishing strong linkages to the community, schools and with 
social service and health organizations; (3) develop a 
community response plan for youth violence, bringing together 
diverse perspectives including health and mental health 
professionals, educators, the media, parents, young people, 
police, legislators, public health specialists, and business 
leaders; and (4) develop a curriculum for the training of 
health care professionals on violent behavior identification, 
assessment and intervention with high risk youth, and integrate 
this curriculum into medical, nursing and other health 
professional training programs.
    D. National Youth Violence Prevention Resource Center.--The 
Committee has included $2,500,000 to establish a National 
Resource Center on Youth Violence Prevention. This center 
should establish a toll free number (in English and Spanish) 
and an internet website, in coordination with existing Federal 
web site resources, to provide accurate youth violence 
prevention and intervention information produced by the 
government and linked to private resources. Hundreds of 
resources are now available on this issue including statistics, 
brochures, monographs, descriptions of practices that work, and 
manuals about how to implement effective interventions. This 
Resource Center will provide a single, user-friendly point of 
access to important, potentially life-saving information about 
youth violence, and an explanation about preventing youth 
violence and how to intervene. Additionally, technical 
assistance on how to establish programs in communities across 
the country by providing local resources would also be made 
available through the National Resource Center.
    E. Health Care Professional Training.--The Committee has 
included sufficient funds for the training of primary health 
care providers, pediatricians and obstetricians/gynecologists 
in detecting child and youth violence stemming from child 
abuse.
2. National Institute of Mental Health
    A. Zero to Five.--Many risk factors are established early 
in a child's life (0 to 5 years), including child abuse and 
neglect. However, less dramatic problems that delay cognitive 
and social and emotional development may also lead to later 
serious conduct problems that are resistant to change. The 
Committee encourages NIMH to address both of these types of 
problems by supporting research to understand and prevent abuse 
and neglect, by encouraging research on how to best instruct 
parents and child care workers in appropriate interventions, 
and by supporting research that develops and evaluates 
interventions for early disruptive behavior in diverse 
preschool and community settings. In addition, the Institute 
should work to ensure that the goals of all interventions 
include effectiveness and sustainability.
    B. Five to twelve.--Attention Deficit Hyperactivity 
Disorder (ADHD) and depression often emerge in the 5-12 year 
age range. Comprehensive research-based programs have been 
developed to provide such children with the mental health 
services and behavioral interactions they need. The Committee 
urges NIMH to continue its work toward the development and 
evaluation of programs aimed at prevention, early recognition, 
and intervention for depression and youth suicide in diverse 
school and community settings to determine their effectiveness 
and sustainability; to support the development and evaluation 
of behavioral interventions for home and classroom to manage 
ADHD; to identify through research the most cost-effective 
features of proven prevention programs for resource poor 
communities; and to support multi-site clinical trials to 
establish safe and effective treatment of acute and long-term 
depression and ADHD.
    C. 12 to 18.--Early adolescence is an important time to 
stop the progression of violent behavior and delinquency. 
Multisystemic therapy (MST), in which specially trained 
individuals work with the youth and family in their homes, 
schools and communities, have been found to reduce chronic 
violent or delinquent behavior. Research has shown sustained 
improvements for at least 4 years, and MST appears to be cost 
effective when compared to conventional community treatment 
programs in that it has proven to reduce hospitalization and 
incarceration.
    D. Behavioral and Psychosocial Therapies.--Therapeutic 
Foster Care is an effective home based intervention for 
chronically offending delinquents. Key elements of the program 
include providing supervision, structure, consistency, 
discipline, and positive reinforcement. This intervention 
results in fewer runaways and program failures than other 
placements and is less expensive. The Committee encourages NIMH 
to work in collaboration with CDC, SAMHSA, and the Department 
of Justice to implement effective model interventions for 
juvenile offenders with conduct disorders in diverse 
populations and settings. NIMH has initiated the nation's first 
large-scale multi-site clinical trial for treatment of 
adolescent depression, and the Committee supports additional 
research to improve recognition of adolescent depression.
    E. Public Health Research, Data Collection and Community-
based Interventions.--There are four cross-cutting areas in 
need of further research action across all agencies: community 
interventions, media, health provider training, and information 
dissemination. The Committee directs NIMH to ensure that 
research focuses on: examining the feasibility of public health 
programs combining individual, family and community level 
interventions to address violence and identify best practices; 
developing curricula for health care providers and educators to 
identify pediatric depression and other risk factors for 
violent behavior; studying the impact of the media, computer 
games, internet, etc., on violent behavior; disseminating 
information to families, schools, and communities to recognize 
childhood depression, suicide risk, substance abuse, and ADHD 
and decreasing the stigma associated with seeking mental health 
care. The Committee also encourages NIMH to work in 
collaboration with CDC and SAMHSA to create a system to provide 
technical assistance to schools and communities to provide 
public health information and best practices to schools and 
communities to work with high risk youth. The Committee has 
included sufficient funds to collect data on the number and 
percentage of students engaged in violent behavior, incidents 
of serious violent crime in schools, suicide attempts, and 
students suspended and/or expelled from school.
    3. National Institute of Drug Abuse.--Drug abuse is a risk 
factor for violent behavior. The Committee encourages NIDA to 
support research on the contribution of drug abuse including 
methamphetamine use, its co-morbidity with mental illness, and 
treatment approaches to prevent violent behavior.
    4. National Institute of Alcohol Abuse and Alcoholism.--The 
Committee encourages NIAAA to examine the relationship of 
alcohol and youth violence with other mental disorders and to 
test interventions to prevent alcohol abuse and its 
consequences.
5. Safe Schools, Healthy students
    Mental Health Counselors/Community Support/Technical 
Assistance and Education.--The Committee has included 
$80,000,000, an increase of $40,000,000 over the fiscal year 
1999 appropriation, to support the delivery and improvement of 
mental health services, including school-based counselors, in 
our nation's schools. These funds allow State and local mental 
health counselors to work closely with schools and communities 
to provide services to children with emotional, behavioral, or 
social disorders. Some of these funds also help train teachers, 
school administrators, and community groups that work with 
youths to identify children with emotional or behavioral 
disorders. The program is being administered collaboratively by 
the Substance Abuse and Mental Health Services Administration 
within the Department of Health and Human Services and the 
Departments of Education and Justice to help school districts 
implement a wide range of early childhood development 
techniques, early intervention and prevention strategies, 
suicide prevention, and increased and improved mental health 
treatment services. Some of the early childhood development 
services include effective parenting programs and home 
visitations.
    6. Parental responsibility/Early Intervention.--
Sociological and scientific studies show that the first three 
years of a child's cognitive development sets the foundation 
for life-long learning and can determine an individual's 
emotional capabilities. Parents, having the primary and 
strongest influence on their child, play a pivotal role at this 
stage of development. Scientists have found that parental 
relationships affect their child's brain in many ways. A 
secure, highly interactive, and warm bond can bolster the 
biological systems that help a child handle their emotions. 
Research further indicates that a secure connection with the 
parent will better equip a child to handle stressful events 
throughout life. Statistics show that the parental assistance 
program in particular has helped to lower the incidence of 
child abuse and neglect, reduces placement of children in 
special education programs, and involves parents more actively 
throughout their child's school years. The Committee recognizes 
that early intervention activities conducted through the 
Department of Education's parent information and resource 
centers program can make a critical difference in addressing 
the national epidemic of youth violence, and therefore includes 
an additional $3,000,000 to expand its services to educate 
parents to work with professionals in preventing and 
identifying violent behavioral tendencies.
7. Safe and Drug-Free Schools
    A. National Programs.--The Committee remains extremely 
concerned about the frequent and horrific occurrence of 
violence in our Nation's schools. Last year, the Committee 
provided $90,000,000 within this account for a school violence 
prevention initiative. As part of an enhanced and more 
comprehensive effort, the Committee has provided $100,000,000 
within the safe and drug-free schools and communities program 
to support activities that promote safe learning environments 
for students. Such activities should include: targeted 
assistance, through competitive grants, to local educational 
agencies for community-wide approaches to creating safe and 
drug free schools; and training for teachers and school 
security officers to help them identify students who exhibit 
signs of violent behavior, and respond to disruptive and 
violent behavior by students. The Committee also encourages the 
Department to coordinate its efforts with children's mental 
health programs.
    B. Coordinator Initiative.--The Committee has included 
$60,000,000, an increase of $25,000,000 over the fiscal year 
1999 appropriation and $10,000,000 more than the budget 
request. The Committee recommendation will enable the 
Department of Education to provide assistance to local 
educational agencies to recruit, hire, and train drug 
prevention and school safety program coordinators in middle 
schools with significant drug and school safety problems. These 
coordinators will be responsible for developing, conducting and 
analyzing assessments of their school's drug and crime 
problems, and identifying promising research-based drug and 
violence prevention strategies and programs to address these 
problems.
    8. 21st Century Community Learning Centers.--The Committee 
has included $400,000,000 for the 21st Century Community 
Learning Centers, an increase of $200,000,000 over the fiscal 
year 1999 level. These funds are intended to be used to reduce 
idleness and offer an alternative to children when they 
conclude their school day, at a time when they are typically 
unsupervised. Nationally, each week, nearly 5 million children 
ages 5-14 are home alone after school, which is when juvenile 
crime rates double. According to the Department of Justice, 50 
percent of all juvenile crime occurs between the hours of 2 
p.m. and 8 p.m. during the week. Therefore, the Committee has 
included funds to allow the Department of Education to support 
after-school programs that emphasize safety, crime awareness, 
and drug prevention.
    9. Teacher Quality Enhancement Grants.--The Committee has 
included $80,000,000 for teacher quality enhancement grants, an 
increase of $2,788,000, for professional development of K-12 
teachers, which is a necessary component to addressing the 
epidemic of youth violence. The Committee encourages the 
Department, in making these grants, to give priority to 
partnerships that will prepare new and existing teachers to 
identify students who are having difficulty adapting to the 
school environment and may be at-risk of violent behavior. 
Funds should also be used to train teachers on how to detect, 
manage, and monitor the warning signs of potentially 
destructive behavior in their classrooms.
    10. Character Education.--The Committee recommends 
$10,300,000 for character education partnership grants. These 
funds will be used to encourage states and school districts to 
develop pilot projects that promote strong character, which is 
fundamental to violence prevention. Character education 
programs should be designed to equip young individuals with a 
greater sense of responsibility, respect, trustworthiness, 
caring, civic virtue, citizenship, justice and fairness, and a 
better understanding of the consequences of their actions.
    11. Elementary School Counseling.--The Committee is 
concerned about the inaccessibility of school counselors for 
young children and therefore is providing $20,000,000 for the 
Elementary School Counseling Demonstration as a part of the 
youth violence prevention initiative. Many students who are 
having a difficult time handling the pressures of social and 
academic demands could benefit from having mental health care 
readily available. The Committee believes that increasing the 
visibility of school counselors would legitimize their role as 
part of the school's administrative framework, thereby, 
encouraging students to seek assistance before resorting to 
violence.
    12. Civic education.--Within the amounts provided, the 
Committee has included $1,500,000 to continue the violence 
prevention initiative begun in fiscal year 1999. The Committee 
encourages that funds be used to conduct a five State violence 
prevention demonstration program on public and private 
elementary, middle, and secondary schools involving students, 
parents, community leaders, volunteers, and public and private 
sector agencies, such as law enforcement, courts, bar 
associations, and community based organizations.
13. Literacy programs
    A. The Committee has included $21,500,000, an increase of 
$3,500,000 for the Reading is Fundamental program to promote 
literacy skills. Studies show that literacy promotion is one 
tool to prevent youth violence. The Committee believes that 
this program, which motivates children to read and increases 
parental involvement is another way to prevent youth violence 
at an early age.
    B. The Committee has included $19,000,000, an increase of 
$2,277,000 for the State Grants for Incarcerated Youth 
Offenders/Prisoner Literacy Programs. This program, which 
assists states to encourage incarcerated youth to acquire 
functional literacy, life and job skills, can also play a role 
in reducing recidivism rates and violent behavior.
    C. The Committee has included $42,000,000 for the Title I 
Neglected and Delinquent/High Risk Youth program, an increase 
of $1,689,000 over the fiscal year 1999 appropriation. These 
funds will assist states to strengthen programs for neglected 
and delinquent children to enhance youth violence prevention 
programs in state-run institutions and for juveniles in adult 
correctional facilities
    These funds will be used to motivate youth to read and 
enhance their academic achievement. Literacy promotion 
encourages young individuals to pursue productive goals, such 
as continued education and gainful employment.
    14. Youth Service delivery systems.--The Committee is aware 
that the Workforce Investment Act (WIA) brings new emphasis to 
the development of coherent, comprehensive youth services that 
address the needs of low-income youth over time. It believes 
that youth service delivery systems under WIA integrate 
academic and work-based learning opportunities, offer effective 
connections to the job market and employers, and have intensive 
private-sector involvement. Such effective systems can provide 
low-income, disadvantaged youth with opportunities in our 
strong economy as alternatives to youth violence and crime. The 
Committee further recognizes the potential of Youth Councils 
for creating the necessary collaboration of private and public 
groups to create community strategies that improve 
opportunities for youth to successfully transition to 
adulthood, postsecondary education and training. Thus, the 
Committee has included funds to continue investments in WIA 
formula-funded youth training and employment activities, the 
Youth Opportunities grant program, the Job Corps, and added 
$15,000,000 to continue and expand the Youth Offender grant 
program serving youth who are or have been under criminal 
justice system supervision.

              reprogramming and initiation of new programs

    Reprogramming is the utilization of funds for purposes 
other than those contemplated at the time of appropriation 
enactment. Reprogramming actions do not represent requests for 
additional funds from the Congress, rather, the reapplication 
of resources already available.
    The Committee has a particular interest in approving 
reprogrammings which, although they may not change either the 
total amount available in an account or any of the purposes for 
which the appropriation is legally available, represent a 
significant departure from budget plans presented to the 
Committee in an agency's budget justification.
    Consequently, the Committee directs that the Departments 
and agencies funded through this bill make a written request to 
the chairman of the Committee prior to reprogramming of funds 
in excess of 10 percent, or $500,000, whichever is less, 
between programs, activities, or elements unless an alternate 
amount for the agency in question is specified elsewhere in 
this report. The Committee desires to have the requests for 
reprogramming actions which involve less than the above-
mentioned amounts if such actions would have the effect of 
changing an agency's funding requirements in future years, if 
programs or projects specifically cited in the Committee's 
reports are affected or if the action can be considered to be 
the initiation of a new program.
    The Committee directs that it be notified regarding 
reorganization of offices, programs, or activities prior to the 
planned implementation of such reorganizations.
    The Committee further directs that each agency under its 
jurisdiction submit to the Committee statements on the effect 
of this appropriation act within 60 days of final enactment of 
this act.

                           transfer authority

    The Committee has included bill language permitting 
transfers up to 1 percent between discretionary appropriations 
accounts, as long as no such appropriation is increased by more 
than 3 percent by such transfer; however, the Appropriations 
Committees of both Houses of Congress must be notified at least 
15 days in advance of any transfer. Similar bill language was 
carried in last year's bill for all three Departments.
    Prior Committee notification is also required for actions 
requiring the use of general transfer authority unless 
otherwise provided for in this act. Such transfers specifically 
include taps, or other assessments made between agencies, or 
between offices within agencies. Funds have been appropriated 
for each office funded by this Committee; it is not the 
intention of this Committee to augment those funding levels 
through the use of special assessments. This directive does not 
apply to working capital funds or other fee-for-service 
activities.

                      TITLE I--DEPARTMENT OF LABOR

                 Employment and Training Administration

                    training and employment services

Appropriations, 1999....................................  $5,271,919,000
Budget estimate, 2000...................................   5,474,798,000
Committee recommendation................................   5,472,560,000

    The Committee recommends $5,472,560,000 for this account in 
2000 which provides funding authorized primarily by the 
Workforce Investment Act [WIA]. This is $200,641,000 more than 
the 1999 level.
    Training and employment services is comprised of programs 
designed to enhance the employment and earnings of economically 
disadvantaged and dislocated workers, operated through a 
decentralized system of skill training and related services. 
This appropriation is generally forward-funded on a July-to-
June cycle. Funds provided for fiscal year 2000 will support 
the program from July 1, 2000, through June 30, 2001.
    Fiscal year 1999 was a transition year from the Job 
Training Partnership Act [JTPA] to the new Workforce Investment 
Act, and fiscal year 2000 will be the first full year of 
operations under the new law, beginning July 1, 2000. The new 
legislation is expected to significantly enhance employment and 
training services, consolidating, coordinating, and improving 
programs utilizing a local level one-stop delivery system.
    The Committee is aware that the information technology 
industry can be an ideal source of employment and supplemental 
income for rural communities and farm families desiring to 
remain on the farm. The Committee is also aware of the desire 
of five rural states to participate in a rural technology jobs 
and entrepreneurship pilot project with training funds 
available under the American Competitiveness and Workforce 
Investment Act. The Committee urges the Department to give full 
consideration to supporting such a project.
    Adult employment and training activities.--For Adult 
Employment and Training Activities, the Committee recommends 
$950,000,000. This is $5,000,000 less than the 1999 comparable 
level. This program is authorized by the Workforce Investment 
Act and is formula-funded to States and further distributed to 
local workforce investment boards. Services for adults will be 
provided through the One-Stop system and most customers 
receiving training will use their individual training accounts 
to determine which programs and providers fit their needs. The 
Act authorizes core services, which will be available to all 
adults with no eligibility requirements, and intensive 
services, for unemployed individuals who are not able to find 
jobs through core services alone.
    Dislocated worker employment and training activities.--For 
Dislocated Worker Employment and Training Activities, the 
Committee recommends $1,595,510,000. This is $195,000,000 more 
than the 1999 comparable level. This increase is allowed as 
part of an overall initiative to begin providing reemployment 
services for all who need them. In this program, the effort is 
a major step toward providing all dislocated workers who want 
and need assistance the resources to train for or find new 
jobs. This program, authorized by WIA, is a State-operated 
effort which provides core services, intensive services, 
training, and supportive services to help permanently separated 
workers return to productive, unsubsidized employment. In 
addition, States use these funds for rapid response assistance 
to help workers affected by mass layoffs and plant closures. 
Eighty percent of funding is distributed by formula to the 
States. The remaining twenty percent is available to the 
Secretary for activities specified in WIA, primarily to respond 
to mass layoffs, plant and/or military base closings, and 
natural disasters across the country, which cannot be otherwise 
anticipated, as well as technical assistance and training and 
demonstration projects.
    The Committee has included bill language removing the WIA 
statute's limitation on Dislocated Worker discretionary funding 
which can be used for pilot and demonstration projects in order 
to allow for the more careful examination of issues surrounding 
the reemployment of our Nation's dislocated workers.
    The Committee recommendation includes funds to continue 
those projects, listed below, which were awarded through the 
Congressionally authorized competition in fiscal year 1999 for 
meeting the needs of a skilled workforce. The Department is 
encouraged to take into account project performance and 
utilization of prior year funding when using these funds.
    The Committee understands that PhAME (Philadelphia Area 
Accelerated Manufacturing Education Inc.) is eligible to apply 
for financial support under National Emergency Grants. If PhAME 
is successful and if additional funds are provided, the program 
would use them for job training program operations, including 
teaching staff salaries, shop supplies, computer software, and 
licenses and teaching aids.
    The Committee understands that Lehigh University's Iacocca 
Institute is eligible to apply under a competition under 
National Emergency Grants for financial support. If the 
Institute is successful and additional funds are provided, 
Lehigh would continue the development of a curriculum to train 
instructors who will work with the PhAME program in 
Philadelphia.
    The Committee is pleased that the Department has made 
funding available to support the retraining of incumbent 
workers as provided for in last year's appropriations 
legislation. The Committee urges the Department to give full 
and fair consideration to similar requests submitted in support 
of efforts undertaken by the Commonwealth of Pennsylvania. The 
Committee recommendation continues incumbent worker bill 
language from last year's appropriations legislation.
    The Committee understands that Women Work! is eligible to 
apply for financial support under National Emergency Grants. 
These funds can be used to support technical assistance for 
State and local workforce investment boards on the provision of 
services to displaced homemakers and non-traditional training 
for women using organizations of demonstrated effectiveness, 
including Women Work!.
    The Committee is aware of the severe worker dislocation 
brought on by the closure of one of three sugarcane plantations 
on the Hawaiian island of Kauai, and the likely closure of 
another plantation. To provide assistance to affected workers 
and communities, the Committee encourages the Department to 
support from National Emergency Grant funds a proposal from the 
Hawaii Department of Labor, the Kauai Cooperative Extension 
Service, and the Hawaii Small Business Development Center to 
provide agricultural and business training to dislocated 
sugarcane workers.
    The Committee encourages the Department to continue support 
for a high technology training initiative on the island of Maui 
and to consider funding a proposal from the American Indian 
Science and Engineering Society, both of which focus on 
improving the representation of women in computer networking, 
telecommunications, and developing training and curriculum 
models to meet the increasing need for workers in 
telecommunications industry. The Committee expects the local 
workforce investment boards under the Workforce Investment Act 
in conjunction with the local business community, community 
colleges and other appropriate parties to develop and maintain 
effective partnerships. The Committee expects that a similar 
effort will be developed at Bethel Native Corporation in 
southwest Alaska.
    The Committee encourages the Department to continue the 
JOBLINKS program administered by the Community Transportation 
Association of America. The JOBLINKS program provides technical 
assistance to local communities in developing and implementing 
strategies to get low income people living in economically 
distressed communities to centers of employment. In light of 
the new work requirements for individuals receiving public 
assistance and the obstacle that the lack of transportation 
poses in gaining a job, the Committee believes that 
continuation of this important program is warranted. The 
Committee encourages support for a center of technical 
assistance on employment and transportation issues and the 
inclusion of additional demonstration sites.
    The Committee supports the efforts of and is encouraged by 
the planning and preparation devoted to the 2001 Special 
Olympics World Winter Games to promote employment opportunities 
for individuals with mental disabilities.
    The Committee recognizes efforts by the Department to 
conduct projects that demonstrate efficient and effective 
methodologies, consistent with the Workforce Investment Act, to 
prepare disenfranchised populations not participating in the 
U.S. economy with the high skills necessary to work within a 
high technology economy.
    The United States steel industry has been adversely 
affected by the recent steel crisis caused by the dumping and 
subsidization of imported steel. The industry has sustained 
significant loss of jobs, almost 340,000 in a period of twenty 
years, despite the fact that the industry has invested over 
$50,000,000,000 in new technology and environmental controls in 
an effort to meet the challenge of global competition. Unfair 
trade practices undermine fair competition standards, resulting 
in several bankruptcies of American steel companies and a 
continued trend of layoffs of dedicated steelworkers. The 
Committee encourages the Department to use national emergency 
grants to supplement other funds in the provision of training 
and placement services for individuals who have lost their jobs 
in the steel industry as a result of these unfair trade 
practices.
    The Committee notes that funding is requested for the 
International Shipyard Worker Training Demonstration Project at 
the Quincy, Massachusetts shipyard. Quincy Shipyard could 
create hundreds of new, highly skilled jobs. Once trained, 
shipyard workers could assist in training hundreds of other 
workers in advanced shipyard techniques and systems.
    The reopening of America's commercial shipyards is an 
opportunity to create high skilled jobs, strengthen our 
national security, and bring into the United States technology 
currently available only in competing economies. Traditional 
worker training programs may not fit the needs of these 
workers. The Department of Labor is expected to make every 
effort to be flexible in the use of worker training funding for 
reactivated shipyards, such as those in Philadelphia, 
Pennsylvania, Ketchikan, Alaska, and Quincy, Massachusetts. The 
Committee encourages the Department to use National Emergency 
Grants to supplement available resources for (1) worker 
training needs at reactivated shipyards that have experienced 
large scale worker dislocation, (2) continuing training to 
utilize the workplace as a site for learning, (3) supporting 
training for American workers at state-of-the-art foreign 
shipyards, and (4) continuing upgrading of workers skills to 
increase employability and job retention.
    The Committee is aware of an effort to develop and 
implement a rapid response program to identify education and 
training needs of employers and then to provide such education 
and training. Immediate programs will be in process plant 
technology and information technology. In process plant 
technology, plant simulation software and educational 
engineering equipment will be used. Process plant operators 
represent one of the highest paying non-baccalaureate entry 
level positions in Montana, with beginning salaries at $15-$20 
per hour. There are a number of jobs available in the refining, 
petrochemical, gas processing and power generation areas. Other 
areas to be considered are computer systems technology, 
information technology support, network certification, client-
server technology, network engineering and management, 
emergency medical technician and dental hygiene, allied health 
care and health care technicians, safety and sanitation, 
environment and water quality technology and software 
simulation.
    The Bureau of Labor Statistics estimates that in Oil and 
Gas and related support industries, almost 60,000 jobs have 
been lost in the U.S. since the price of oil crashed in 
November 1997. Despite the fact that the price of oil has 
rebounded slightly in recent weeks, job losses are expected to 
continue, and state workforce development agencies in energy-
producing states have strained to meet the demands posed by 
these massive layoffs. The Committee is aware of requests for 
dislocated worker discretionary funds to supplement other funds 
in the provision of training and placement services for 
individuals who have lost their jobs in the energy sector in 
areas disproportionately impacted by decreases in energy 
commodity prices.
    The Committee notes that climatic challenges presented in 
the Arctic for oil field development and operations require 
specialized training for workers to meet the high standards of 
the American oil industry. The Committee encourages the 
Department to support a demonstration project to provide 
training to foreign workers, including Russians, in Arctic oil 
field modular construction and management support operations.
    The Committee is aware that the Philadelphia Housing 
Authority and the Detroit Works Partnership are developing a 
national demonstration project to prepare low income residents, 
in Philadelphia and Detroit, to enter into trade skill 
apprenticeship programs and begin on a career path with a 
livable wage and financial stability. This national 
demonstration model will provide incentives, supervision, 
internal support and realistic exposure to work experience 
necessary to support unemployed and underemployed Philadelphia 
and Detroit residents transitioning to sustained employment.
    Manufacturing employers throughout the nation have 
indicated that their need for skilled manufacturing workers 
will escalate dramatically in the foreseeable future as a 
result of an increased demand for manufactured goods combined 
with a higher rate of present worker retirement. The Committee 
believes that it is in the best interest of the country to 
address the critical shortage of highly skilled manufacturing 
workers not only for the purpose of keeping America competitive 
but also as a matter of national security. The program underway 
in central Iowa called SMART Partners (Skills for Manufacturing 
in America Right for Tomorrow) could be a model for addressing 
how the highly skilled future manufacturing workforce could be 
developed and sustained through public-private partnerships. 
Des Moines Area Community College is leading the effort to 
partner with key industries, area high schools, School-to Work 
and Tech Prep initiatives, and minority communities to inform 
and recruit young women and men into high skilled manufacturing 
careers. This project is an industry-driven ``integrated 
manufacturing'' community college education program in which 
industry partners will guarantee full-time employment to those 
students who meet the competencies and skill standards required 
in modern advanced high performance manufacturing.
    The Committee also is aware of the Department of Labor's 
collaboration with the Manufacturing Skill Standards Counsel 
(MSSC). MSSC is a National Skill Standards Board voluntary 
partnership that represents the manufacturing industry and 
businesses throughout the United States and is defining the 
skill requirements for work in high skilled manufacturing 
settings. The Department of Labor plans are to integrate the 
skill requirements of the manufacturing industry into the 
nationwide Occupational Information Network or O*NET. Linking 
them to the job openings and resumes in America's Job Bank and 
Talent Bank respectively can add real value to the schools and 
other training providers engaged in guiding young careers 
towards manufacturing and designing curriculum to help young 
women and men acquire the skills necessary in the new high-
skills, high wage careers of the advanced manufacturing 
industry. The Committee encourages the Department of Labor to 
explore various ways to build on partnership efforts such as 
the SMART Partners Program and the MSSC.
    The Committee is aware of a proposal from Chipola Junior 
College for education challenge grants to help retrain 
dislocated workers for jobs that already exist in Jackson and 
Gulf Counties in Florida. The Committee recommends that full 
and fair consideration be given to requests for dislocated 
worker funds to supplement other funds in this proposal. These 
funds would permit the College to train these dislocated 
workers in the allied health professions which cannot be filled 
by the existing workforce.
    The Committee is aware of the Puget Sound Center for 
Teaching, Learning and Technology (PSC), a collaborative 
partnership of Shoreline Community College, Edmonds Community 
College, and the Morgridge Family Foundation. The Puget Sound 
Center for Teaching, Learning and Technology will help 
alleviate the critical shortage of information technology 
workers in the Puget Sound region. PSC will focus on high end 
information technology training certification for incumbent and 
unemployed workers, basic computer application training for 
high-risk youth and academically and educationally 
disadvantaged adults, and high school students who are 
interested in careers in information technology.
    The Committee recognizes a proposed program at the 
University of Albany which will be aimed at creating a platform 
for workforce training in a real manufacturing environment to 
take advantage of new computer chip fabrication plants expected 
to come online domestically in the next year or two. The 
laboratories will be the basis for the creation of a statewide 
distributed-learning network that taps into the combined 
educational resources of the state's 2- and 4-year colleges, as 
well as research universities, to provide viable instructional 
programs for workforce training and retraining in a real 
manufacturing environment.
    The Committee recognizes an effort to expand a program in 
New Mexico of intensive services for training and employment of 
dislocated workers and other eligible workers in new 
telecommunications industry jobs, including expansion of the 
program into low-income rural areas.
    To help disadvantaged and dislocated workers, the Committee 
is aware of efforts to create the Virginia Peninsula Workforce 
Development Center in Virginia.
    The Committee understands that the University of Idaho, as 
the State's land grant institution, proposes to build upon its 
existing statewide cooperative education network, distance 
education capabilities, and partnerships with other educational 
institutions, government agencies, communities, and the private 
sector, to coordinate an education and training assistance 
program to help those dislocated from agriculture to make the 
difficult shift to an alternative career. An integrated program 
could provide short-term technical training, remote 
participation in educational and training programs, and 
financial assistance to those who choose to pursue or complete 
a degree.
    The Committee recognizes the importance of the proposed 
maintenance and training complex at the Pittsburgh 
International Airport to the Southwestern Pennsylvania region. 
The Department is urged to work with Allegheny County officials 
to develop a job training plan to upgrade the skills of airline 
maintenance employees, enabling them to work on newer aircraft 
which the proposed maintenance complex would service.
    During defense downsizing in St. Louis in the early 1990s, 
the Committee understands that approximately 5 percent of the 
displaced workers chose to start their own business. The 
Committee recognizes the past efforts of the St. Louis County 
Economic Council as the lead agency for the St. Louis 
Metropolitan Defense Adjustment Program in developing a 
regional business incubator system to launch successful 
businesses. Two incubators were operated to assist displaced 
workers with small businesses and technology enterprises, and 
additional assistance was provided for counseling, technical 
assistance, and loans/equity investment in qualified St. Louis 
business enterprises. With significant layoffs at the Boeing 
Corporation and the recent loss of 4,000 jobs at the former 
ATCOM facility, the Committee urges the Secretary to take the 
necessary steps to support a small business incubator and loan 
fund program to serve displaced defense-related workers in the 
greater St. Louis area.
    Youth activities.--For Youth Activities, the Committee 
recommends $1,000,965,000, the same as the 1999 comparable 
level. Youth Activities, authorized by WIA, consolidates the 
Summer Youth Employment and Training Program under JTPA Title 
IIB, and Youth Training Grants under JTPA Title IIC. In 
addition to consolidating programs, WIA also requires Youth 
Activities to be connected to the One-Stop system as one way to 
link youth to all available community resources. The purpose of 
Youth Activities is to provide eligible youth with assistance 
in achieving academic and employment success through improving 
educational and skill competencies and providing connections to 
employers. Other activities include providing mentoring 
opportunities, opportunities for training, supportive services, 
summer employment opportunities that are directly linked to 
academic and occupational learning, incentives for recognition 
and achievement, and activities related to leadership 
development, citizenship, and community service.
    Youth opportunity grants.--For Youth Opportunity Grants, 
the Committee recommends $250,000,000, the same level as the 
1999 comparable level. Youth Opportunity Grants are newly-
authorized in the recent Workforce Investment Act. These grants 
are aimed at increasing the long-term employment of youth who 
live in empowerment zones, enterprise communities, and other 
high-poverty areas. Recent surveys conducted by the Department 
of Labor have found employment rates for out-of-school youth as 
low as 24 percent in selected high-poverty neighborhoods. Youth 
Opportunity Grants will attempt to dramatically increase these 
employment rates, and thus improve all aspects of life for 
persons living in these communities.
    School-to-work opportunities.--For School-to-Work 
Opportunities, the Committee recommends $55,000,000. This is 
$70,000,000 less than the 1999 comparable level. School-to-Work 
is an educational strategy that aims to improve learning by 
connecting what goes on in the classroom to future careers and 
to real work situations, and to increase student access to a 
range of opportunities for postsecondary education and advanced 
training. Through the School-to-Work Opportunities Act, 
operated through a partnership between the Departments of 
Education and Labor, every State has access to seed money to 
design and implement a comprehensive school-to-work transition 
system. These systems are integrating academic and vocational 
education, linking secondary and postsecondary education, and 
providing learning opportunities at the work site. Students in 
School-to-Work systems are expected to meet high State academic 
standards. States and localities have broad latitude to design 
systems that include the core components of school-based 
learning, work-based learning, and connecting activities.
    Job Corps.--For Job Corps, the Committee recommends 
$1,347,191,000. This is $37,977,000 more than the 1999 
comparable level. Job Corps, authorized by WIA, is a nationwide 
network of residential facilities chartered by federal law to 
provide a comprehensive and intensive array of training, job 
placement and support services to at-risk young adults. The 
mission of Job Corps is to attract eligible young adults, teach 
them the skills they need to become employable and independent, 
and place them in meaningful jobs or further education. 
Participation in the program is voluntary and is open to 
economically disadvantaged young people in the 16-24 age range 
who are unemployed and out of school. Most Job Corps students 
come from disruptive or debilitating environments, and it is 
important that they be relocated to residential facilities 
where they can benefit from the highly structured and carefully 
integrated services provided by the Job Corps program. A 
limited number of opportunities are also available for non-
residential participation.
    The Committee encourages Job Corps to establish effective 
working relationships with work force development entities, 
including employers, that will enhance services to students and 
increase students' career opportunities. The Department is 
encouraged to intensify its efforts to meet industry standards 
in its occupational offerings by developing a multiyear process 
to review, upgrade, and modernize its vocational curricula, 
equipment, and programs in order to create career opportunities 
for students in appropriate growth industries. The Committee 
also encourages the Department of Labor's Employment and 
Training Administration to encourage Job Corps centers to 
coordinate with community-based organizations, such as 
substance abuse treatment centers, in innovative ways.
    The Committee understands that the Job Corps program has 
procedures in place to help Centers establish on-site childcare 
facilities. The Committee is aware of a partnership that has 
been formed between the Northlands Job Corps Center and the 
Vermont Agency of Human Services to better match the resources 
of the Job Corps program with the needs of single mothers 
seeking to gain financial independence through job training.
    The Committee supports the goal of the Workforce Investment 
Act of 1998 to integrate our nation's many diverse job training 
programs, and its approach of retraining the national character 
of the Job Corps program within the new framework. The 
Committee encourages the Department to continue its work to 
develop national partnerships with major regional and national 
employers to increase employment opportunities for Job Corps 
graduates. The Department should also continue to establish 
connections between Job Corps and State workforce development 
programs, and between Job Corps and other national and 
community partners, to provide the most efficient, cost-
effective services possible.
    The Committee recognizes the importance of providing 
appropriate education and professional development to ensure 
future management leadership of the Job Corps, and encourages 
the Department to conduct a demonstration program which would 
address this concern.
    In January, the Department designated Carville, Louisiana; 
Exeter, Rhode Island; Hartford, Connecticut; and Wilmington, 
Delaware as the sites for four new Job Corps centers. The 
Committee requests the Department provide a detailed report on 
progress in constructing these four centers, including the most 
current projections for their commencing operations.
    The Committee encourages the Department of Labor to pursue 
funding in its fiscal year 2001 budget request to expand the 
Job Corps program, and urges that consideration be given to 
expansion in states that have the lowest percentages of youth 
served by Job Corps.
    Native Americans.--For Native Americans, the Committee 
recommends $60,000,000. This is $2,185,000 more than the 1999 
comparable level. This program, authorized by WIA, is designed 
to improve the economic well-being of Native Americans 
(Indians, Eskimos, Aleuts, and Native Hawaiians) through the 
provision of training, work experience, and other employment-
related services and opportunities that are intended to aid the 
participants to secure permanent, unsubsidized jobs. The 
Department of Labor allocates formula grants to Indian tribes 
and other Native American groups whose eligibility for such 
grants is established in accordance with Department's 
regulations.
    The Committee recommendation includes $55,000,000 for 
Indian Workforce Investment Act programs, an increase of 
$1,185,000 over the budget request, which is necessary to 
fulfill the WIA statutory requirement. The Committee also 
stresses the need for heightened intra-agency and inter-agency 
coordination to ease the transition of native communities from 
welfare to work.
    The Committee recognizes requests for the State of Hawaii 
to complete the co-location of Federal and State funded work 
force investment activities. Consistent with fiscal year 1999, 
these funds will be administered by the Department of Housing 
and Urban Development through an inter-agency transfer. There 
are approximately 20,000 to 25,000 American Samoans residing in 
Hawaii. The indigenous people have a unique status as U.S. 
nationals and are the only Pacific islander people under 
territorial protection of the United States possessing the 
right to travel freely throughout the U.S. states and 
territories. The center is located in public housing at Kuhio 
Park Terrace/Kuhio Homes.
    Migrant and seasonal farmworkers.--For Migrant and Seasonal 
Farmworkers, the Committee recommends $75,996,000. This is 
$2,521,000 less than the 1999 comparable level. This program, 
authorized by WIA, is designed to serve members of economically 
disadvantaged families whose principal livelihood is derived 
from migratory and other forms of seasonal farmwork, or 
fishing, or logging activities. Through training and other 
employability development services, the program prepares 
eligible seasonal farmworkers and their family members for 
stable, year-round employment, both inside and outside of the 
agricultural industry. The program also provides health care, 
day care and other supportive services for farmworkers who 
choose to stay in agriculture. At least 94 percent of each 
year's appropriation is allocated to States according to a 
population-based formula. The remainder of each year's 
appropriation is set aside for technical assistance to grantees 
and for other special projects to benefit seasonal farmworkers 
such as the Migrant Farmworker Housing Program.
    For migrant and seasonal farmworker housing, the Committee 
recommendation includes $3,000,000, the same as the fiscal year 
1999 level.
    The Committee understands that the Department of Labor has 
implemented a new Migrant and Seasonal Farmworker allocation 
formula. To hold those states harmless who were adversely 
affected by this change, and to restore funding to the PY 1998 
level, the Committee recommends $1,551,000 to be available 
immediately for PY 1999, and an additional $2,928,000 be 
available in PY 2000. The Committee takes this action as a 
temporary measure to provide additional time to develop a long-
range solution through the authorization process.
    The Committee believes that the Association of Farmworker 
Opportunity Programs (AFOP) provides valuable assistance to 
JTPA and WIA grantees serving migrant and seasonal farmworker 
adults and youth in the form of technical assistance and 
training and serves as a reliable, unified voice of the larger 
grantee community. The Committee encourages the Department of 
Labor to continue to support AFOP's technical assistance and 
training activities.
    The Committee notes that in the last few years, the 
seasonal agriculture industry has reported critical labor 
shortages, prompting some growers to seek the importation of 
foreign non-immigrant workers to cultivate and harvest their 
crops. These shortages have been reported despite high rates of 
unemployment in major agricultural counties. The Committee 
recognizes the Administration's efforts to develop an 
Agricultural Labor Network (AgNet) to help meet the needs of 
American agriculture and U.S. agricultural workers by affording 
growers access to a timely and legal U.S. agricultural work 
force. The Committee believes that AgNet should be designated 
to provide an efficient and expeditious means of matching 
qualified U.S. workers with employment opportunities in 
seasonal agriculture. Given the critical importance for the 
nation's food production system to have an effective tool for 
linking domestic farmworkers and agricultural employment, the 
Committee will reconsider the matter upon receipt of a more 
specific proposal from the Department.
    Veterans workforce investment programs.--For Veterans 
Workforce Investment Programs, the Committee recommends 
$7,300,000. This is the same as the 1999 comparable level. This 
budget activity, authorized by WIA, supports efforts to provide 
lifelong learning and skills development to veterans who have 
service-connected disabilities, who have significant barriers 
to employment, who served on active duty in the armed forces 
during a war or in a campaign or expedition for which a 
campaign badge has been authorized, or who are recently 
separated.
    National programs.--For National Programs, the Committee 
recommends $130,598,000. This is $43,000,000 more than the 1999 
comparable level. This activity includes WIA-authorized 
programs in support of the workforce system including technical 
assistance and incentive grants, evaluations, pilots, 
demonstrations and research. In addition, the activity includes 
the National Skills Standards Advisory Board, Women in 
Apprenticeship, and the Homeless Veterans Reintegration 
Project.
    Technical Assistance/Incentive Grants.--The Committee 
recommends $5,000,000 for the provision of technical 
assistance, staff development, and replication of programs of 
demonstrated effectiveness; as well as incentive grants to each 
State that exceeds State adjusted levels of performance for WIA 
State programs.
    Pilots and Demonstrations.--The Committee recommends 
$98,500,000 for grants or contracts to conduct research, pilots 
or demonstrations that improve techniques or demonstrate the 
effectiveness of programs.
    Recognizing the severity of addressing the problem faced by 
youth who are or have been under the criminal justice system, 
the Committee is encouraged by the Department of Labor's 
progress in awarding grants to communities to test creative 
ways to link job training and employment activities and 
juvenile justice activities to significantly reduce recidivism, 
gang involvement and community-wide delinquency among low-
income youth and to increase their educational attainment and 
employment. The Committee recommends $15,000,000 to continue to 
strengthen and expand the number of grants awarded to 
communities committed to strengthen the coordination of 
prevention and recovery services for juveniles and exhibiting a 
high degree of resource integration that results in improved 
services to low-income, at-risk youth. Among the programs and 
efforts that communities will be encouraged to link to are 
formula-funded youth training and employment activities under 
the Workforce Investment Act, the Youth Opportunities grant 
program, School-to-Work activities, Safe Schools/Healthy 
Students programs, and other Federal programs and efforts that 
could contribute to juvenile crime prevention such as 
vocational-technical education, YouthBuild, and Safe Future and 
Juvenile Justice gang prevention, intervention and suppression 
activities.
    The Committee acknowledges changes under the Workforce 
Investment Act to develop and implement techniques and 
approaches, and demonstrate the effectiveness of specialized 
methods, of addressing the employment and training needs of 
individuals. The Committee encourages the Department to ensure 
that these projects are coordinated with local boards. Most new 
awards are subject to competitive requirements, unless projects 
are funded jointly, with other public or private entities 
providing a portion of funds. Appropriate time limits are 
established for projects. Grant applications for over $500,000 
are subject to peer review. The Committee encourages the 
Department of Labor to consider project performance, demand for 
activities or services, and fund utilization in making 
decisions to continue project investments and to ensure that 
project performance is adequately documented and evaluated.
    The Committee recommendation includes funds to continue 
those projects, listed below, which were awarded through the 
Congressionally authorized competition in fiscal year 1999 for 
meeting the needs of a skilled workforce. The Department is 
encouraged to take into account project performance and 
utilization of prior year funding when using these funds.
    The Committee recognizes that the hardest to employ 
individuals have many barriers to employment and need access to 
a wide range of services, including life skills training, 
remedial education and occupational training. The Committee 
understands that with additional funding there may be a number 
of promising approaches to help those at-risk individuals 
obtain and retain employment, including more formal replication 
of the model Argus Learning for Living Program. The Committee 
further recognizes the importance of the Department's 
activities to partner with other private and public entities to 
study these approaches using independent, objective, formal 
evaluations.
    The Committee recommendation includes funding for the 
continuation of the Samoan/Asian Pacific Island job training 
program in Hawaii. The funding will be used to conduct targeted 
outreach in the Samoan community through the Samoan Providers 
Association [SPA] and for two one-stop job help stores which 
will provide access to bilingual and vocational education, job 
training and placement services, and outreach/distribution 
services in predominately immigrant communities. The Committee 
appreciates the Department's support of this program, which has 
been very beneficial.
    The Committee recommends continued funding, based on 
demonstrated performance, for special native Hawaiian 
vocational education demonstration initiatives that provide 
basic education skills and preemployment tutoring for high-risk 
youth residing in rural communities, with an emphasis on 
vocations that benefit these communities, such as child care 
workers and teachers.
    The Committee continues to recognize that, due to the 
geographic isolation associated with rural communities in the 
States of Alaska and Hawaii, disadvantaged populations residing 
in these areas lack access to skill training programs, 
education opportunities, and other self-development initiatives 
which has contributed to the high rates of poverty, 
unemployment, school dropouts, teen pregnancy, substance abuse, 
and mental illness.
    The Committee recommends continued funding for projects to 
support training, education, and employment and entrepreneurial 
opportunities to improve the economic health and welfare of 
adults on the neighbor islands and Hawaii and in Alaska. In 
Hawaii, the Committee urges that community colleges be the 
focal point of these programs. In Alaska, taking into account 
the rate of fund utilization, the Committee suggests that of 
the funds provided, 40 percent would be provided to Ilisagvik 
College in Barrow, AK, 30 percent would be provided to Kawerak, 
Inc., in Nome, AK and 20 percent to Koahnic Broadcasting, Inc. 
in Anchorage, AK for continuation or initiation of vocational 
job training programs for Alaska Natives and 10 percent to the 
Yukon-Kuskokwim Health Corporation in Bethel, AK.
    The Committee is aware of a request for funding for the 
Alaska Native Heritage Center to train Alaska Natives as 
cultural tour guides for the new Native Heritage Center and to 
create an apprenticeship program for young Native artists to 
study with established Alaska Native artists-in-residence at 
the Center. This project will create jobs and cultural 
awareness for Native youth and will help develop artistic 
skills and techniques in young Native artists. The Committee is 
aware of a project to develop joint educational and cultural 
programs based on China trade patterns among the Alaska Native 
Heritage Center, the Peabody-Essex Museum in Salem, 
Massachusetts and the Bishop Museum in Hawaii. Further, the 
Committee is also aware of funding needs for similar training 
projects being developed by these two institutions to train 
area low income youths for jobs as cultural tour guides and in 
museum operations.
    The Committee recommends continued support for the Alaska 
Federation of Natives Foundation consistent with the goals of 
the AFN Foundation bylaws, section 13, to develop and train 
highly skilled Alaska native workers for year-round employment 
within the petroleum industry in Alaska. The Committee 
recommends that the Department make these funds available to 
match contributions under the 1995 Alaska Native Utilization 
Agreement and that such funds be expended with the advice and 
consent of the advisory board established under section 9 of 
the Alaska Native Utilization Agreement.
    The Committee recommends continued funding of the 
Springfield Workforce Development Center in Springfield, 
Vermont, which is eligible to apply under a competition for 
financial support. With additional federal funding, this center 
could demonstrate the use of technology to train highly skilled 
employees for careers in machine technology, hospitality and 
travel, financial services and food services.
    The Committee recommendation includes funding to conduct 
projects that demonstrate efficient and effective 
methodologies, consistent with the Workforce Investment Act, to 
prepare disenfranchised populations not participating in the 
U.S. economy with the high skills necessary to work within a 
high technology economy.
    The Labor Department is encouraged to continue and provide 
technical assistance to the Role Models America Academy 
demonstration program.
    The Committee notes that the Lower Merrimack Valley 
Regional Employment Board and the Lowell Regional Employment 
Board are requesting funds for a Department of Labor pilot 
program to assist welfare recipients gain economic self-
sufficiency. Funds would be used to increase the number of 
child care providers offering services during nontraditional 
hours, and support individualized transportation options to 
both the workplace and the childcare provider.
    The Committee notes that Jobs for the Future Foundation in 
Boston, Massachusetts is requesting funds to enable it to study 
aspects of the implementation of the Workforce Investment Act 
and related education and training legislation and to provide 
periodic reports to the Department of Labor and the workforce 
investment system. Funds used would complement--and not 
duplicate--ongoing WIA and related implementation activities.
    The Committee is aware of plans by the Urban League of 
Nebraska, in collaboration with First Data Resources and Xerox, 
to propose a welfare-to-work pilot program and to seek funds to 
establish the program. The program hopes to work with 50 to 100 
participants, creating jobs paying approximately $9 per hour.
    The Committee is aware of plans to develop a Regional 
Center for Education and Work at the University of Missouri-St. 
Louis. The project would support start-up, design, 
implementation, and testing of a new model for regional 
resources that unites major teacher preparation and 
professional development agencies with key labor and business 
organizations. The Regional Center for Education and Work would 
represent a unique central resource for workplace skills 
testing, training, and education.
    The Committee recognizes that Focus HOPE, an innovative 
Detroit based human rights organization with a mission of 
education and training, is expanding its efforts into the 
information technology industry. While this expansion will 
receive some private funding, additional financial assistance 
from the federal government is also needed to help with the 
start up of the program.
    The Committee understands that the City of San Francisco's 
Life Learning Academy serves 60 students, ages 14 to 18, who 
have come into contact with the juvenile justice system. With 
additional funding, more students could be served. Students 
participate in rigorous academic and project-based learning. 
The Academy's curriculum is organized around vocationally 
oriented themes and activities, including life skills and other 
programs where students work at a cafe and learn to cook, 
package and sell food.
    The Committee is aware that the National Guard Youth 
Challenge program has been successful in helping young people 
obtain job skills and employment, and urges the Department of 
Labor to collaborate with the Department of Defense in 
augmenting existing funding. Twelve states are not yet served.
    The Committee is aware of that the State of Vermont faces 
significant challenges providing a sufficient number of skilled 
workers to serve a growing number of high technology 
manufacturing companies. Many students discover, late in their 
high school education, that these jobs require three years of 
upper level math and science prior to taking a two-year 
technically oriented college program. Vermont's Learn to Earn 
program is a business-job training partnership that provides 
pre-employment counseling to students and parents concerning 
the courses students will need to take to qualify for these 
jobs. With additional federal funding, this program could be 
replicated throughout the state.
    The Committee is aware of the South Carolina workforce 
development project undertaken by Economic Development, Inc. 
This project will assess the gap between employer skill needs 
and current and prospective employee skills in a way that goes 
beyond the education and skills needed for certain jobs, and 
leads to a strategy which addresses identified training needs 
through an ongoing public-private partnership.
    The Committee is aware that the Collegiate Consortium for 
Workforce and Economic Development (formerly the Shipyard 
College) provides workforce training to support economic 
development initiatives in the Philadelphia region. Federal 
funding is needed for curriculum and materials, development, 
establishment of a technology-based distance learning center, 
development of a new regional computer training academy, and 
establishment of a transportation-oriented technology delivery 
system.
    The Committee recognizes that historically black colleges 
and universities (HBCUs) can provide unique and valuable 
program services to develop and expand long-term education and 
career employment programs for low-income adults under the 
Workforce Investment Act and hard-to-employ welfare recipients 
under the Welfare-to-Work program--particularly single, female-
headed families. The Committee is aware that Vorhees College is 
an example of HBCU's efforts in helping such welfare recipients 
progress toward self-sufficiency. The Committee encourages the 
Department of Labor to continue to provide technical assistance 
to HBCUs to enable them to compete for pilot and demonstration 
grant opportunities issued by the Department of Labor and to 
enhance opportunities for them to offer their services to State 
and local workforce investment boards under the WIA.
    The Committee is aware of and supports the innovative and 
effective efforts of Green Door in Washington, D.C. to 
coordinate with appropriate local public and private agencies 
to provide comprehensive services, including job training and 
placement, to prepare people with severe and persistent mental 
illness to work and live independently.
    The Committee recognizes the outstanding efforts of the 
George Gervin Youth Center in San Antonio, Texas in 
successfully training at-risk teenage youth in a variety of 
highly marketable construction skills and then facilitating the 
utilization of those young people and skills in the 
construction of homes for low income families.
    The Committee is aware that Jobs for America's Graduates 
(JAG) is the nation's largest school-to-work system for at-risk 
and disadvantaged youth. Since its inception nearly twenty 
years ago, JAG has served 250,000 at-risk youth people. Some 
50,000 young people in 800 high schools in twenty-eight states 
and territories will be enrolled this year. JAG has a 90 
percent graduation rate, an overall 80 percent success rate at 
the end of twelve months of follow-up after leaving school, and 
thirty percent improvement in employment for this high-risk 
population. JAG is organized around state affiliates which are 
the fully authorized and accredited sponsors of the JAG 
programs in their states. The Committee requests that the 
Department of Labor consider including within its technical 
assistance plans to improve the quality of services to 
disadvantaged youth, the successful activities of Jobs for 
America's Graduates (JAG) and thus, expand this successful 
intervention to disadvantaged youth.
    The Committee is aware of a proposal from Jefferson State 
Community College in Alabama to establish a one-stop workforce 
development center at which targeted employee training, 
employee skill assessment, job placement and leadership 
development for strategic economic planning will occur.
    The Committee is aware that Peirce College in Philadelphia 
County operates a Center for the Development of Urban 
Entrepreneurs. Funds would be used to assist this Center in 
providing workplace skills, training, and certificate programs 
to Philadelphia area workers.
    The Committee is aware of the job-training activities of 
the Intertribal Bison Cooperative located in Rapid City, South 
Dakota related to the reintroduction of bison to native 
cultures. These efforts are bringing vocational training and 
work experience to 47 native tribes in a number of areas such 
as animal husbandry and herd management, meat processing, hide 
tanning and leather work.
    The Committee is aware that Lorain County Community College 
(LCCC) is proposing a workforce demonstration focused on three 
regional growth occupations in Northeast Ohio--engineering, 
information technologies, and allied health. LCCC is proposing 
to provide greater incentives and access for training as well 
as career placement through a unique distance learning program 
that provides opportunities for applied experience and solid 
linkages to regional employment.
    The Committee is aware of a proposal by the Vermont 
Technical College, University of Vermont, and the Vermont 
Department of Labor's innovative program that addresses the 
difficult issue of underemployment by providing Vermonters with 
the skills they require for jobs in the 21st Century.
    The Committee recognizes that the Alaska Works program will 
train chronically unemployed, unskilled Alaska Natives and 
other residents of rural Alaska to qualify for the many 
skilled, well-paid jobs that are expected to be available in 
Alaska over the next several years. Approximately 13,000 
persons are employed in the construction industry in Alaska and 
there is a need for another 1,000 skilled workers in 1999. 
Alaska natives are under-represented by over 40 percent in the 
construction industry in Alaska. The Committee encourages the 
Alaska Works program to coordinate with State and local 
workforce investment boards to eliminate this disparity.
    The Committee is aware of the need for comprehensive 
vocational/technical training for youth and adults in the 
interior region of Alaska to prepare them for existing and 
emerging jobs in interior Alaska. The Hutchison Career Center 
is a partnership between the Tanana Valley Campus of the 
University of Alaska Fairbanks and the Fairbanks North Borough 
School District. Funding would help to equip and upgrade this 
training center. When complete, the center is expected to serve 
480 high school students and 500 adults, year round, to provide 
technical training beginning in high school and finishing in 
one or two years with a certificate or associate in TVC 
programs located in the same facility.
    The Committee is aware of the interest in the Center for 
Workforce Preparation at the Chamber of Commerce in partnering 
with the Department of Labor to provide information and best 
practices to American business--particularly small- and medium-
size companies to strengthen active partnerships with local 
workforce investment systems. If the Chamber of Commerce is 
successful and funds are provided, the nature of these 
partnerships could result in active participation on local 
workforce investment boards and ultimately, in more employment 
opportunities for Americans, including welfare recipients and 
other low-income, low skilled workers.
    Right Track Partnerships.--The Administration requested 
$75,000,000 for this new competitive grant program under WIA 
Pilot, Demonstration, and Research authority. The program's 
goal is intended to prevent economically disadvantaged youth 
from dropping out of school and to encourage those who already 
have done so to return to school. However, due to severe 
budgetary constraints, the Committee recommendation does not 
include funding for this new program.
    Research and evaluation.--The Committee recommends 
$9,098,000 to provide for the continuing evaluation of programs 
conducted under WIA, as well as of federally-funded employment-
related activities under other provisions of law.
    National Skills Standards Advisory Board.--The Committee 
recommends $7,000,000 for the Board to continue the development 
of voluntary partnerships.
    Homeless Veterans Reintegration Project.--The Committee 
recommends $10,000,000 for this program assisting homeless 
veterans to find jobs, $5,000,000 above the President's request 
and $7,000,000 above the fiscal year 1999 level.
    Women in Apprenticeship.--The Committee recommends 
$1,000,000 to continue the current level of the Women in 
Apprenticeship and Nontraditional Occupations program. This 
activity provides technical assistance to employers and unions 
to assist them in training, placing, and retraining women in 
nontraditional jobs and apprenticeships.

            community service employment for older americans

Appropriations, 1999....................................    $440,200,000
Budget estimate, 2000...................................     440,200,000
Committee recommendation................................     440,200,000

    The Committee recommends $440,200,000, the same as the 
budget request and the same as the fiscal year 1999 
appropriation for community service employment for older 
Americans. The Committee recommends 78 percent of the funds for 
national sponsors and 22 percent for State sponsors; this is 
the same percentage distribution as has been required by 
apropriations law for the past several years. This program, 
authorized by title V of the Older Americans Act, provides 
part-time employment in community service activities for 
unemployed, low-income persons aged 55 and over. It is forward-
funded from July to June, and the 2000 appropriation will 
support the program from July 1, 2000, through June 30, 2001. 
These funds are to be distributed in the same manner as 
currently authorized under the Older Americans Act, unless this 
law is subsequently altered. Current law states that title V 
funds should be targeted to eligible individuals with the 
greatest economic need. The Committee believes that within the 
title V community service employment for older Americans, 
special attention should be paid to providing community service 
jobs for older Americans with poor employment prospects, 
including individuals with a long-term detachment from the 
labor force, older displaced homemakers, aged minorities, 
limited English-speaking persons, and legal immigrants.
    The Committee is concerned about alleged program 
irregularities reported by the Inspector General, attributed to 
a national sponsor, and notes that appropriate avenues of 
resolution are being pursued. Currently, grants are awarded 
annually to sponsoring organizations and agencies on a non-
competitive basis. The Committee recommends that if 
satisfactory resolution of irregularities with a national 
sponsor is not accomplished, that consideration be given to 
awarding such grant funds, competitively or through other 
means, among the other national sponsors, taking into 
consideration performance and the difficulty in reaching target 
populations. Implementing such a modification must, however, be 
sensitive to the need to avoid disruption to program 
participants in the event of a change in grantee.

              federal unemployment benefits and allowances

Appropriations, 1999....................................    $360,700,000
Budget estimate, 2000...................................     314,400,000
Committee recommendation................................     415,150,000

    The Committee recommends $415,150,000, an increase of 
$100,750,000 over the budget request and an increase of 
$54,450,000 above the 1999 enacted level for Federal 
unemployment benefits and allowances. These are entitlement 
funds.
    The trade adjustment line item has two activities totaling 
$349,000,000 in fiscal year 2000.
    The first activity, trade adjustment assistance benefits, 
provides for special unemployment benefit payments to workers 
as authorized by the Trade Act of 1974, as amended. For this 
activity the Committee recommends $255,000,000. This is an 
increase of $43,000,000 above the budget request and an 
increase of $37,000,000 above the 1999 comparable level. These 
funds will permit payment of benefits, averaging $222 per week, 
to 37,700 workers for 2000. Of these workers, 24,100 will 
participate in training programs, receiving benefits for an 
average of 30.5 weeks. The remaining 9,600 workers receiving 
benefits will receive training waivers and collect benefits.
    The second activity, trade adjustment assistance training, 
provides training, job search, and job relocation allowances to 
workers adversely affected by imports. The funding for this 
activity is also authorized under the Trade Act of 1974, as 
amended. The Committee recommends $94,000,000 for this 
activity. This is a decrease of $400,000 below the budget 
request and a decrease of $300,000 below the 1999 comparable 
level. These funds will provide services for an estimated 
25,600 workers.
    For NAFTA activities, $66,150,000 is provided, in two 
components.
    The first component, NAFTA transitional adjustment 
assistance benefits, provides for weekly benefit payments to 
workers affected by imports from Mexico and Canada. These 
payments are also authorized by the Trade Act of 1974, as 
amended as a result of the signing of the North American Free 
Trade Agreement [NAFTA]. The Committee recommends $29,000,000 
for this activity. This is $21,000,000 more than the budget 
request and an increase of $3,000,000 over the 1999 comparable 
level and represents the current services funding level.
    The second component, NAFTA transitional adjustment 
assistance training, provides funds for training, job search 
and job relocation to workers affected by imports from Mexico 
and Canada. The fiscal year 2000 current services 
recommendation is $37,150,000, an increase of $14,750,000 over 
the fiscal year 1999 enacted level.
    The Administration has not only requested an extension of 
NAFTA-TAA but also proposed related legislative reforms for 
programs funded herein. The Committee recommendation is based 
on the Department's midsession review estimates for the 
currently-expiring legislation. Resources related to the 
Administration's legislative proposals will be considered upon 
enactment of the requested legislation.

     state unemployment insurance and employment service operations

Appropriations, 1999....................................  $3,262,630,000
Budget estimate, 2000...................................   3,506,773,000
Committee recommendation................................   3,358,073,000

    The Committee recommends $3,358,073,000 for this account. 
This is $148,700,000 below the budget request and $95,443,000 
above the 1999 comparable level. Included in the total 
availability is $3,161,121,000 authorized to be drawn from the 
``Employment Security Administration'' account of the 
unemployment trust fund, and $196,952,000 to be provided from 
the general fund of the Treasury.
    The funds in this account are used to provide 
administrative grants and assistance to State agencies which 
administer Federal and State unemployment compensation laws and 
operate the public employment service.
    For unemployment insurance [UI] services, the bill provides 
$2,315,958,000. This total includes a regular contingency 
amount of $151,333,000 which may be drawn from the ``Employment 
Security Administration'' account of the unemployment trust 
fund. In addition the bill further provides for a second 
contingency amount should the unemployment workload exceed an 
average weekly insured claims volume of 2,638,000. This second 
contingency amount would fund the administrative costs of 
unemployment insurance workload over the level of 2,638,000 
insured unemployed per week at a rate of $28,600,000 per 
100,000 insured unemployed, with a pro rata amount granted for 
amounts of less than 100,000 insured unemployed.
    The unemployment insurance service recommendation provides 
an increase of $21,443,000 above the fiscal year 1999 level. 
The allowance includes $2,154,625,000 for State operations, a 
decrease of $51,500,000 below the budget request. Included in 
the Committee recommendation is $39,500,000 for UI integrity 
and other activities that States determine are essential in the 
administration of the UI program, a $19,500,000 increase over 
the fiscal year 1999 level. The Department shall allocate these 
funds to the states in the same manner as directed by the 
Fiscal Year 1999 Conference Report.
    Included in the net change for UI is a decrease of 
$40,000,000 resulting from the one-time appropriation of this 
amount in 1999 for Y2K needs.
    The Committee encourages the Labor Department to work with 
the Commonwealth of Pennsylvania, Department of Labor and 
Industry, to study the financial impact of professional 
employer arrangements on the Unemployment Compensation Fund.
    For the employment service, the Committee recommends 
$868,615,000 which includes $23,452,000 in general funds 
together with an authorization to spend $845,163,000 from the 
``Employment security administration'' account of the 
unemployment trust fund.
    Included in the recommendation for the employment service 
[ES] is $761,735,000 for State grants, available for the 
program year of July 1, 2000, through June 30, 2001. This is 
the same as the budget request and the 1999 comparable level. 
Also included is $66,880,000 for national activities, an 
increase of $43,300,000 above the budget request and $7,000,000 
above the 1999 comparable level. This increase above the 2000 
request level of $23,580,000 includes an additional $5,000,000 
for processing of the labor certification workload. Also 
included in the Employment Service recommendation is 
$40,000,000 in trust funds for Reemployment Service Grants as 
part of the overall initiative to begin providing reemployment 
services for all who need them. This funding is targeted to 
expanding services to help workers receiving UI benefits obtain 
the help they need in finding new jobs.
    The recommendation includes $146,500,000 for one-stop 
career centers, which is $2,500,000 below the budget request 
and the same as the 1999 comparable level. This Committee 
recommendation includes funding which is also part of the 
overall initiative to begin providing reemployment services for 
all who need them. It allows for new methods of providing 
employment and related information through America's Labor 
Market Information System and the One Stop system recently 
expanded in the Workforce Investment Act. Activities include a 
``talking'' America's Job Bank for the blind, mobile service 
centers for sparsely populated areas, and a 1-800 service for 
easier access to information to upgrade skills.
    The recommendation includes $27,000,000 for part of the 
President's proposed new Work Incentives Grants program to help 
persons with disabilities find and retain jobs through the One-
Stop Career Center system mandated by the Workforce Investment 
Act. The $27,000,000 provided will support systems building 
grants intended to ensure that one-stop systems integrate and 
coordinate mainstream employment and training programs with 
essential employment-related services for persons with 
disabilities. The Committee has deferred consideration of the 
remaining $23,000,000 of the President's request related to 
work incentive counseling grants, pending authorization for 
these grants in the Work Incentives Improvement Act currently 
being considered by Congress.
    The Committee is concerned about the current state of the 
permanent labor certification program. This program, which 
provides access to needed workers in those cases where a 
shortage of American workers can be shown, is suffering from a 
lack of adequate funding and a significant increase in 
applications received, which has led to problems in 
administering the program.
    The Department of Labor requested a transfer of the alien 
labor certification program from the Employment and Training 
Administration to the Employment Standards Administration, but 
the Committee rejects this transfer proposal as unnecessary. 
Instead, the Committee provides an increase of $5,000,000 over 
the fiscal year 1999 level and directs the Employment and 
Training Administration and the States to work diligently to 
improve the administration of this important program, with the 
intent of eliminating backlogs.
    The Committee agrees that the work opportunity tax credit 
[WOTC], and the welfare-to-work tax credit provide important 
resources to create new jobs, particularly for those Americans 
who would otherwise be dependent on welfare. Therefore, the 
Committee recommendation includes $22,000,000 for these 
initiatives, an increase of $2,000,000 above the request and 
fiscal 1999 enacted level to address the backlog of 
applications.

        advances to the unemployment trust fund and other funds

Appropriations, 1999....................................    $357,000,000
Budget estimate, 2000...................................     356,000,000
Committee recommendation................................     356,000,000

    The Committee recommends $356,000,000 the same as the 
budget request and a decrease of $1,000,000 below the 1999 
comparable level, for this account. The appropriation is 
available to provide advances to several accounts for purposes 
authorized under various Federal and State unemployment 
compensation laws and the black lung disability trust fund, 
whenever balances in such accounts prove insufficient. The bill 
anticipates that fiscal year 1998 advances will be made to the 
black lung disability trust fund.
    The separate appropriations provided by the Committee for 
all other accounts eligible to borrow from this account in 
fiscal year 2000 are expected to be sufficient. Should the need 
arise, due to unanticipated changes in the economic situation, 
laws, or for other legitimate reasons, advances will be made to 
the needy accounts to the extent funds are available. Funds 
advanced to the black lung disability trust fund are now 
repayable with interest to the general fund of the Treasury.

                         program administration

Appropriations, 1999....................................    $144,703,000
Budget estimate, 2000...................................     141,050,000
Committee recommendation................................     149,340,000

    The Committee recommendation includes $103,208,000 in 
general funds for this account, as well as authority to expend 
$46,132,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund, for a total of 
$149,340,000. This is $8,290,000 greater than the budget 
request reflecting the Committee's denial of the Department's 
proposed transfer of the Alien Certification program from ETA 
to ESA.
    General funds in this account provide the Federal staff to 
administer employment and training programs under the Workforce 
Investment Act, the Older Americans Act, the Trade Act of 1974, 
and the National Apprenticeship Act. Trust funds provide for 
the Federal administration of employment security functions 
under title III of the Social Security Act and the Immigration 
and Nationality Act, as amended. Federal staff costs related to 
the Wagner-Peyser Act in this account are split 97 percent to 3 
percent between unemployment trust funds and general revenue, 
respectively.

              Pension and Welfare Benefits Administration


                         SALARIES AND EXPENSES

Appropriations, 1999....................................     $90,570,000
Budget estimate, 2000...................................     101,831,000
Committee recommendation................................      99,831,000

    The Committee recommendation provides $99,831,000 for this 
account, which is $2,000,000 less than the budget request and 
an increase of $9,261,000 over the 1999 comparable level. The 
reduction from the request was necessary due to severe budget 
constraints facing the Committee in fiscal year 2000.
    The Pension and Welfare Benefits Administration [PWBA] is 
responsible for the enforcement of title I of the Employee 
Retirement Income Security Act of 1974 [ERISA] in both civil 
and criminal areas. PWBA is also responsible for enforcement of 
sections 8477 and 8478 of the Federal Employees' Retirement 
Security Act of 1986 [FERSA]. PWBA provides funding for the 
enforcement and compliance; policy, regulation, and public 
services; and program oversight activities.
    The Committee is aware that funding is needing to provide a 
one time increase to process the new Form 5500 Series report 
filing for plan year 1999 in the new ERISA Filing and 
Acceptance System (EFAST) in fiscal year 2000; to expand 
implementation, including compliance assistance, of health 
insurance portability and other reforms under new health 
benefit laws covering private employers; and to provide 
enhanced research and policy analysis on emerging pension and 
health care issues.
    Funding for the implementation of a new system devoted to 
processing form 5500 series financial data required under the 
Employee Retirement Income Security Act will enable employees 
to submit annual benefit plan reports electronically, reducing 
the cost, paperwork burden, and enhancing protection of pension 
funds. The Committee intends for the Internal Revenue Service 
and the Department of Labor to continue to share the ongoing 
operating costs of the system in the same manner as under the 
current system.

                  Pension Benefit Guaranty Corporation

    The Corporation's estimate for fiscal year 2000 includes 
benefit payments of $963,373,000, multiemployer financial 
assistance of $94,331,000, administrative expenses limitation 
of $11,352,000, and services related to terminations expenses 
of $153,599,000.
    The Pension Benefit Guaranty Corporation is a wholly owned 
Government corporation established by the Employee Retirement 
Income Security Act of 1974. The law places it within the 
Department of Labor and makes the Secretary of Labor the Chair 
of its Board of Directors. The Corporation receives its income 
primarily from insurance premiums collected from covered 
pension plans, collections of employer liabilities imposed by 
the act, and investment earnings. It is also authorized to 
borrow up to $100,000,000 from the Treasury. The primary 
purpose of the Corporation is to guarantee the payment of 
pension plan benefits to participants if covered plans fail or 
go out of existence.

                  Employment Standards Administration


                         SALARIES AND EXPENSES

Appropriations, 1999....................................    $315,104,000
Budget estimate, 2000...................................     376,487,000
Committee recommendation................................     342,787,000

    The Committee recommendation includes $342,787,000 for this 
account. This is $33,700,000 less than the budget request and 
an increase of $27,683,000 above the 1999 comparable level. The 
reduction from the request was necessary due to severe budget 
constraints facing the Committee in fiscal year 2000. The bill 
contains authority to expend $1,740,000 from the special fund 
established by the Longshore and Harbor Workers' Compensation 
Act; the remainder are general funds. In addition, an amount of 
$28,676,000 is available by transfer from the black lung 
disability trust fund. This is the same as the request and 
$1,515,000 less than the 1999 comparable level. The Committee 
recommendation supports the budget request for a new equal pay 
initiative which will help improve the way businesses pay their 
employees, and assist in education about the importance of 
equal pay.
    The Employment Standards Administration is involved in the 
administration of numerous laws, including the Fair Labor 
Standards Act, the Immigration and Nationality Act, the Migrant 
and Seasonal Agricultural Workers' Protection Act, the Davis-
Bacon Act, the Family and Medical Leave Act, the Federal 
Employees' Compensation Act [FECA], the Longshore and Harbor 
Workers' Compensation Act, and the Federal Mine Safety and 
Health Act (black lung).
    The Committee is deeply concerned about the rising 
instances of child labor in the United States. Although no 
official estimate exists, studies place the number of illegally 
employed children in the United States between 300,000 and 
800,000. Therefore, the Committee has included full funding for 
the President's initiative on domestic child labor. 
Furthermore, the Committee strongly believes that effective 
enforcement must be a part of any comprehensive strategy to 
eliminate illegal child labor.

                            SPECIAL BENEFITS

Appropriations, 1999....................................    $179,000,000
Budget estimate, 2000...................................      79,000,000
Committee recommendation................................      79,000,000

    The Committee recommends continuation of appropriation 
language to provide authority to require disclosure of Social 
Security account numbers by individuals filing claims under the 
Federal Employees' Compensation Act or the Longshore and Harbor 
Workers' Compensation Act and its extensions.
    The recommendation includes $79,000,000, the same as the 
budget request and a decrease of $100,000,000 below the 1999 
comparable level. This appropriation primarily provides 
benefits under the Federal Employees' Compensation Act [FECA]. 
The payments are prescribed by law.
    The total amount to be available in fiscal year 2000, 
including anticipated reimbursements from Federal agencies of 
$1,923,000,000 is $2,002,000,000, a decrease of $23,000,000 
below the 1999 comparable level.
    The Committee recommends continuation of appropriation 
language that provides authority to use the FECA fund to 
reimburse a new employer for a portion of the salary of a newly 
reemployed injured Federal worker. The FECA funds will be used 
to reimburse new employers during the first 3 years of 
employment not to exceed 75 percent of salary in the worker's 
first year, declining thereafter. Costs will be charged to the 
FECA fund.
    The Committee again includes appropriation language that 
retains the drawdown date of August 15. The drawdown authority 
enables the agency to meet any immediate shortage of funds 
without requesting supplemental appropriations. The August 15 
drawdown date allows maximum flexibility for continuation of 
benefit payments without interruption.
    The Committee recommends continuation of appropriation 
language to provide authority to deposit into the special 
benefits account of the employees' compensation fund those 
funds that the Postal Service, the Tennessee Valley Authority, 
and other entities are required to pay to cover their fair 
share of the costs of administering the claims filed by their 
employees under FECA. The Committee concurs with requested bill 
language to allow the Secretary to use fair share collections 
to fund capital investment projects and specific initiatives to 
strengthen compensation fund control and oversight.

                    black lung disability trust fund

Appropriations, 1999....................................  $1,021,000,000
Budget estimate, 2000...................................   1,014,000,000
Committee recommendation................................   1,014,000,000

    The bill includes authority to obligate $1,014,000,000 from 
the black lung disability trust fund in fiscal year 2000. This 
is a decrease of $7,000,000 below the 1999 comparable level and 
the same as the administration request.
    The total amount available for fiscal year 2000 will 
provide $430,506,000 for benefit payments, and $50,494,000 for 
administrative expenses for the Department of Labor. Also 
included is $533,000,000 for interest payments on advances. In 
fiscal year 1999, comparable obligations for benefit payments 
are estimated to be $453,725,000 while administrative expenses 
for the Departments of Labor and Treasury, respectively, are 
$50,919,000 and $356,000. The Committee reiterates its 
directive to prevent the closing of and to ensure the staffing 
of black lung field offices.
    The trust fund pays all black lung compensation/medical and 
survivor benefit expenses when no responsible mine operation 
can be assigned liability for such benefits, or when coal mine 
employment ceased prior to 1970, as well as all administrative 
costs which are incurred in administering the benefits program 
and operating the trust fund.
    It is estimated that 63,200 people will be receiving black 
lung benefits financed from the trust fund by the end of fiscal 
year 2000. This compares with an estimated 67,000 receiving 
benefits in fiscal year 1999.
    The basic financing for the trust fund comes from a coal 
excise tax for underground and surface-mined coal. Additional 
funds come from reimbursement payments from mine operators for 
benefit payments made by the trust fund before the mine 
operator is found liable, and advances. The advances to the 
fund assure availability of necessary funds when liabilities 
may exceed other income. The Omnibus Budget Reconciliation Act 
of 1987 continues the current tax structure until 2014.
    For the first time, the Committee recommendation includes 
appropriations bill language providing indefinite budget 
authority for the payment of all benefits from the Black Lung 
Disability Trust Fund. This action is taken to ease the 
program's administration by providing an appropriation tied to 
outgo rather than receipts, thereby eliminating drawdowns from 
the next year's budget authority when total trust fund 
obligations exceed the amount of the current year's budget 
authority.
    The Committee has received the report of the Inspector 
General of the Department of Labor and the Social Security 
Administration providing ``A Joint Assessment of the Memorandum 
of Understanding Between the Social Security Administration and 
the Department of Labor's Employment Standards Administration's 
Division of Coal Mine Workers' Compensation Program on Handling 
Part B Black Lung Claims'' as specified in the Conference 
Committee's Report on the fiscal year 1998 Budget. The 
Committee notes that both agencies have agreed to implement the 
report's recommendation that DOL and SSA study the feasibility 
of transferring the entire Part B program to DOL. DOL and SSA 
are directed to report the results of that study to the 
Committee, when completed, and to incorporate the results in 
their subsequent appropriation budget requests.

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

Appropriations, 1999....................................    $354,375,000
Budget estimate, 2000...................................     388,142,000
Committee recommendation................................     388,142,000

    The Committee recommendation includes $388,142,000 for this 
account. This is the same as the budget request and an increase 
of $33,767,000 above the 1999 comparable level. This agency is 
responsible for enforcing the Occupational Safety and Health 
Act of 1970 in the Nation's workplaces.
    The Committee recommendation includes funding to support 
the development and implementation of a comprehensive 
compliance assistance program including outreach and training 
as critical factors in reducing injuries and illnesses; to 
provide for the maintenance, replenishment, and investment in 
the agency's information technology infrastructure; and to 
bolster resources for targeted enforcement programs and support 
for assumed safety and health coverage at the United States 
Postal Service.
    The Committee is aware of the State of New Jersey's pending 
application for a Public Employee Occupational Safety and 
Health Program.
    In addition, the Committee has included language to allow 
OSHA to retain up to $750,000 per fiscal year of training 
institute course tuition fees to be utilized for occupational 
safety and health training and education grants in the private 
sector.
    The Committee retains language carried in last year's bill 
effectively exempting farms employing 10 or fewer people from 
the provisions of the act except those farms having a temporary 
labor camp. The Committee also retains language exempting small 
firms in industry classifications having a lost workday injury 
rate less than the national average from general schedule 
safety inspections. These provisions have been in the bill for 
many years.
    The Committee is very pleased with OSHA's efforts in 
placing high priority on the voluntary protection programs 
(VPP) and other voluntary cooperative programs. The agency's 
work in expanding participation in the programs, and promoting 
prompt review and processing of applications is particularly 
noteworthy. In fiscal year 2000 the Committee expects OSHA to 
continue to place high priority on the VPP, making every effort 
to ensure 25 percent growth in participation by sites covered 
under federal OSHA jurisdiction. Cooperative voluntary 
programs, especially the VPP, are an important part of OSHA's 
ability to assure worker safety and health and should be 
administered in conjunction with an effective strong 
enforcement program.
    The Committee has received information that workers who are 
employed in outdoor occupations are at substantial risk for 
developing skin cancer from unprotected exposure to sunlight. 
There is also evidence that sunlight is a major cause for 
cataracts. The Committee urges the Occupational Safety and 
Health Administration (OSHA) and the National Institute for 
Occupational Safety and Health (NIOSH) to jointly undertake a 
survey in four varied geographical regions of the country at 
selected times of the year to determine what instruction, 
supervision and protection from sunlight exposure for both the 
skin and eyes is currently provided to workers engaged in 
outdoor construction, road construction, agricultural activity 
and the postal service. A timely report of the findings along 
with recommendations of possible remedial actions is expected.
    The Committee recognizes the public health threat facing 
many categories of outdoor workers as a result of occupational 
exposure to Lyme disease. The Committee encourages the 
Occupational Safety and Health Administration to develop 
appropriate mechanisms to help protect these workers from this 
occupational health risk.
    The Committee also intends that the Office of Regulatory 
Analysis continue to be funded as nearly as possible at its 
present level.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

Appropriations, 1999....................................    $215,913,000
Budget estimate, 2000...................................     228,373,000
Committee recommendation................................     230,873,000

    The Committee recommendation includes $230,873,000 for this 
account. This is $2,500,000 more than the budget request and 
$14,960,000 more than the 1999 comparable level.
    This agency insures the safety and health of the Nation's 
miners by conducting inspections and special investigations of 
mine operations, promulgating mandatory safety and health 
standards, cooperating with the States in developing effective 
State programs, and improving training in conjunction with 
States and the mining industry.
    The Committee recommendation includes funding to retool the 
metal and nonmetal safety and health program for reducing 
fatalities, injury incidence rates, and miners' overexposures 
to health hazards; to increase educational and training 
assistance to the metal/nonmetal mining sector; and to increase 
Federal sampling for respirable coal mine dust and quartz.
    The Committee is aware that the Federal Mine Health and 
Safety Academy is the only federally funded service academy 
dedicated solely to promoting miners' safety and health. 
Although it remains a thoroughly modern facility, the Academy 
was constructed more than twenty years ago and currently 
requires physical improvements to bring it up to code and into 
compliance with the Americans with Disabilities Act. 
Furthermore, in order for the Mine Safety and Health 
Administration to continue to provide effective safety and 
health to a younger generation of miners, the Academy needs to 
incorporate the most modern technologies, such as electronic 
learning media, into its education programs. The Committee, 
recommendation therefore includes increased funding over the 
budget request for needed physical improvements.
    The Committee is aware that the Mine Safety and Health 
Administration's programs, expertise, and resources are pivotal 
to the dramatic safety and health progress achieved by the 
American mining industry. The Committee encourages MSHA to 
actively engage in exchange of mine safety and health 
techniques, knowledge, and resources to enhance miners' safety 
throughout the world.
    The Committee commends MSHA for its proactive approach in 
seeking the root causes of and solutions to persistent problems 
affecting miners' safety and health. In particular, the 
Committee is pleased with the agency's work to eliminate black 
lung disease and silicosis. Miners continue to be diagnosed 
with these diseases and black lung alone costs the Federal 
Government more than $1,000,000,000 annually. Understanding 
that changes and improvements to the program to protect miners' 
health are necessary, the Committee strongly urges the agency 
to continue to implement the recommendations of the Advisory 
Committee on the Elimination of Pneumoconiosis Among Coal Mine 
Workers. To that end, the Committee fully funds the 
administration's request for expansion of the coal dust 
sampling program, a unanimous recommendation of the Advisory 
Committee.
    Consistent with last year's expectations, the 
Appropriations Bill strikes the current provision which 
prohibits funds be used to carry out section 115 of the Federal 
Mine Safety and Health Act of 1977 or to carry out that portion 
of section 104(g)(1) of the Act relating to the enforcement of 
any training requirements, with respect to shell dredging, or 
with respect to any sand, gravel, surface stone, surface clay, 
colloidal phosphate, or surface limestone mines.
    The Committee commends the good faith actions taken by MSHA 
to develop final training regulations for the miners working at 
the above named mines by the end of fiscal year 1999. The 
Committee is advised that MSHA is on-schedule to promulgate 
final training regulations, and that MSHA received substantial 
input from the affected industries, mine operators, workers, 
labor organizations and other interested parties. The Committee 
expects that MSHA will continue to work with all parties to 
ensure successful implementation of the final training 
regulations. The Committee applauds the efforts of MSHA, the 
Coalition for Effective Miner Training, employers, labor 
representatives, and miners for their collective efforts to 
improve safety and health training for mine workers.
    The Committee finds that the Department of Labor's programs 
promote and protect workers' safety and health throughout the 
world and make American industry more competitive. Every year, 
the American mining industry, through cooperative efforts of 
labor, industry, and the MSHA, becomes safer and more 
productive. The Committee is pleased that MSHA has an 
established program to share its expertise and to actively 
promote mine safety and health globally, as we recommended in 
last year's report. The Committee continues to encourage the 
Department's and MSHA's work in this area.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

Appropriations, 1999....................................    $398,870,000
Budget estimate, 2000...................................     420,919,000
Committee recommendation................................     409,444,000

    The Committee includes $409,444,000 for this account, which 
is $11,475,000 less than the budget request and $10,574,000 
more than the 1999 comparable level. This includes $55,663,000 
from the ``Employment Security Administration'' account of the 
unemployment trust fund, and $353,781,000 in Federal funds. The 
reduction from the request was necessary due to severe budget 
constraints facing the Committee in fiscal year 2000.
    The Bureau of Labor Statistics is the principal fact 
finding agency in the Federal Government in the broad field of 
labor economics.
    The Committee has included $6,986,000 for the Consumer 
Price Index revision; this effort should remain the highest 
priority for the Bureau.
    The Committee believes that funds provided under the 
amended Wagner-Peyser Act for Employment Statistics (formerly 
known as Labor Market Information) should be available to the 
states for three years. This is a change from the former Bureau 
of Labor Statistics practice of making funds available for only 
one year. The Committee recognizes that it is difficult for 
states to fulfill the statutory obligation to gather regional 
statistics due to short-term budgetary allocations. The 
Committee believes the three year availability would give 
states greater confidence in relying on long-term, labor market 
information objectives.
    The Committee encourages the Department to consider, as 
part of its fiscal year 2001 budget submission, changes to the 
financing of employment statistics (formerly known as Labor 
Market Information), including three-year availability of funds 
to the states, consistent with the changes envisioned in the 
Workforce Investment Act (WIA).
    The Committee is concerned that current methods used by the 
Bureau of Labor Statistics to measure unemployment do not 
adequately reflect true unemployment figures, as measured by 
adults capable of working but for whom no jobs exist, in remote 
communities in Alaska and other isolated locations. The 
Committee believes that by using methodologies for computing 
unemployment in cities and suburbs, BLS is seriously 
undercounting the rates of unemployment in Alaskan villages and 
in other remote locations. Since many government assistance 
programs for which these communities might be eligible depend 
upon unemployment rates, the consequences of this possible 
undercounting may be severe. The Committee urges the Secretary 
to develop a plan to adequately measure actual unemployment in 
such locations and to report its findings in a timely manner.

                        Departmental Management


                         SALARIES AND EXPENSES

Appropriations, 1999....................................    $201,098,000
Budget estimate, 2000...................................     257,654,000
Committee recommendation................................     247,311,000

    The Committee recommendation includes $247,311,000 for this 
account, which is $10,343,000 less than the budget request and 
$46,213,000 above the 1999 comparable level. This consists of 
$247,001,000 in general funds and authority to transfer 
$310,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund. In addition, an amount 
of $21,144,000 is available by transfer from the black lung 
disability trust fund, which is the same as the budget request. 
The reduction from the request was necessary due to severe 
budget constraints facing the Committee in fiscal year 2000.
    The primary goal of the Department of Labor is to protect 
and promote the interests of American workers. The departmental 
management appropriation finances staff responsible for 
formulating and overseeing the implementation of departmental 
policy and management activities in support of that goal. In 
addition, this appropriation includes a variety of operating 
programs and activities that are not involved in departmental 
management functions, but for which other salaries and expenses 
appropriations are not suitable.
    The program direction and support activity contains 
$2,000,000 to update the FMLA Commission Survey to determine 
the impact of the FMLA on families and businesses. Funds are 
also in this account to support several Department-wide cross-
cutting initiatives to strengthen program coordination between 
the Department, employers, employees and other stakeholders.
    The Committee intends that the Women's Bureau maintain 
support at the fiscal year 1997 level for technical assistance 
and training on displaced homemaker programming through 
effective programs such as the Women Work Program. This 
assistance is critical as State and local agencies develop and 
implement new models for work force development and welfare 
reform. The Committee recommends $8,369,000 for the Women's 
Bureau, an increase of $567,000 over the fiscal year 1999 
level.
    The Committee directs the Women's Bureau to analyze data on 
federal contractors collected over the last two years and to 
examine wage trends to determine how well federal contractors 
meet equal employment opportunity requirements, and to identify 
areas where compensation practices can be improved to ensure 
pay equity for women and minorities. The report should assess 
how occupational segregation affects women's and minorities' 
opportunities for advancement, pay and benefits, including how 
pay for women in traditional, female-dominated jobs compares to 
men in traditional male jobs of similar skill, effort, 
responsibility and working conditions.
    The Committee urges the Women's Bureau to continue support 
at the fiscal year 1999 level for effective organizations such 
as Women Work! to provide technical assistance and training on 
displaced homemaker programming.
    The Committee recommends the full request of $2,485,000 for 
the President's Task Force on Employment of Persons with 
Disabilities, by providing $1,400,000 in this account for S&E; 
and other related expenses of the Task Force and $1,085,000 in 
the Social Security Administration account for policy research 
and other activities as needed to support the goals of the Task 
Force.
    The Committee recommendation fully funds the budget request 
of $30,000,000 for international child labor activities.
    The Committee recognizes the value of the reports completed 
by the Bureau of International Labor Affairs in recent years 
documenting the incidence of international child labor in 
various industries and countries as well as some of the 
innovative approaches to reduce the use of abusive and 
exploitative child labor.
    The Committee notes the positive work being done by the 
ILO's International Programme for the Elimination of Child 
Labor (IPEC), including funds made available to the Secretary 
of Labor by this Committee to carry out programs to reduce the 
incidence of child labor. At this time, the Committee believes 
it is appropriate to review IPEC programs for efficiency and 
results. The Committee encourages the Department to work with 
IPEC to do such a review.
    Further, the Committee requests that the Bureau undertake a 
study identifying countries in which abusive and exploitative 
child labor is prevalent. The Committee urges the Bureau to 
work from the 1998 report and to make efforts to include 
countries not analyzed in previous reports. This review should 
examine the lack of policies and initiatives by relevant 
foreign governments to reduce the exploitation of children. The 
study should also include an analysis of the countries' adult 
unemployment rate, military spending and social spending to 
include expenditures on health care and education.
    It is the Committee's intent that the Department of Labor 
continue its work to establish a methodology and format for 
reporting regularly on the use of sweatshops in the production 
of apparel for import into the United States. The Department is 
encouraged to conduct a pilot study to apply its methodology to 
working conditions in the apparel industry in a limited number 
of apparel-exporting countries, based on any indicators that 
have been developed by the Department.
    The Committee recognizes the increasing role assigned to 
the Secretary of Labor in the international arena. This is 
reflected in part by funding increased foreign technical 
assistance through a two-pronged initiative, direct and 
multilateral, at the total level of $35,400,000. The Committee 
provides $10,400,000, the same as the budget request, for 
increased bilateral technical assistance, through the 
Department of Labor, to help Labor Ministries develop 
sustainable, institutionalized capabilities to create and 
operate social safety net programs and health and safety 
initiatives. The Committee provides to the Department 
$25,000,000, the full amount requested by the Administration, 
for managing, and operating through the International Labor 
Organization, a program advancing the capacity of developing 
countries, Labor Ministries in particular, to oversee, monitor 
and implement core labor standards.
    In general, the increased international role of the 
Department confers representational responsibilities upon the 
Secretary, and creates the need for commensurate authority to 
fulfill ceremonial and protocol standards. Bill language has 
been included to provide up to $10,000 in resources for these 
additional activities, to be drawn from available salaries and 
expenses appropriation accounts.
    The Committee encourages the Department to research job 
quality in the gambling industry, as measured by income levels, 
health insurance coverage and affordability, pension benefits, 
job security and other similar indicators. The Committee 
believes that the research should include information on 
gambling jobs in a variety of communities and regions, job 
quality and availability in the gambling industry, and job 
quality at casinos.
    The Committee retains bill language intended to ensure that 
decisions on appeals of Longshore and Harborworker Compensation 
Act claims are reached in a timely manner.
    The Committee has provided funding in various accounts to 
support the Department's efforts to implement three major 
programmatic cross-cutting initiatives designed to strengthen 
program coordination between the Department of Labor and 
employers, employees and constituent groups. These cross-
cutting initiatives include: (1) One Stop Outreach to Workers 
which will allow the Department to offer information to help 
workers understand their workplace rights and protections and 
find employment and training programs; (2) One Stop Outreach to 
Employers designed to offer employers access to information in 
one location about compliance assistance, safety and health 
standards and the tools to better understand their rights and 
responsibilities under DOL programs; and (3) Improving Customer 
Service with New Technology to provide innovative ways of 
delivering a new generation of technological support for 
employers, employees and other parties interested in obtaining 
information about the programs administered by the Labor 
Department. These cross cut programs are to be supported by 
several Information Technology initiatives to allow the 
Department to tackle common information technology issues 
across agencies in a cohesive and consistent manner.

        Assistant Secretary for Veterans Employment and Training

Appropriations, 1999....................................    $182,719,000
Budget estimate, 2000...................................     185,613,000
Committee recommendation................................     185,613,000

    The Committee recommendation includes $185,613,000 to be 
expended from the ``Employment Security Administration'' 
account of the unemployment trust fund. This is the same as the 
budget request and $2,894,000 above the 1999 comparable level.
    For State grants the bill provides $80,215,000 for the 
Disabled Veterans Outreach Program and $77,253,000 for the 
Local Veterans Employment Representative Program.
    For Federal administration, the Committee recommends 
$28,145,000, an increase of $2,544,000 over the fiscal year 
1999 level. The Committee supports the concept of the 
Transition Assistance Program administered jointly with the 
Department of Defense which assists soon-to-be-discharged 
service members in transitioning into the civilian work force 
and includes funding to maintain an effective program. The 
Committee notes the budget request includes $2,000,000, the 
same as the fiscal 1999 level, for the National Veterans 
Training Institute [NVTI]. This Institute provides training to 
the Federal and State staff involved in the direct delivery of 
employment and training related services to veterans. The 
Committee urged that funding for the Institute be maintained, 
to the extent possible, at the 1999 level.
    The recommendation also authorizes the Department of Labor 
to permit the Veterans' Employment and Training Service [VETS] 
to also fund activities in support of the VETS' Federal 
Contractor Program [FTP] from funds currently made available to 
States for veterans' employment activities.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 1999....................................     $48,500,000
Budget estimate, 2000...................................      55,178,000
Committee recommendation................................      51,925,000

    The bill includes $51,925,000 for this account, a decrease 
of $3,253,000 below the budget request and $3,425,000 above the 
1999 comparable level. The bill includes $48,095,000 in general 
funds and authority to transfer $3,830,000 from the 
``Employment Security Administration'' account of the 
unemployment trust fund. In addition, an amount of $318,000 is 
available by transfer from the black lung disability trust 
fund. The reduction from the request was necessary due to 
severe budget constraints facing the Committee in fiscal year 
2000.
    The Office of the Inspector General [OIG] was created by 
law to protect the integrity of departmental programs as well 
as the welfare of beneficiaries served by those programs. 
Through a comprehensive program of audits, investigations, 
inspections, and program evaluations, the OIG attempts to 
reduce the incidence of fraud, waste, abuse, and mismanagement, 
and to promote economy, efficiency, and effectiveness

                           General Provisions

    General provision bill language is included to:
    Prohibit the use of Job Corps funding for compensation of 
an individual at a rate in excess of Executive Level III (sec. 
101), and
    Permit transfers of up to 1 percent between appropriations 
(sec. 102).

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

              Health Resources and Services Administration

                     health resources and services

Appropriations, 1999....................................  $4,116,758,000
Budget estimate, 2000...................................   4,141,083,000
Committee recommendation................................   4,365,498,000

    The Committee recommends an appropriation of $4,365,498,000 
for health resources and services. This is $224,415,000 above 
the administration request and $248,740,000 more than the 
fiscal year 1999 allowance.
    Health Resources and Services Administration [HRSA] 
activities support programs to provide health care services for 
mothers and infants; the underserved, elderly, homeless; 
migrant farm workers; and disadvantaged minorities. This 
appropriation supports cooperative programs in community 
health, AIDS care, health provider training, and health care 
delivery systems and facilities.

                      CONSOLIDATED HEALTH CENTERS

    The Committee provides $1,024,000,000 for the consolidated 
health centers [CHC's], which is $99,294,000 above the 1999 
level and $79,000,000 above the administration request for this 
group of programs, which includes community health centers, 
migrant health centers, health care for the homeless, and 
public housing health service grants.

Community health centers

    The community health centers provide comprehensive, case-
managed primary health care services to medically indigent and 
underserved populations in rural and urban areas. Of the 
clients served by community health centers, about 44 percent 
are children and 66 percent have incomes below the poverty 
line.
    The Committee understands that nearly forty percent of 
patients served by health centers have no health insurance. The 
Committee expects that funding increases will be reasonably 
allocated to increase grant levels for existing grantees 
(particularly those serving greater numbers of uninsured 
persons) and to initiate new sites in underserved areas, 
particularly in rural regions.
    The Committee notes the expeditious manner in which HRSA 
has distributed a substantial portion of the additional 
resources provided to the health center program in fiscal year 
1999 and with the use of a funding methodology that targets 
these funds to centers with the highest burden of uninsured 
patients. The Committee encourages that new funding made 
available in fiscal year 2000 be given to stabilizing existing 
health centers and to enlarging existing health centers to 
serve the needs of communities without access to primary and 
preventive care.
    The Committee does not set aside any additional 
appropriations for loan guarantee authority under Section 
330(d) of the Public Health Service Act. The Committee intends 
that loan guarantee authority made available from the 
$6,000,000 allocations in both fiscal year 1997 and fiscal year 
1998 continue to be available for guarantees of both loan 
principal and interest; intends that guarantees for managed 
care plans be at 100 percent of the amount of the loan and 
interest amount approved; and notes that nothing in section 
330(d) specifies that a lesser percentage is required or 
appropriate. The Committee encourages the Secretary to examine 
the feasibility of a pooling approach to allow HRSA to issue 
direct guarantees rather than depend upon indirect guarantees 
to non-Federal lenders. The Committee continues to encourage 
the agency to make all necessary efforts to make loan funds 
available to qualified applicants and to expedite the 
processing of applications.
    The Committee is concerned about the low number of centers 
in rural areas where shortages of health professionals are the 
greatest. The Committee encourages the agency to place 
appropriate priority on applications for new centers on rural 
areas which fall within the service area of an existing center 
but where no satellite clinic has been established.
    The Committee repeats bill language from previous years 
limiting the amount of funds available for the payment of 
claims under the Federal Tort Claims Act to $5,000,000.
    Within the consolidated health center line, sufficient 
funds have been provided to support the activities intended to 
reduce health disparities among ethnic/racial groups with high 
rates of adverse health outcomes.
    It has been brought to the Committee's attention that there 
is no community health center on the island of Kauai in the 
State of Hawaii. The neighbor islands of Hawaii are 
extraordinarily rural in nature and have unique and pressing 
health care needs. Kauai has a population with the high 
uninsured and poverty rates, with approximately one of out of 
seven residents who are uninsured and nearly one of three 
living below the poverty level. Without public health clinics 
that provide primary care, the medically indigent on Kauai are 
dependent upon charity care and cannot afford to travel to Oahu 
for regular treatment. Furthermore, there are clusters of 
Native Hawaiians on Kauai in particular need of culturally 
sensitive care including those from the island of Niihau. 
Accordingly, the agency is strongly urged to begin the planning 
process for establishing a Kauai center, and should capitalize 
upon the evolving telehealth network within the state. The 
existing community college system is another asset that could 
be developed for health professional training in association 
with a new community health center.
    The Committee understands that the agency has funded the 
Hui and encourages continued and increased support to address 
the unique health care needs of Hawaii's underserved 
population. Native Hawaiian indigenous populations continue to 
experience significant health problems, including asthma and 
diabetes. The Committee urges HRSA to implement a program under 
which the systematic utilization of native Hawaiian health 
expertise may effectively impact the health status in these 
populations. The Committee recommends that community health 
centers serve as a safety net for this program, utilizing nurse 
practitioners and psychologists as care providers for these 
underserved populations.
    Funds are available to continue the demonstration project 
by the Utah area health education centers. The project seeks to 
show if these centers' support to primary care residencies in 
states with one regional health science center and medical 
school will improve access of health services to rural and 
underserved populations. The project also seeks to establish 
cooperation between a state council of medical education and a 
Utah AHEC program to support primary care residencies and 
participation by residents in those programs at remote and 
frontier sites.
    The Committee notes the high prevalence of hepatitis C 
(HCV) in the low income communities served by Community Health 
Centers (CHC). The Committee urges adequate funding to permit 
CHCs to train their medical personnel on the risks and 
treatment protocols for HCV as well as resources for culturally 
appropriate educational materials for CHC clientele.
    The Committee is aware of the effort by East Tennessee 
State University to undertake a project in rural Appalachian 
Kentucky, Tennessee and Virginia to improve access to cancer 
prevention, screening, diagnosis, treatment, and continuity of 
care through the mobilization and coordinated use of community 
and regional health care resources.
    The Committee is aware that the Burlington Community Health 
Center is expanding to meet the growing health care needs of 
residents of the New North End, Vermont's only designated 
enterprise community. The Committee encourages HRSA to aid its 
efforts to expand.
    The Committee is aware of the proposal by the East Liberty 
Family Health Care Center of Pittsburgh, Pennsylvania, to 
initiate services to the medically underserved region of 
Pittsburgh's eastern section. The agency is encouraged to 
identify steps that would assist this entity attain its 
operational goals.
    The Committee is further aware of the proposal by the 
Family Practice Center of Casper, Wyoming, to enhance health 
delivery to rural residents in the area.
    The Committee is aware of the effort to establish a 
demonstration program with Missouri's community health centers 
to increase access to oral health care.
    The Committee is also concerned that regulations and 
application procedures currently governing distribution of 
community health center funds are preventing remote rural areas 
in states like Alaska and Hawaii from applying for and 
receiving funding for health centers despite severe shortages 
of health professionals and great need. For example, the 
Committee understands that in fiscal year 1998, community 
health centers in Alaska received only $3,400,000 out of a 
national fund of approximately $900,000,000. The Committee 
urges the agency to give appropriate priority to locating new 
health centers in such remote communities and to developing a 
flexible approach to working with Native health pro-

viders and other similar groups to help meet the health needs 
of low income persons living in extremely remote locations.
    The Committee is aware of a proposal from Healthy 
Springfield 2000 in Springfield, Illinois to establish a 
community health center to serve the area's low income and 
uninsured populations. The Committee encourages the agency to 
work with the local sponsor on this important project.
    The Committee is aware of the efforts by the Community 
Medical Centers of Fresno, California, toward initial 
development of an ambulatory care system to serve migrant and 
indigent populations in central California. This area is 
encountering chronic, double-digit unemployment, a Medicaid 
eligibility level that is twice the state average, and 
significant numbers of individuals who are severely medically 
underserved.

Migrant health centers

    The program helps provide culturally sensitive 
comprehensive primary care services to migrant and seasonal 
farm workers and their families. Over 80 percent of the centers 
also receive funds from the community health centers program.

Health care for the homeless

    The program provides project grants for the delivery of 
primary health care services, substance abuse services, and 
mental health services to homeless adults and children. About 
one-half of the projects are administered by community health 
centers. The other one-half are administered by nonprofit 
coalitions, inner-city hospitals, and local public health 
departments.
    It has been brought to the Committee's attention that the 
Department may be developing a regulation to revise the process 
for designating health professions shortage areas and medically 
underserved populations. Recognizing the adverse impact of 
residential instability and poverty on access to health care, 
the Committee urges the department to consider designating 
homeless persons, migrant and seasonal farm workers, as 
medically underserved populations. The Committee further urges 
the Department to take steps to make health services provided 
by the department as fully accessible as possible to persons 
experiencing homelessness.

Public housing health service grants

    The program awards grants to community-based organizations 
to provide case-managed ambulatory primary health and social 
services in clinics at or in proximity to public housing. More 
than 60 percent of the programs are operated by community 
health centers.

Native Hawaiian health care

    The Committee again includes the legal citation in the bill 
for the Native Hawaiian Health Care Program. The Committee has 
included funding for the consolidated health centers line so 
that health care activities funded under the Native Hawaiian 
Health Care Program can be supported under the broader 
community health centers line. The Committee expects that not 
less than $5,000,000 be provided for these activities in fiscal 
year 2000.
    The purpose of this activity is to improve the health 
status of native Hawaiians by making primary care, health 
promotion, and disease prevention services available through 
the support of native Hawaiian health systems. Services 
provided include health screening, nutrition programs, and 
contracting for basic primary care services. This activity also 
supports a health professions scholarship program for native 
Hawaiians.
    The Committee continues to support the concept of malama. 
This innovative, culturally sensitive community partnership 
program addresses the prenatal needs of minorities in rural 
Hawaii. The Committee encourages the HRSA to support the 
replication of this project to include teen pregnancies. The 
ever increasing epidemic of teen pregnancy makes the maximum 
utilization of effective strategies a necessity.
    The Committee is supportive of the efforts by the Papa Ola 
Lokahi organization of Hawaii to advance the health care needs 
of native Hawaiians. The Committee is further aware of the 
special health care needs of Hana, Maui. Its geographical 
isolation and the unique culture of its inhabitants presents a 
challenge for the improvement of the health of native 
Hawaiians. The agency is encouraged to identify steps with the 
Papa Ola Lokahi to assist this community address those needs.
    The Committee encourages the agency to establish a 
demonstration project in Hawaii to develop an integrated health 
and social services model, to include traditional healing, 
prevention, and disease management, that addresses the 
disparities in health status and barriers to accessing health 
and social services among native Hawaiians and other minority 
populations at the Waimanalo Health Center.
    The Committee encourages the development of a Center of 
Excellence for Indigenous Health and Healing at the University 
of Hawaii School of Public Health and on other schools serving 
a large population of native peoples including American 
Indians, Alaska Natives, native Hawaiians and Pacific Islanders 
to incorporate traditional medicine and healing practices into 
their training for medical, nursing, social work, psychology, 
and public health students. The Committee encourages HRSA, CDC, 
and SAMSHA to support this effort in their grants by including 
traditional practitioners as providers of care where there are 
native and indigenous people residing in the service area of 
the grantee.

National Health Service Corps: Field placements

    The Committee provides $36,997,000 for field placement 
activities, which is $235,000 below the 1999 level and the same 
as the administration request. The funds provided for this 
program are used to support the activities of National Health 
Service Corps obligors and volunteers in the field, including 
travel and transportation costs of assignees, training and 
education, recruitment of volunteers, and retention activities. 
Salary costs of most new assignees are paid by the employing 
entity.

National Health Service Corps: Recruitment

    The Committee provides $78,166,000 for recruitment 
activities, which is $25,000 above the 1999 level and the same 
as the administration request. This program provides major 
benefits to students (full-cost scholarships or sizable loan 
repayment) in exchange for an agreement to serve as a primary 
care provider in a high priority federally designated health 
professional shortage area. The Committee reiterates its 
intention that funds support multiyear, rather than single-
year, commitments.
    The Committee urges the program to increase the level of 
services to medically underserved rural communities and areas. 
These areas are consistently in need of the kinds of services 
and care that NHSC professionals provide.
    The Committee again intends that $3,000,000 of funds 
appropriated for this activity be used for State offices of 
rural health. The Committee continues to be concerned about 
possible overlap and duplication between primary care offices 
[PCO's] supported in every State through the health centers 
appropriation and State offices of rural health [SORH's] 
supported in each State through the National Health Service 
Corps appropriation. While some required activities are 
exclusive to one program or another, the majority are similar. 
These include assessment of need for health services and 
available resources, targeting areas of unmet need, site and 
community development, technical assistance, and training. The 
Committee reiterates its recommendation that HRSA encourage 
States to create agreements between each State's PCO and SORH 
delineating joint and separate activities and promoting 
collaboration to the satisfaction of program officials.
    The Committee encourages the National Health Service Corps 
to support a demonstration project aimed at expanding and 
integrating the services of behavioral and mental health 
professionals, including psychologists, with other health 
services. The Committee intends that this program be targeted 
at underserved urban and rural areas through community health 
centers, with particular attention focused on the mental health 
problems created by the current farm crisis.
    The Committee recognizes the importance of increasing 
health care availability in underserved areas. Illinois, while 
the fifth largest producer of medical professionals, also has 
the fourth largest number of underserved areas. The Committee 
encourages the NHSC to expand the number of SEARCH grantees so 
as to include other underserved areas such as those served by 
the Illinois Primary Health Care Association and their 
partners.

                           HEALTH PROFESSIONS

    For all HRSA health professions programs, the bill includes 
$226,916,000, which is $75,000,000 less than the fiscal year 
1999 appropriation and $24,778,000 less than the overall 
administration request for these programs.
    The Committee recommends consolidated funding for programs 
authorized under titles VII and VIII programs.
    The following clusters and their associated programs are 
included in this consolidated account:

A. Cluster for workforce information and analysis

Health professions data and analysis

    This program supports the collection and analysis of data 
on the labor supply in various health professions and on future 
work force configurations.

Research on certain health professions issues

    This program supports research on the extent to which debt 
has a detrimental effect on students entering primary care 
specialties; the effects of federally funded education programs 
for minorities attending and completing health professions 
schools; and the effectiveness of State investigations in 
protecting the health of the public. The Committee reiterates 
its support for the three centers for health professions 
research that are current grantees.

B. Training for diversity cluster

Centers of excellence

    This program was established to fund institutions that 
train a significant portion of the Nation's minority health 
professionals. Funds are used for the recruitment and retention 
of students, faculty training, and the development of plans to 
achieve institutional improvements. The institutions that are 
designated as centers of excellence are private institutions 
whose mission is to train disadvantaged minority students for 
service in underserved areas. Located in poor communities and 
usually with little State funding, they serve the health care 
needs of their patients often without remuneration. The 
Committee is pleased that the agency has refocused the minority 
centers of excellence program on providing support to 
historically minority health professions institutions.
    The Committee urges the agency to consider establishing at 
least one center for excellence focused on training Alaska 
Natives as community health aides to serve as sole community 
health providers in remote Alaska Native villages across 
Alaska.

Health careers opportunity program

    This program provides funds to medical and other health 
professions schools for recruitment of disadvantaged students 
and preprofessional school preparations. The Committee is 
pleased that HRSA has given priority consideration for grants 
to minority health professions institutions, and recommends 
that grant review committees have proportionate representation 
from these institutions.
    The Committee has been supportive of this program's 
critical role in improving the health status of minority and 
disadvantaged citizens by increasing available opportunities 
for those individuals seeking a health professions career. The 
Committee understands that minority providers are more likely 
to serve in underserved areas. The program has recognized the 
contribution of historically minority health professions 
schools, and have supported those institutions which have made 
the greatest contribution to increasing the number of 
minorities in health professions careers.

Faculty loan repayment

    This program provides for the repayment of education loans 
for individuals from disadvantaged backgrounds who are health 
professions students or graduates, and who have agreed to serve 
for not less than 2 years as a faculty member of a health 
professions school.

Scholarships for disadvantaged students

    This program provides grants to health professions schools 
for student scholarships to individuals who are from 
disadvantaged backgrounds and are enrolled as full-time 
students in such schools. The Committee continues to intend 
that all health professions disciplines made eligible by 
statute be able to participate in the scholarships program.
    The Committee continues to recognize the importance of 
training greater numbers of psychologists and other health 
professionals from disadvantaged backgrounds to participate on 
interdisciplinary primary care teams addressing a range of 
behavioral and mental health needs.

C. Cluster for training in primary care medicine and dentistry

    The administration proposes to terminate the programs 
within this cluster, however, the Committee intends that the 
programs receive funding from the consolidated appropriations 
allocated for fiscal year 2000 in proportion to the amount 
provided in fiscal year 1999, relative to the other health 
professions accounts. With the continued need for primary care 
throughout the country, the Committee believes these programs 
serve an important role in maintaining the country's public 
health infrastructure.

Family medicine training

    Family medicine activities support grants for graduate 
training in family medicine, grants for predoctoral training in 
family medicine, grants for faculty development in family 
medicine, and grants for the establishment of departments of 
family medicine. The Committee reiterates its support for this 
program and recognizes its importance in increasing the number 
of primary care physicians in underserved areas.

General internal medicine and pediatrics training

    This program provides funds to public and private nonprofit 
hospitals and schools of medicine and osteopathic medicine to 
support residencies in internal medicine and pediatrics. Grants 
may also include support for faculty.

Physician assistants

    This program supports planning, development, and operation 
of physician assistant training programs.

General dentistry and pediatric dental residencies

    This program assists dental schools and postgraduate dental 
training institutions to meet the costs of planning, 
developing, and operating residency training and advanced 
education programs in general practice of dentistry and funds 
innovative models for postdoctoral general dentistry and 
pediatric dentistry.
    The Committee continues to recognize the importance of 
training greater numbers of psychologists and other health 
professionals from disadvantaged backgrounds to participate on 
interdisciplinary primary care teams addressing a range of 
behavioral and mental health needs.

D. Cluster for public health workforce development

    The administration proposes to terminate the programs 
within this cluster, however, the Committee intends that the 
programs receive funding from the consolidated appropriations 
allocated for fiscal year 2000 in proportion to the amount 
provided in fiscal year 1999, relative to the other health 
professions accounts. With the continued need for public health 
training throughout the country, the Committee believes these 
programs serve an important role in maintaining the country's 
public health infrastructure.

Public health and preventive medicine

    This program supports awards to schools of medicine, 
osteopathic medicine, public health, and dentistry for support 
of residency training programs in preventive medicine and 
dental public health; and for financial assistance to trainees 
enrolled in such programs.
    The Committee encourages the increase of residency training 
opportunities in dental public health so that Federal, State, 
and community-based programs have the leadership capabilities 
to prevent dental disease, promote oral health, and improve 
treatment outcomes.

Health administration traineeships and special projects

    This program provides grants to public or nonprofit private 
educational entities, including schools of social work but not 
schools of public health, to expand and improve graduate 
programs in health administration, hospital administration, and 
health policy analysis and planning; and assists educational 
institutions to prepare students for employment with public or 
nonprofit private agencies.

E. Cluster for interdisciplinary, community-based linkages

Area health education centers

    This program links university health science centers with 
community health service delivery systems to provide training 
sites for students, faculty, and practitioners. The program 
supports three types of projects: Core grants to plan and 
implement programs; special initiative funding for schools that 
have previously received AHEC grants; and model programs to 
extend AHEC programs with 50 percent Federal funding. The 
Committee intends that adequate funding be provided to the area 
health education centers [AHEC] grant program since AHEC's are 
an important component of the Federal/State partnership in 
addressing rural health issues.
    The Committee encourages the development of a training 
curriculum on chronic fatigue and associated illnesses for 
health care providers in practice and in training. Such a 
curriculum holds significant potential in improving the 
detection, diagnosis, treatment, and management of CFIDS 
patients.
    The Committee continues to support the WAMI medical 
educational consortium for eligible residents of the States of 
Washington, Alaska, Montana, and Idaho. The program seeks to 
establish rural training programs for medical students and 
telecommunication links between participating centers. The 
Committee expects the agency and the AHEC program to work with 
the consortium and to grant full and fair consideration for the 
concepts advanced by WAMI.
    It has been brought to the attention of the Committee that 
the program has been emphasizing physical health needs, while 
more could be done in addressing behavioral and mental health 
needs. The Committee encourages the Bureau to train more 
behavioral and mental health professionals in the AHEC program.
    It has been brought to the Committee's attention that 
recent legislation requires a 50/50 local-Federal match for all 
AHEC grants. However, this formula may be unnecessarily 
disruptive to current AHEC grantees who received funding prior 
to the enactment of the reauthorization. The Committee urges 
the agency to hold harmless all AHEC grants that were active 
prior to the reauthorizing legislation.

Border health training centers

    These centers provide training to improve the supply, 
distribution, and quality of personnel providing health 
services in the State of Florida or along the border between 
the United States and Mexico and in other urban and rural areas 
with populations with serious unmet health care needs.

Allied health advanced training and special projects

    The Committee expects this program to continue to support 
schools or programs with projects designed to plan, develop, or 
expand postbaccalaureate programs for the advanced training of 
allied health professions; and provide traineeships or 
fellowships to postbaccalaureate students who are participating 
in the program and who commit to teaching in the allied health 
profession involved. The administration requested termination 
of funding. This program also provides funds to expand existing 
training programs or develop new ones, recruit individuals into 
allied professions with the most severe shortages or whose 
services are most needed by the elderly, and increase faculty 
recruitment and education, and research.
    The Committee intends that the program receive funding from 
the consolidated appropriations allocated for fiscal year 2000 
in proportion to the amount provided in fiscal year 1999, 
relative to the other health professions accounts. It has been 
brought to the Committee's attention that shortages of allied 
health personnel exist in medically underserved and rural 
communities, especially those who assist the elderly. The 
Committee understands that a workforce database is being 
developed that could detail the extent of these shortages. The 
Committee continues to recommend that the agency continue to 
play a role in partnership with state governments and private 
institutions in raising the number of allied health 
professionals.
    The Committee continues to encourage HRSA to give priority 
consideration to those projects for schools training allied 
health professionals experiencing shortages, such as medical 
technologists and cytotechnologists.
    It has been brought to the Committee's attention that there 
is a lack of trained health professionals in Nevada. Given the 
large increase in Nevada's population, especially the elderly, 
the Committee encourages the agency to contribute technical 
assistance to the University of Nevada at Reno and Las Vegas 
toward the establishment of educational channels for a school 
of pharmacy.

Geriatric education centers and training

    The Committee expects this program to continue to support 
grants to health professions schools to establish geriatric 
education centers and to support geriatric training projects. 
The administration requested termination of funding. These 
centers and geriatric training programs play a vital role in 
enhancing the skill-base of health care professionals to care 
for our Nation's growing elderly population. The Committee is 
concerned about the shortage of trained geriatricians and urges 
the agency to give priority to building the work force 
necessary to care for the Nation's elderly.

Quentin N. Burdick program for rural health interdisciplinary training

    This program addresses shortages of health professionals in 
rural areas through interdisciplinary training projects that 
prepare students from various disciplines to practice together, 
and offers clinical training experiences in rural health and 
mental health care settings to expose students to rural 
practice.
    The Committee notes its continuing support for the rural 
interdisciplinary training program designed to improve access 
to health care and health professionals in rural areas and has 
included sufficient funds to maintain this program at current 
levels. The Committee expects that this program will continue 
its current levels of support for addressing the issue of how 
the delivery of chiropractic health care can be enhanced in 
rural areas, and how more women and minorities can be recruited 
as chiropractic health care practitioners in rural areas.
    The Committee also urges the bureau to consider 
implementation of telecommunications and telehealth initiatives 
for providing distance education and training for nurses, 
community health aides, and other health professionals serving 
rural areas.

Podiatric primary care training

    The program provides grants to hospitals and schools of 
podiatric medicine for residency training in primary care. In 
addition to providing grants to hospitals and schools of 
podiatric medicine for residency training in primary care, the 
program also permits HRSA to study and explore ways to more 
effectively administer postdoctoral training in an ever 
changing health care environment.

Chiropractic demonstration grants

    The program provides grants to colleges and universities of 
chiropractic to carry out demonstration projects in which 
chiropractors and physicians collaborate to identify and 
provide effective treatment of spinal and lower back 
conditions. The Committee recommends that the program be 
continued and funded at current levels.

F. Cluster for nursing workforce development

Advanced nurse education

    This program funds nursing schools to prepare nurses at the 
master's degree or higher level for teaching, administration, 
or service in other professional nursing specialties.

Nurse practitioner/nurse midwife education

    This program supports programs preparing nurse 
practitioners and nurse midwives to effectively provide primary 
health care in settings such as the home, ambulatory, and long-
term care facilities, and other health institutions. These 
professionals are in especially short supply in rural and 
underserved urban areas.

Professional nurse traineeships

    Traineeships fund registered nurses in programs of advanced 
nursing education, including preparation for teaching, 
administration, supervision, clinical specialization, research, 
and nurse practitioner and nurse midwife training.

Nurse anesthetist traineeships

    Grants are awarded to eligible institutions to provide 
traineeships for licensed registered nurses to become certified 
registered nurse anesthetists [CRNA]. The program also supports 
fellowships to enable CRNA faculty members to obtain advanced 
education.

Basic nurse education and practice

    Authorized by Public Law 105-392, the goal of this program 
is to improve the quality of nursing practice. Activities under 
this program will initiate new projects that will change the 
educational mix of the basic nursing workforce and empower the 
workforce to meet the demands of the current health care 
system.
    The Committee encourages the agency to consider a 
demonstration project to determine the health outcomes of 
clients utilizing nurse-managed centers, and the impact and 
relevancy of these findings to the overall health care system. 
The Committee notes the Regional Nursing Centers Consortium of 
Philadelphia is especially well suited to conducting such a 
demonstration.

Nursing workforce diversity

    The goal of this program is to improve the diversity of the 
nursing workforce through increased educational opportunities 
for individuals from disadvantaged backgrounds. Such diversity 
in the nursing workforce enables the health care system to 
deliver more culturally appropriate and sensitive care in 
disadvantaged neighborhoods.

Graduate medical education payments to children's hospitals

    The administration proposed $40,000,000 for a new program 
that would disburse payments to hospitals dedicated to the 
medical care of children. Such payments are intended to support 
training of resident physicians involved in pediatric care. The 
administration has submitted authorizing legislation to the 
relevant committees of the Congress. The Committee has deferred 
funding of this proposal, pending action by the authorizing 
committees of Congress.

                          other hrsa programs


Hansen's disease services

    The Committee has included $17,282,000 for the Hansen's 
Disease Program, which is $4,381,000 below the 1999 level and 
the same as the administration request. The agency is 
implementing the transfer of the Carville facility to the State 
of Louisiana, the moving of the center to another location 
within Louisiana, paying yearly stipends to residents who 
choose to live independently, and restructuring overall 
operations. The Committee has provided funding for the payment 
to Hawaii as a separate line item.

Maternal and child health block grant

    The Committee recommends $695,000,000 for the maternal and 
child health [MCH] block grant. This is $223,000 over the 
fiscal year 1999 level and the same as the administration 
request.
    The MCH block grant funds are provided to States to support 
health care for mothers and children. According to statute, 
12.75 percent of funds over $600,000,000 are used for 
community-integrated service systems [CISS] programs. Of the 
remaining funds, 15 percent is used for special projects of 
regional or national significance [SPRANS] while 85 percent is 
distributed on the same percentage split as the basic block 
grant formula.
    The Committee has transferred funding previously included 
within SPRANS for the traumatic brain injury State 
demonstration projects to the critical care cluster.
    The Committee encourages the bureau to utilize SPRANS funds 
to support the proposal, family initiatives in children's 
health centers, to be administered by families for children 
with special health care needs. Affiliated with a family-run 
national technical assistance center and three regional 
technical assistance centers, this proposal provides health 
care information and education for families of children with 
special health care needs to assure that families receive 
timely and accurate information to make informed decisions 
about their children's unique health care needs. Under this 
proposal, the national center will collect information from the 
family-run centers to monitor health access, delivery, and 
financing for children with special health care needs and act 
as an information clearinghouse for the State-based centers.
    Within the funds provided, the Committee encourages the 
availability and accessibility of newborn screening services to 
apply public health recommendations for expansion of effective 
strategies including screening for fetal alcohol syndrome/fetal 
alcohol effect. HRSA, in collaboration with the Centers for 
Disease Control and Prevention [CDC] and the National 
Institutes of Health [NIH], is encouraged to develop and 
implement a strategy for evaluating and expanding newborn 
screening programs, pilot demonstration projects, and the use 
of contemporary public health recommendations on specific 
conditions, such as cystic fibrosis and the fragile X syndrome. 
If implemented, the Committee directs that tangible steps be 
taken to protect patient privacy and to avert discrimination 
based upon information derived from the screenings.
    Within the funds provided, HRSA is encouraged to consider a 
service demonstration to develop a targeted initiative for 
prenatal providers to better screen at-risk alcohol-using 
pregnant women in order to reduce their alcohol use during 
pregnancy and to refer them to alcohol treatment services.
    HRSA is also encouraged to consider a service demonstration 
to develop new programs for use by prenatal providers in Native 
communities to screen pregnant women for alcohol use during 
pregnancy and to refer them to alcohol treatment services. The 
Committee notes that Alaska has the highest rate of fetal 
alcohol syndrome in the nation.
    The Committee has been pleased with the Bureau's efforts in 
responding to the joint effort with the NIH's Child Health 
Institute in the Back to Sleep Campaign for sudden infant death 
syndrome, and by continuing to focus on outreach to underserved 
populations. The MCH Bureau is also commended for establishing 
the SIDS program support center as recommended by the 
nationwide survey of sudden infant death services in 
conjunction with the Sudden Infant Death Syndrome Alliance and 
encouraged to continue the research and data collection this 
center has begun.
    The Committee reiterates its support for childhood vision 
screening as a cost-effective public health activity. Within 
the allocation, the Committee encourages the agency to initiate 
implementation of screening efforts, including grants to 
States.
    Dental caries (tooth decay) is one of the most common 
health problems among children, and fluoridation has proven to 
be the single most cost-effective preventive measure. It is 
estimated that Medicaid spends significantly more per child to 
care for a child's teeth in nonfluoridated areas compared to 
districts whose water supply is fluoridated. The Committee 
reiterates its support for implementation of enhanced 
fluoridation efforts, particularly in underutilized areas of 
the country, and intends that an amount no less than that 
expended last year by the agency be used for those States with 
fluoridation levels below 25 percent to allow them to develop 
implementation plans for increased fluoridation.
    It has been brought to the Committee's attention that 
dental sealants are an effective preventive measure against 
tooth decay. For children in low income families, sealants form 
the basis for an effective oral health intervention. The 
Committee urges the bureau to establish, with the funds 
provided to the block grant, a multistate demonstration to 
support models of preventive care for underserved rural and 
inner city children. The Committee would urge that such an 
initiative include community and school-based linkages and 
notes that the program currently being implemented by the 
University of Florida college of dentistry could be a model for 
consideration and replication.
    The Committee also urges the bureau to establish an 
additional single-state demonstration project in a non-
contiguous state to support models of preventive dental care, 
including use of sealants, focused on underserved rural and 
Native populations. The Committee urges that such an initiative 
include Native health organizations and community health center 
linkages and notes that the Alaska Department of Health and 
Social Services has proposed a similar program.
    The Committee recognizes the important role of hemophilia 
treatment centers in the prevention and treatment of the 
complications of hemophilia. Funds are available to maintain 
support for these centers in order to sustain their treatment 
outreach to persons with hemophilia and ensure their 
participation with CDC and FDA on blood safety surveillance and 
patient notification efforts.
    The Committee is pleased with the role that HRSA's Office 
of Adolescent Health is playing regarding promotion of mental 
health and substance abuse treatment services for adolescents 
in the primary health care setting. In particular, the 
Committee is interested in the collaborative activity between 
the Office of Adolescent Health and the three Centers of 
Substance Abuse and Mental Health Services Administration that 
explores and examines health services delivery models which 
will enhance access to and effective utilization of mental 
health and substance abuse treatment services by children, 
adolescents, and their families. The Committee encourages that 
this activity be expanded to include a set of evaluated 
demonstration projects.
    The Committee also values the initiative, Mental Health in 
Schools, and encourages that the state level partnerships be 
expanded and the technical assistance, training and resource 
centers continue their work with educators and health care 
professionals.
    The Committee encourages the Office of Adolescent Health to 
take action on the recommendations made at the 1998 Health 
Futures of Youth II Conference, and is pleased that an 
initiative is planned that promotes healthy developmental 
transitions from childhood to adolescence. The Committee 
further encourages collaboration with the Administration on 
Children, Youth and Families.
    It has been brought to the Committee's attention that in 
fiscal year 1999 the Maternal and Child Health Bureau intends 
to reduce its support for investigator-initiated studies in 
developmental and behavioral research. The Committee encourages 
the HRSA Administrator to involve the scientific community in 
its deliberations concerning the future of this research 
program and to make any appropriate redetermination in the 
support level.
    The Committee encourages the development of a comprehensive 
demonstration of national significance to address the disparity 
in health status among Native Hawaiians and other minority 
populations by expanding integrated perinatal service models 
that are culturally appropriate in meeting the perinatal health 
care needs of the diverse population groups in Hawaii. The 
Committee urges collaboration between HRSA, CDC, SAMHSA, NIH, 
and other appropriate agencies to develop this project.
    The Committee is pleased at the progress that has been made 
to provide newborn screening for hearing loss and believes that 
screening would be a judicious use of block grant funds. Such 
screening can be performed at minimal cost and can prevent 
significant health and education costs for children.
    The Committee is aware of a proposal by an organization, 
Vision Research, to initiate vision screening among school aged 
children at a wider scale, using advanced ocular screening 
technology.

Healthy start initiative

    The Committee recommends $110,000,000 for the healthy start 
infant mortality initiative. This amount is $5,033,000 over the 
fiscal year 1999 amount and $5,000,000 over the administration 
request.
    The healthy start initiative was developed to respond to 
persistently high rates of infant mortality in this Nation. The 
initiative was expanded in fiscal year 1994 by a special 
projects program, which supported an additional seven urban and 
rural communities to implement infant mortality reduction 
strategies and interventions.
    The program is currently undertaking the replication phase 
started in fiscal year 1998. This phase will replicate and 
disseminate aspects of perinatal care found to be successful by 
projects during the demonstration phase.
    The Committee is pleased with the achievements of the 
healthy schools, healthy communities initiative which has been 
particularly effective in providing comprehensive school-based, 
school-linked, family centered, community based primary care to 
approximately 24,000 children.

Universal newborn hearing screening and early intervention

    The Committee provides $4,000,000 for universal newborn 
hearing screening and early intervention activities, which is 
the same as the administration request. This is a new program 
for fiscal year 2000. The Committee understands that screening 
technology has enabled health providers to conduct accurate, 
cost-efficient newborn hearing screenings prior to hospital 
discharge. By detecting newborn hearing deficiencies, health 
providers can implement necessary treatment to the infant and 
advice to affected family members. Funds provided will support 
grants to states to: develop and expand statewide screening 
programs; link screening programs with community-based 
intervention efforts; monitor the impact of early detection and 
intervention activities; and provide technical assistance.

Organ procurement and transplantation

    The Committee provides $10,000,000 for organ transplant 
activities. This is the same as the administration request and 
$3,000 more than the fiscal year 1999 appropriation.
    The Committee considers increasing the supply of organs, 
particularly livers, available for voluntary donation to be a 
top public health priority. Last year the Committee doubled the 
administration request to catalyze an aggressive, nationwide 
effort to improve public awareness and educate health care 
providers.
    These funds support a scientific registry of organ 
transplant recipients and kidney dialysis patients, and the 
National Organ Procurement and Transplantation Network to match 
donors and potential recipients of organs. A portion of the 
appropriated funds may be used for education of the public and 
health professionals about organ donations and transplants, and 
to support agency staff providing clearinghouse and technical 
assistance functions. The Committee encourages the agency to 
establish linkages with state and federal transportation 
officials to improve coordination of donation following 
vehicular accidents.
    To increase the rate of organ donation, the Committee urges 
increased behavioral research to better target and increase the 
effectiveness of public awareness campaigns.
    The Committee is aware of the proposal by the University of 
Alabama at Birmingham to conduct research on measures that 
could increase the number and quality of organs obtained from 
donors.
    The Committee considers increasing the supply of organs, 
particularly livers, available from voluntary donations to be a 
top public health priority and expects that funds be committed 
to those activities having the greatest demonstrable impact on 
donation rates.

Health teaching facilities interest subsidies

    The Committee recommends $150,000 for interest subsidies 
for three health professions teaching facilities. This is the 
same as the administration request and the fiscal year 1999 
appropriation. This program continues support of interest 
subsidies and loan guarantees for two loans for construction of 
health professions teaching facilities under a now discontinued 
Public Health Service Act authority. The remaining Federal 
commitment on these loans will expire in the year 2004.

National bone marrow donor program

    The Committee has included $18,000,000 for the national 
bone marrow donor program. This is the same as the 
administration request and $6,000 above the fiscal year 1999 
level. The National Bone Marrow Donor Registry is a network, 
operated under contract, that helps patients suffering from 
leukemia or other blood diseases find matching volunteer 
unrelated bone marrow donors for transplants. The program also 
conducts research on the effectiveness of unrelated marrow 
transplants and related treatments.

Rural health outreach grants

    The Committee recommends $31,396,000 for health outreach 
grants. This amount is $12,000 higher than the fiscal year 1999 
level and the same as the administration request. This program 
supports projects that demonstrate new and innovative models of 
outreach in rural areas such as integration and coordination of 
health services and rural telemedicine projects. The Health 
Care Consolidation Act of 1996 authorized a new rural network 
development program intended to develop integrated 
organizational capabilities among three or more rural health 
provider entities.
    The Committee remains supportive of the effort by Southwest 
Alabama Network for Education and Telemedicine to build a 
telemedicine project dedicated to serving rural, poor, and 
medically underserved communities through a high-speed, 
community-access telecommunication network.
    The Committee is aware of the Montana State University-
Billings proposal to obtain and operate a mobile unit which 
could be moved around the State to demonstrate and teach the 
use of assistive technologies. The medical community has access 
to an increasing number of devices and technologies to assist 
those who are handicapped or restricted. Keeping up with 
advances and moving them quickly into rural areas could be 
facilitated by such a unit. The program would focus on rural 
areas and tribal entities, including the Native American 
population which resides adjacent to the reservations.
    The Committee is aware of the diabetes lower extremity 
amputation prevention program run by the University of South 
Alabama, the Louisiana State University medical school and the 
Roosevelt Institute for Rehabilitation.
    The Committee continues to be supportive of the work being 
conducted by Low Country Health Care Systems.
    The Committee is aware of the proposal by the University of 
Maine to develop a model infrastructure to reduce obstacles 
faced by rural families in obtaining hearing screening tests 
for infants. Early intervention for hearing impairment can 
avert many debilitating sequelae such as learning disabilities 
and language difficulties.
    The Committee is aware of the proposal by the nursing 
school of the University of North Carolina at Wilmington to 
establish a mobile medical facility to serve underserved 
populations in rural North Carolina.
    The Committee is aware of the efforts of the Radford 
University school of nursing to acquire a mobile health clinic.

Critical care programs

    The Committee has grouped the following ongoing and 
proposed activities into a new cluster proposed by the 
administration: emergency medical services for children, the 
traumatic brain injury program, trauma care/emergency medical 
services, and poison control centers.
    The Committee provides $17,000,000 for emergency medical 
services for children. This is $2,005,000 above the 1999 level 
and $2,000,000 above the administration request. The program 
supports demonstration grants for the delivery of emergency 
medical services to acutely ill and seriously injured children. 
The Committee urges HRSA to consider EMSC a high priority, 
focusing on the development of prevention and treatment 
programs and education of emergency personnel in remote and 
rural areas such as Alaska and Hawaii, using telemedicine 
technology. For example, a collaborative effort with Tripler 
Army Medical Center, using the telemedicine technology already 
available would enhance the development of the EMSC 
initiatives.
    The Committee provides $5,000,000 for the traumatic brain 
injury program, which is the same as the 1999 level and the 
administration request. This item was previously funded through 
the SPRANS component of the maternal and child health block 
grant. The program supports implementation and planning grants 
to States for coordination and improvement of services to 
individuals and families with traumatic brain injuries. Such 
services can include: prehospital care, emergency department 
care, hospital care, rehabilitation, transitional services, 
education, employment, and long-term support.
    The Committee provides $1,000,000 for trauma/emergency 
medical services, which is the same as the administration 
request. This is a new activity for fiscal year 2000. This 
program is intended to improve the Nation's overall emergency 
medical system, including the joint efforts between HRSA and 
the National Highway Traffic Safety Administration to assess 
state systems and recommend improvements to the current system.
    The Committee provides $3,000,000 for poison control center 
activities, which is $1,500,000 above the administration 
request. This is a new activity for fiscal year 2000. The 
Committee is pleased with the actions by HRSA and CDC to 
initiate planning for a national toll-free telephone number for 
poison control services. The funds provided will support the 
development and assessment of uniform patient management 
guidelines and will support HRSA's participation with CDC and 
the joint CDC/HRSA advisory committee on planning efforts.
    The Committee commends the Emergency Medical Services for 
Children program for the delivery of emergency medical services 
to acutely ill and seriously injured children. The Committee 
also commends the Partnership for Children initiative which has 
provided useful training and information to pediatric emergency 
care personnel. The Committee urges HRSA to consider EMSC a 
high priority, focusing on the development of prevention and 
treatment programs and education of emergency personnel in 
remote and rural areas such as Alaska and Hawaii. Hana, on the 
island of Maui, provides an excellent example of EMSC design 
and implementation efforts targeted toward rural communities. 
Hana is extraordinarily isolated with pressing health care 
needs and has a population that is nearly one-third children 
and adolescents.
    The Committee supports the effective collaboration between 
NHTSA and HRSA in the administration of the EMSC program. The 
Committee urges the EMSC program to develop practice guidelines 
and other quality of care assessment and enhancement 
initiatives. The Committee encourages the EMSC program to 
continue a research focus and to develop a means of collecting 
data to ensure accountability and to better track 
accomplishments and needs.

Black lung clinics

    The Committee includes $6,000,000 for black lung clinics. 
This is $1,002,000 above the fiscal year 1999 amount and 
$1,000,000 above the administration request. This program funds 
clinics which treat respiratory and pulmonary diseases of 
active and retired coal miners. These clinics reduce the 
incidence of high-cost inpatient treatment for these 
conditions.

Nurse loan repayment for shortage area service

    The Committee includes $2,279,000 for nurse loan payment 
for shortage area services. This amount is $1,000 higher than 
last year's amount and the administration request.
    This program offers student loan repayment to nurses in 
exchange for an agreement to serve not less than 2 years in an 
Indian health service health center, native Hawaiian health 
center, public hospital, community or migrant health center, or 
rural health clinic.

Payment to Hawaii, Hansen's disease treatment

    Within the amount provided for Hansen's disease services, 
the Committee has provided $2,045,000 for the fiscal year 2000 
payment to the State of Hawaii for the medical care and 
treatment in its hospital and clinic facilities of persons with 
Hansen's disease at a per diem rate not greater than the 
comparable per diem operating cost per patient at the Gillis W. 
Long National Hansen's Disease Center in Carville, LA. This 
amount is essentially the same as the administration request 
and the 1999 level.
    The Committee appreciates the Institute of Medicine study 
of the Pacific Basin health care delivery system, conducted in 
1998. It is the Committee's understanding that the IOM cited 
findings for all health indicators for the people residing in 
the freely associated states, as being significantly worse than 
those for mainland Americans. The Committee, therefore, expects 
the Department to review the IOM findings and initiate 
implementation of its recommendations which include: 
jurisdictional coordination by the Pacific Islanders Health 
Officers Association; use of Tripler Army Medical Center and 
Guam Naval Hospital for care coordination, with emphasis on 
telehealth assessment and management; development of and 
participation in a regional health information system for 
information tracking and storage; continuing education for all 
health providers; and increased involvement in health care, 
particularly womens' health issues.

                  acquired immune deficiency syndrome


                        Ryan White AIDS programs

    The Committee provides $1,610,500,000 for Ryan White AIDS 
programs. This is $100,000,000 above the administration request 
and $199,649,000 above the 1999 level.
    Recent advances in diagnosis, treatment, and medical 
management of HIV disease has resulted in dramatic improvements 
in individual health, lower death rates and transmission of HIV 
from mother to infant. The Committee recognizes, however, that 
not all HIV infected persons have benefited from these medical 
advances and expects that the Ryan White CARE Act programs 
provide social and other support services with the specific 
intent of obtaining and maintaining HIV-infected individuals in 
comprehensive clinical care.
    The department is encouraged to identify obstacles 
confronting people with HIV/AIDS in receiving medical care 
funded through the Ryan White programs and to re-examine the 
design of both Ryan White programs and Medicaid in light of the 
changing medical needs of a patient population that is living 
longer with current therapies.
    The Committee is aware of the proposal by the National 
Training Institute to enhance volunteer training, support and 
retention model developed over the past twenty-five years to 
assist people with cancer and HIV/AIDS to help other 
populations needing supportive services.
    The Committee recognizes the recent advances in the 
treatment and medical care of persons with HIV disease and the 
need for early access to these interventions and services. 
Furthermore, the Committee understands that disparities exist 
in accessing and maintaining the benefits of these recent 
advances among communities highly impacted by HIV and AIDS. The 
Committee requests that the Secretary fund an independent study 
through the Institute of Medicine to evaluate the effectiveness 
of the current role and structure of the Ryan White CARE Act 
programs on improving access to effective HIV treatments among 
underserved communities. The report should include a review of 
the current structure of the types of services funded through 
the CARE Act and their relation to medical care, mechanisms to 
assure access to quality medical services to underserved and 
uninsured populations, and the effectiveness of the funding 
allocation formulas in targeting communities of the greatest 
need. The report should include recommendations to ensure that 
all persons with HIV-infection have reasonable access to new 
treatments and quality medical care and providers. The study 
should be made available by the end of the fiscal year.
    The Committee urges HRSA to assume a leadership role in 
ensuring that the prevention, treatment, and management of HIV/
AIDS in correctional facilities is a high priority and that the 
care rendered meets current medical standards for AIDS care. 
The Committee encourages HRSA to collaborate with the Federal 
Bureau of Prisons, CDC, the White House Office on AIDS Policy, 
and other entities of jurisdiction.

Emergency assistance--title I

    The Committee recommends $541,200,000 for emergency 
assistance grants to eligible metropolitan areas 
disproportionately affected by the HIV/AIDS epidemic. This 
amount is $36,161,000 above the fiscal year 1999 amount and 
$20,000,000 above the administration request. These funds are 
provided to metropolitan areas meeting certain criteria. One-
half of the funds are awarded by formula and one-half are 
awarded through supplemental competitive grants.
    The Committee is concerned about the limited AIDS therapy 
options for children and pregnant women, and encourages the 
Secretary, when awarding supplemental title I funds, to give 
priority as appropriate to EMA's whose applications increase 
services to women and children with AIDS/HIV infection.
    The Committee notes the work by the Department with Alameda 
County, California, which is the only county and health 
jurisdiction thus far which has declared a public health 
emergency on AIDS in the African-American community. Recent 
data clearly indicates that new HIV infections and AIDS 
diagnoses among African-Americans are growing. The county has 
requested emergency assistance to provide prevention and 
treatment services, as well as research in communities where 
HIV/AIDS prevalence is at crisis levels. The declared public 
health emergency has moved HHS to give a high priority to the 
city of Oakland and Alameda County. HHS plans to deploy a 
crisis response team to further evaluate the disease's 
devastating impact in Alameda County's health jurisdiction.

Comprehensive care programs--title II

    The Committee has provided $843,000,000 for HIV health care 
and support services. This amount is $60,000,000 above the 
administration request and $105,235,000 above the 1999 level. 
These funds are awarded to States to support HIV service 
delivery consortia, the provision of home and community-based 
care services for individuals with HIV disease, continuation of 
health insurance coverage for low-income persons with HIV 
disease and support for State AIDS drug assistance programs 
[ADAP].
    The Committee continues to be encouraged by the progress of 
protease inhibitor therapy in reducing the mortality rates 
associated with HIV infection and in enhancing the quality of 
life of patients on medication. The Committee has approved bill 
language for $536,000,000 for AIDS medications, compared to 
$461,000,000 provided for this purpose in fiscal year 1999. The 
Committee further urges HRSA to encourage States to utilize 
Federal ADAP funding in the most cost-effective manner to 
maximize access to HIV drug therapies and to eliminate cost-
shifting from Medicaid to the State ADAP programs. States with 
ADAP funding should be allowed the flexibility to purchase and 
maintain insurance policies for eligible clients including 
covering any costs associated with these policies, or continue 
to pay premiums on existing insurance policies that provide a 
full range of HIV treatments and access to comprehensive 
primary care services, as determined by a State. Funds should 
not be committed to purchase insurance deemed inadequate by a 
State in its provision of primary care or in its ability to 
secure adequate access to HIV treatments.
    It has been brought to the Committee's attention that many 
state HIV/AIDS programs seek increased flexibility to use some 
ADAP resources to fund medical care, laboratory tests, and 
services to enhance patient adherence to pharmaceuticals. The 
agency should consider allowing states to redirect a reasonable 
portion of ADAP funds, as determined in collaboration with the 
states, to such services that enhance the ability of eligible 
people with HIV/AIDS to gain access to, adhere to, and monitor 
their progress in taking HIV-related medications. The agency 
should submit a report to the Committee with details on the 
implications of such a change prior to implementation.

Early intervention program--title III-B

    The Committee recommends $140,300,000 for early 
intervention grants. This is $46,030,000 above the 1999 level 
and $10,000,000 above the administration request. These funds 
are awarded competitively to primary health care providers to 
enhance health care services available to people at risk of HIV 
and AIDS. Funds are used for comprehensive primary care, 
including counseling, testing, diagnostic, and therapeutic 
services.
    To the extent practicable, the Committee encourages HRSA to 
fairly allocate the increase for title III-B between existing 
grantees and new providers. The Committee understands that 
existing grantees have been level-funded throughout the history 
of the CARE Act. By providing additional funds to current 
grantees, the Committee intends to strengthen the HIV care 
infrastructure already established in title III-B clinics. The 
Committee also supports expansion of the number of communities 
receiving assistance from this title.
    Priority should be placed on funding new projects in rural, 
medically underserved areas, and secondary cities outside of 
major metropolitan areas in order to build clinical capacity 
for the delivery of HIV care among clinicians serving high-risk 
populations, minorities, and those who are unable to access 
clinical HIV care for economic reasons. In building capacity, 
the goal is to develop regional centers of knowledgeable 
clinicians to improve access to quality HIV treatment based 
upon the evolving HIV treatment guidelines of DHHS.
    As noted last year, the Committee is aware that the FDA has 
approved at-home telemedicine diagnostic testing methods which 
seem to offer important fiscal, privacy and public health 
advantages. A study published by CDC indicates that a 
significant percentage of individuals using public clinics for 
on-site HIV testing do not return for their results. HRSA data 
indicates that the average cost for on-site testing, counseling 
and referral services is about $160 per person, compared with 
the $40 cost for at-home telemedicine testing. The Committee 
again requests HRSA to evaluate and report on the benefits and 
costs of varying testing methods, including at-home 
telemedicine and to make program changes that are warranted.

Pediatric AIDS demonstrations--title IV

    The Committee recommends $53,000,000 for title IV pediatric 
AIDS, which is $5,000,000 higher than the administration 
request and $7,015,000 above the 1999 amount. This program 
supports demonstration grants to develop innovative models that 
foster collaboration between clinical research institutions and 
primary/community-based medical and social service providers 
for underserved children, youth, pregnant women, and their 
families.
    With additional funding, the Committee urges HRSA to expand 
comprehensive services for youth, including case finding, 
mental health and early intervention services. The Committee 
also urges the agency to expand services for HIV-positive women 
and men who are primary care givers of infected or affected 
children or youth. In allocating new funds, the Committee 
further urges the agency to create a consolidated grant 
application process and to ameliorate administrative burdens to 
grantees to the fullest extent that is practical. The Committee 
is aware of the efforts of the AIDS Policy Center for Children, 
Youth and Families to expand necessary services to those in 
need.
    Some 5 percent of the funds appropriated under this section 
may be used to provide peer-based technical assistance. Within 
this amount, sufficient funds are available to maintain and 
expand work being done to create a national consumer and 
provider education center on the use of various strategies and 
planning in the care of children, youth, women and families 
infected with or affected by HIV and AIDS.
    Transmission of HIV to newborns can be reduced by over 90 
percent if pregnant women are aware they are HIV-positive and 
are effectively treated with drugs prior to birth. To improve 
testing of pregnant women and reduce the incidence of HIV 
births, last year the Committee encouraged consideration of 
demonstration projects involving at-home diagnostic testing 
with telemedicine support, yet no action was taken. The 
Committee continues to strongly believe the use of at-home 
telemedicine services for HIV testing would be an effective 
outreach tool for pregnant women in high HIV prevalence states 
and urges HRSA to proceed with demonstrating this approach.

AIDS dental services

    The Committee provides $9,000,000 for AIDS dental services, 
which is $1,000,000 above the administration request and 
$1,202,000 above the 1999 level. This program provides grants 
to dental schools and postdoctoral dental education programs to 
assist with the cost of providing unreimbursed oral health care 
to patients with HIV disease.
    The Committee recognizes the importance of oral health care 
providers in the diagnosis of HIV and in treating the painful 
and debilitating oral manifestations of this disease. The 
Committee supports this program as it improves access to oral 
health services for low-income and uninsured people living with 
HIV and AIDS by providing partial reimbursement to dental 
education institutions for delivering care.

AIDS education and training centers

    The Committee recommends $24,000,000 for the AIDS education 
and training centers [AETC's]. This amount is $4,006,000 above 
the 1999 level and $4,000,000 above the administration request. 
AIDS education and training centers train health care 
practitioners, faculty, and students who care for AIDS patients 
outside of the traditional health professions education venues, 
and support curriculum development on diagnosis and treatment 
of HIV infection for health professions schools and training 
organizations. The targeted education efforts by AETC's are 
needed to ensure the cost-effective use of the significant 
expenditures in Ryan White programs and the AIDS drugs 
assistance program. The agency is urged to fully utilize the 
AETC's to ensure the quality of medical care and to ensure, as 
much as possible, that no individual with HIV receives 
suboptimal therapy due to the lack of health care provider 
information.
    Emphasis should be placed on building clinical treatment 
capacity by reaching health professionals providing care to 
persons within medically underserved areas, minorities, the 
economically underprivileged, and rural populations. The goal 
is to provide clinical education and consultation to increase 
knowledge and skills of the targeted clinician group providing 
care to low or medium volume of HIV patients thereby improving 
the early and ongoing access to quality HIV treatment by 
clinicians within urban and rural medically underserved areas 
and secondary cities outside of major metropolitan areas.

Ricky Ray hemophilia trust fund

    The Committee has included $50,000,000 for payments 
authorized by the Ricky Ray Hemophilia Relief Trust Fund Act, 
Public Law 105-369. This is a new activity for fiscal year 
2000. The act authorizes the establishment of a trust fund 
administered by the Secretary for the purpose of disbursing 
payments to persons with hemophilia who contracted HIV through 
the use of contaminated blood products between July 1982 and 
December 1987. Spouses and children of affected individuals who 
became HIV-infected are also eligible for payment.

Family planning

    The Committee recommends $222,432,000 for the title X 
family planning program. This is $17,520,000 below the 
administration request and $7,500,000 above the 1999 level. 
Title X grants support primary health care services at more 
than 4,000 clinics nationwide. About 85 percent of family 
planning clients are women at or below 150 percent of poverty 
level.
    Title X of the Public Health Service Act, which established 
the family planning program, authorizes the use of a broad 
range of acceptable and effective family planning methods and 
services. The Committee believes this includes oral, 
injectable, and other preventive modalities.
    The Committee remains concerned that programs receiving 
title X funds ought to have access to these resources as 
quickly as possible. The Committee, therefore, again instructs 
the Department to distribute to the regional offices all of the 
funds available for family planning services no later than 60 
days following enactment of this bill.
    The Committee intends that at least 90 percent of funds 
appropriated for Title X activities be for clinical services 
authorized under section 1001 of the Act. All such funds for 
section 1001 activities are to be provided to the regional 
offices to be awarded to grantees to provide family planning 
methods and services as specified by the Title X statute. The 
Committee further expects the Office of Family Planning to 
spend all available year-end funds in section 1001 activities.

Rural health research

    The Committee recommends $6,085,000 for the Office of Rural 
Health Policy. This is $4,000 more than the fiscal year 1999 
level and the same as the administration request. The funds 
provide support for the Office as the focal point for the 
Department's efforts to improve the delivery of health services 
to rural communities and populations. Funds are used for rural 
health research centers, grants to telemedicine projects, the 
National Advisory Committee on Rural Health, and a reference 
and information service.
    The Committee is supportive of continuing funds to the 
Children's Health Fund to implement a rural health initiative 
that would expand availability and accessibility of pediatric 
care to underserved rural communities.

Health care facilities

    The Committee provides $10,000,000 for health care 
facilities, which is $55,324,000 below the 1999 level and 
$10,000,000 above the administration request. Funds are made 
available to public and private entities for construction and 
renovation of health care and other facilities.

National Hanson's Disease Program Buildings and facilities

    The Committee recommends $250,000 for buildings and 
facilities, the same as the administration request and the same 
as the fiscal year 1999 amount.

Rural hospital flexibility grants

    The Committee includes $25,000,000 for rural hospital 
flexibility grants, which is the same as the administration 
request and $8,000 higher than last year's appropriation.
    This program administers the Rural Health Flexibility 
Program previously administered by the Health Care Finance 
Administration. Under this program, eligible rural hospitals 
may convert themselves into limited service facilities termed 
Critical Care Hospitals. Such entities are then eligible to 
receive cost-based payments from Medicare. The grant component 
of the program assists states with the development and 
implementation of state rural health plans, conversion 
assistance, and associated activities.

National practitioner data bank

    The Committee has not provided Federal funding for the 
national practitioner data bank, which is the same as the 
administration request. The Committee and the administration 
assume that $16,000,000 will be provided entirely through the 
collection of user fees and will cover the full cost of 
operating the data bank, an amount that is $4,000,000 higher 
than what was authorized to be collected in fiscal year 1999. 
Traditional bill language is included to ensure that user fees 
are collected to cover all costs of processing requests and 
providing such information to data bank users.

Health care integrity and protection data bank

    The administration has proposed to create a new data bank 
intended to collect, maintain, and report on certain actions 
taken against health care providers, suppliers, and 
practitioners. This information would be collected from and 
made available to government agencies, health plans, and to 
self-queries made by individuals and entities. The 
administration further proposes to fund the data bank through 
user fees. The Committee assumes that $8,000,000 will be 
provided entirely though the collection of user fees and will 
cover the full cost of operating the data bank, an amount that 
is $5,260,000 higher than the amount allocated last year.

Office for the Advancement of Telehealth

    The Committee provides $20,000,000 for the Office for the 
Advancement of Telehealth, which is $6,876,000 more than the 
administration request and fiscal year 1999. Activities for the 
office were previously funded through the budget of the Office 
of Rural Health Policy. This office was established to promote 
the use of certain technologies to improve access to health 
services and to promote health education.
    The Committee notes that telehealth development could have 
major benefits to efforts now underway to prepare the nation 
against bioterrorist threats. Linkages between state, local, 
and Federal health authorities along with hospitals, clinics, 
and health care practitioners will be central to improving 
surveillance and response.
    The Committee is supportive of HRSA's efforts to include 
EMS issues in its Telemedicine/Telehealth initiative and 
encourages the Office of Rural Health Policy, the Office of 
Telemedicine/Telehealth and EMSC program to collaborate on 
projects to improve emergency medical service for children.
    The Committee suggests that the Office for the Advancement 
of Telehealth establish a number of regional centers for the 
advancement of telehealth. Such centers could serve advance 
cost-effective deployment of telehealth technologies and 
provide technical assistance to health care providers. The 
centers could conduct research, evaluations, and assessments to 
determine the appropriate application of telehealth 
technologies that span across health care disciplines, 
applications, and settings.
    The Committee is aware of HRSA's increased commitment to 
telehealth demonstration projects to serve as models for the 
efficient delivery of health care services to rural, 
underserved, and hard to reach populations. The Committee urges 
an increased focus on demonstration grants for providing 
behavioral and mental health services and advanced training for 
providers in prisons and other public institutions.
    The Committee is aware of the continued development of the 
South Alabama Telemedicine Project.
    The Committee is aware of a joint proposal between the 
states of New Mexico and Hawaii to establish a telehealth 
project in remote and rural areas. These states are engaged in 
developing a joint high performance computing project in Maui, 
Hawaii as a foundation for this initiative.
    The Committee is aware of a proposal by the Children's 
Hospital and Regional Medical Center in Seattle, Washington to 
establish an interactive telemedicine system to serve patients 
in Washington, Wyoming, Alaska, Montana, and Idaho.
    The Committee is aware of the efforts by the Alaska Federal 
Health Care Partnership Statewide Telemedicine Project to place 
telemedicine stations and kiosks in each of Alaska's 237 
villages. This network would link health services the villages 
with regional and tertiary care facilities in Anchorage and 
Fairbanks.
    The Committee is aware of the proposal by the Montana State 
University-Billings to develop in collaboration with medical 
facilities in the area a telemedicine program to provide 
preventive medicine and support services to the large elderly 
population in Billings and eastern Montana. The focus would be 
on serving nursing homes, assistive care facilities and others 
who care for the elderly. Programs would cover health care 
administration, long-term health care, rural nursing care, and 
the management of mental health care systems.
    The Committee is aware of a proposal to link, via 
telemedicine capabilities, a private college (Rocky Mountain 
College in Montana) and a medical facility (Deaconess Billings 
Clinic of Montana). Together they could provide medical imagery 
and education as well as create communication links to the 
described geographical area. The proposal features distance 
learning centers that offer both education and telemedicine 
services.
    The Committee understands that following certain major 
natural disasters, such as Hurricane Andrew and the North 
Dakota floods, extension agents were trained in crisis 
intervention and stress management to better equip them to deal 
with emotional and stress related problems. In view of the 
continuing difficulty of reaching rural populations with 
behavioral and mental health services and the success of the 
post-disaster projects, the Committee encourages consideration 
of telehealth and distance learning proposals that 
cooperatively involve the Extension Service in the delivery of 
services to rural populations.
    The Committee is aware of the San Bernardino County Medical 
Center proposal to create a ``hospital without walls.'' In 
addition, the Santa Rosa Memorial Hospital is proposing the 
creation and implementation of a Northern California 
Telemedicine Network to provide health care access to the 
California north coast's remote and underserved populations.
    The Committee encourages a special focus on grants to 
demonstrate cost effective models to reach prison and other 
public institution populations with behavioral and mental 
health services that combine delivery of service with advanced 
training of health care professionals. The Committee is aware 
of the efforts of the California School of Professional 
Psychology to provide a training and service demonstration in 
this area.
    The Committee notes the proposal of the Louisiana Community 
Hospital Telehealth Consortium to link a number of health 
facilities through the region.
    The Committee encourages the agency to assess the current 
status of rural frontier facilities providing extended stay 
primary care services and the merits of establishing a multi-
state demonstration project to determine the extent and 
efficacy of upgrading certain rural primary care clinics.
    The Committee is aware of the proposal by a consortium of 
health care providers in northern Vermont and upstate New York 
to create a rural telemedicine system to link rural trauma 
care, education and prevention programs.
    The Committee encourages the agency to work in partnership 
with medical librarians and other health information 
specialists in the development and implementation of its 
telehealth projects, especially those involving rural health 
care.
    The Committee is aware of a proposal by the Institute for 
Health Policy Studies that would extend the video conferencing 
links among biomedical research facilities within Russia, 
nearby academic facilities and American institutions. The 
Committee understands this international project would promote 
the peaceful uses of medical knowledge and the sharing of key 
epidemiological information between the U.S. and Russia.
    The Committee is aware of efforts to establish a 
telemedicine network between the Medical University of South 
Carolina, Walter Reed Medical Center, and Sloan Kettering 
Memorial Hospital to extend prostate cancer education, 
prevention, and treatment to underserved populations.
    The Committee understands that the Utah Telehealth Network 
holds significant promise in linking rural and frontier 
communities should additional Federal resources be made 
available.
    The Committee is aware of the National Information Display 
Laboratory project which involves the University of 
Pennsylvania Medical Center. The project has been involved in 
clinical trials which have produced significant results related 
to breast cancer detection and diagnosis. With additional 
funding, the project would be able to make considerable strides 
through its existing collaborations with other federal 
technology agencies.
    The Committee urges the agency to administer rural health 
demonstration pilots in Alaska, Mississippi, Nevada, Oklahoma, 
South Carolina, Texas, and Washington for community-based 
telecommunications infrastructure development to improve access 
to health care. These projects will advance access to health 
services and related educational programs in rural areas by 
maximizing resources committed or under development by 
government and private sources.
    The Committee encourages the efforts of the Los Angeles 
County Community Development Commission and the Los Angeles Eye 
Institute to expand their operations to provide high quality 
health care for high-risk medically underserved populations, 
including expansion of the nation's first urban telemedicine 
program.

Program management

    The Committee recommends $133,000,000 for program 
management activities for fiscal year 2000. This is $11,337,000 
higher than the administration request and $4,038,000 more than 
the fiscal year 1999 level.
    The Committee continues to support the efforts of the 
American Foundation for Negro Affairs of Philadelphia and 
expects continued support at the level appropriated in fiscal 
year 1999.
    Health professional shortage areas.--It has been brought to 
the Committee's attention that in 1998, HRSA published a 
proposed methodology for designating health professional 
shortage areas. In response to public comment, HRSA has agreed 
to reconsider the methodology. The Committee urges HRSA to 
ensure that any new methodology is not detrimental to 
underserved rural or frontier communities. As part of this 
process, HRSA should also define the term ``frontier,'' using 
appropriate measures of population density and distance in 
miles, and time in minutes, to the nearest medical facility. 
The current HPSA designation methodology requires a community 
with a small population to lose its only physician before it 
will qualify as a HPSA. The Committee believes that this 
endangers the health of rural residents. The Committee urges 
HRSA to establish a waiver of the physician-to-population 
requirements or another process that will allow communities to 
qualify as HPSAs when they know that a physician is planning to 
leave. This would enable communities to qualify for physician 
recruitment assistance in time to replace the leaving 
physician.
    The Committee urges HRSA to consult with ``frontier 
states'' such as Alaska and Hawaii as part of its process of 
reconsidering this methodology to ensure that its final 
regulation meets the needs of frontier communities as well as 
rural ones.
    The Committee is very concerned about the increasing 
numbers of Americans who are obese. Over one fifth of all 
adults are obese; over half are overweight. Obesity is known to 
cause serious diseases including type 2 diabetes, hypertension, 
stroke and several cancers. Deaths due to poor diet and 
inactivity are the second leading cause of preventable death in 
the United States. According to a recent study by the American 
Obesity Association, the direct health care costs of obesity in 
1999 will be over $100,000,000,000. Obesity among women over 20 
is increasing at over 1 percent a year. Obesity is growing 
among school children with increasing prevalence of diabetes 
and hypertension at younger ages. The Committee is very 
concerned about the increasing numbers of Americans who are 
obese. Over one fifth of all adults are obese; over half are 
overweight. Obesity is known to cause serious diseases 
including type 2 diabetes, hypertension, stroke and several 
cancers. Deaths due to poor diet and inactivity are the second 
leading cause of preventable death in the United States. 
According to a recent study by the American Obesity 
Association, the direct health care costs of obesity in 1999 
will be over $100,000,000,000. Obesity among women over 20 is 
increasing at over 1 percent a year. Obesity is growing among 
school children with increasing prevalence of diabetes and 
hypertension at younger ages. Therefore, the Committee 
encourages the Secretary to develop a comprehensive plan for 
expanding research on obesity at the National Institutes of 
Health and the Center for Disease Control and Prevention as 
well as education programs at the Department of Education.
    Hemophilia report.--The Committee is concerned that HRSA 
has not provided the report requested regarding the 
participation of hemophilia treatment centers (HTCs) in the 
Public Health Service drug pricing program (DPP). The report 
was requested to be delivered in six months after enactment of 
the fiscal year 1998 appropriations act. The Committee remains 
concerned that the agency will require HTCs to distribute 
clotting factor and participate in the DPP as a condition of 
receiving their grant from the Maternal and Child Health 
Bureau. It has been brought to the Committee's attention that 
incentives exist that allow HTCs to participate in the DPP as a 
means of generating revenues through markups of the prices that 
HTCs charge hemophilia patients for factor products. This is, 
in the Committee's view, inconsistent with the intent of the 
program.

               medical facilities guarantee and loan fund

Appropriations, 1999....................................      $1,000,000
Budget estimate, 2000...................................       1,000,000
Committee recommendation................................       1,000,000

    The Committee recommends $1,000,000 for the medical 
facilities guarantee and loan fund. This is the same as the 
administration request and the fiscal year 1999 appropriation. 
These funds are used to comply with the obligation of the 
Federal Government to pay interest subsidies on federally 
guaranteed loans throughout the life of the loans. These loans 
were used for hospital modernization, construction, and 
conversion. The bill includes language, as in prior years, 
which prohibits commitments for new loans or loan guarantees in 
fiscal year 2000.

                   health education assistance loans

    The Committee recommends no additional guarantee authority 
for new HEAL loans in fiscal year 2000, which is the same as 
the President's request.
    The Committee recommends $31,500,000 to liquidate 1999 
obligations from loans guaranteed before 1992, which is the 
same as the administration request and $5,500,000 below the 
1999 appropriation.
    For administration of the HEAL Program including the Office 
of Default Reduction, the Committee recommends $3,688,000, 
which is $1,000 above the 1999 appropriation and the same as 
the administration request.
    The HEAL Program insures loans to students in the health 
professions and helps to ensure graduate student access to 
health professions education, especially among minority, 
disadvantaged students, and those from behavioral and mental 
health fields. The Budget Enforcement Act of 1990, changed the 
accounting of the HEAL Program. One account is used to pay 
obligations arising from loans guaranteed prior to 1992. A 
second account was created to pay obligations and collect 
premiums on loans guaranteed in 1992 and after. Administration 
of the HEAL Program is separate from administration of other 
HRSA programs.

                 vaccine injury compensation trust fund

Appropriations, 1999....................................     $63,000,000
Budget estimate, 2000...................................      63,000,000
Committee recommendation................................      63,000,000

    The Committee recommends that $63,000,000 be released from 
the vaccine injury compensation trust fund in fiscal year 2000, 
of which $3,000,000 is for administrative costs. This amount is 
the same as the budget request and the fiscal year 1999 amount.
    The National Vaccine Injury Compensation Program provides 
compensation for individuals with vaccine-associated injuries 
or deaths. Funds are awarded to reimburse medical expenses, 
lost earnings, pain and suffering, legal expenses, and a death 
benefit. The vaccine injury compensation trust fund is funded 
by excise taxes on certain childhood vaccines.

               Centers for Disease Control and Prevention


                disease control, research, and training

Appropriations, 1999....................................  $2,771,229,000
Budget estimate, 2000...................................   2,820,440,000
Committee recommendation................................   2,802,838,000

    For the Centers for Disease Control and Prevention [CDC], 
the Committee provides $2,802,838,000, which is $31,539,000 
above the 1999 level and $17,602,000 below the budget request.
    The activities of the CDC focus on four major priorities: 
provide core public health functions; respond to urgent health 
threats; promote women's health; and provide leadership in the 
implementation of nationwide prevention strategies to encourage 
responsible behavior and adoption of lifestyles that are 
conducive to good health.
    The Committee has provided additional funds for 
bioterrorism and related public health infrastructure 
activities within the public health and social services fund.

Preventive health and health services block grant

    The Committee recommends $118,161,000 for the preventive 
health and health services block grant. Of the amount provided, 
$115,914,000 is for program activities, which is $31,839,000 
below the 1999 level and the same as the administration 
request. For salaries and expenses within this category of 
activities, $2,247,000 has been provided, which is the same as 
the 1999 level and $1,839,000 below the request. The Committee 
recommendation includes an additional $51,000,000 from the 
violent crime reduction trust fund for rape and domestic 
violence prevention and education activities authorized by the 
Violence Against Women Act to be carried out through the 
preventive health and health services block grant. This amount 
is $16,000 more than the 1999 appropriation.
    The preventive health and health services block grant 
provides States with funds for services to reduce preventable 
morbidity and mortality and improve the quality of life. The 
grants give States flexibility in deciding how available 
funding can be used to meet State preventive health priorities. 
Programs eligible for funding include screening, laboratory 
services, health education, and outreach programs for such 
conditions as high blood pressure and cholesterol, and breast 
and uterine cancer.

Prevention centers

    The Committee recommends $15,500,000 for prevention 
centers. Of the amount provided, $15,000,000 is for program 
activities, which is $2,000,000 above the 1999 level and the 
administration request. For salaries and expenses within this 
category of activities, $500,000 has been provided, which is 
the same as the 1999 level and the administration request.
    CDC's prevention centers program provides grants to 
academic programs to support applied research designed to yield 
tangible results in health promotion, disease prevention, 
tobacco use prevention, and injury control. This network of 
collaborating prevention centers works to fill the knowledge 
gaps that block achievement of prevention goals. The centers 
work with State and local health departments and other 
organizations to increase the implementation of research 
findings.
    Prevention marketing and health behavior change.--The 
Committee encourages the CDC to consider establishing a focus 
on prevention marketing and behavior change strategies for 
enhancing health in disadvantaged communities.
    Cardiovascular disease prevention.--The Committee is 
encouraged by the agency's work with numerous health 
organizations to develop an integrated and comprehensive 
national cardiovascular disease program. CDC should identify 
additional States and localities for future expanded efforts in 
cardiovascular disease risk reduction, surveillance, and 
laboratory capacity. Priority should continue to be given to 
those States with the highest age-adjusted death rates due to 
cardiovascular diseases.
    The Committee is supportive of a peer-review process that 
takes into account the scientific and public health merits of 
proposals, among other important factors. Those applicants 
deemed most qualified ought to receive priority for funding.
    Sufficient funds are available to continue existing 
prevention centers at the previous fiscal year's level or 
higher.
    The Committee is aware of the incidence of cancer and 
chronic illnesses in the Appalachian region and urges the 
agency to give consideration to establishing a prevention 
center in the region.
    The Committee is aware of the proposal by the University of 
South Alabama to establish a birth defects monitoring and 
prevention center.
    The Committee encourages the continued support of center 
activities aimed at improving knowledge about the usefulness 
and effectiveness of health promotion programs for persons with 
disabilities.
    The Committee continues to support within the prevention 
center program a tobacco prevention research network to 
increase the knowledge base on the most effective strategies 
for preventing and reducing youth tobacco use, as well as on 
the social, physiological and cultural reasons for tobacco use 
among children.

Sexually transmitted diseases

    The Committee recommends $128,808,000 for sexually 
transmitted disease prevention and control. Of the amount 
provided, $115,711,000 is for program activities, which is 
$5,055,000 above the 1999 level and is the same as the 
administration request. For salaries and expenses within this 
category of activities, $13,097,000 has been provided, which is 
the same as the 1999 level and $1,841,000 below the 
administration request.
    The mission of the STD program is to survey, prevent, and 
control the transmission of STD's by providing national 
leadership for: prevention and control programs; monitoring 
disease trends; behavioral and clinical research; education and 
training; building partnerships for STD prevention; the STD 
accelerated prevention campaign; and infertility. Grants are 
awarded to State and local health departments and other 
nonprofit entities to support primary prevention activities, 
surveillance systems, screening programs, partner notification 
and counseling, outbreak control, and clinical skills training.
    Syphilis and chlamydia elimination.--The agency has 
requested $5,000,000 to begin implementation of a comprehensive 
strategy to eliminate the prevalence of the disease. The 
Committee recognizes the opportunity to eliminate syphilis in 
the nation. The Committee also urges the agency to also address 
chlamydia as a disease with widespread prevalence among teens 
and youth adults.
    Tuskegee activities.--The administration proposes 
$2,000,000 in support of bioethics activities at Tuskegee 
University.

Immunization

    The Committee recommends $512,273,000 for immunization 
activities in fiscal year 2000 authorized under section 317 of 
the Public Health Service Act. Of the amount provided, 
$463,364,000 is for program activities, which is $62,796,000 
above the 1999 level and is the same as the administration 
request. For salaries and expenses within this category of 
activities, $48,909,000 has been provided, which is the same as 
the 1999 level and $13,894,000 below the administration 
request.
    The Omnibus Reconciliation Act [OBRA] of 1993 established a 
new vaccine purchase and distribution system that provides, 
free of charge, all pediatric vaccines recommended for routine 
use by the Advisory Committee on Immunization Practices to all 
Medicaid-eligible children, uninsured children, underinsured, 
and native Americans through program-registered providers. 
Included in the Medicaid estimate for fiscal year 2000 is 
$545,043,000 for the purchase and distribution of vaccines for 
a total immunization program level of $1,057,316,000 in the 
bill.
    The administration of safe and effective vaccines remains 
the most cost-effective method of preventing human suffering 
and reducing economic costs associated with vaccine-preventable 
diseases. Through the immunization program, the CDC provides 
leadership and support for national and international efforts 
to prevent and/or control vaccine-preventable diseases.
    Within the amounts appropriated, sufficient funds are 
provided for the purchase of vaccine under the 317 program. As 
in previous years, the Director has discretion to make 
transfers from among funds provided for 317 vaccine purchase 
and infrastructure grants based upon the program requirements. 
This will ensure that States receive up to their maximum 
estimates for vaccine purchases and provide CDC with sufficient 
flexibility to reallocate vaccine purchase dollars if States' 
needs prove lower than the amount provided. The Committee 
continues to expect that the CDC provide notification of the 
amount of any transfer, the latest State carryover balance 
estimates, and the justification for the transfer.
    The Committee recommendation assumes the continuation of 
the bonus program to improve immunization rates. Using State-
specific immunization coverage data, CDC provides payments to 
States for 2-year-olds who have been fully immunized.
    The Committee recommendation includes the President's 
budget request for polio eradication, a $17,000,000 increase 
over the fiscal year 1999 level, in order to support CDC's 
capacity to meet the goal of global eradication of polio by the 
year 2000. The Committee is encouraged by the progress which 
has made the Americas, the Western Pacific including China, and 
virtually all of Europe polio-free, but recognizes that South 
Asia and Sub-Saharan Africa remain major reservoirs for the 
polio virus. The Committee believes the recommended increase is 
needed to ensure that African countries meet the goal of polio 
eradication by the year 2000.
    The recommendation includes sufficient funds for the CDC, 
as part of their global polio eradication efforts, to provide 
measles vaccine for supplemental measles immunization campaigns 
and to expand epidemiologic, laboratory, and programmatic/
operational support to the WHO and its member countries. Such 
support should build on the global disease control and 
surveillance infrastructure developed for polio eradication in 
a manner that does not compromise ongoing global polio 
eradication activities. The Committee also encourages the 
Director to provide sufficient staff support for this 
accelerated international measles control effort.
    The Committee continues to be supportive of the research 
exploring the promise of plant-delivered oral vaccines being 
undertaken by the Thomas Jefferson Center for Biomedical 
Research in collaboration with the Delaware Valley College. 
Through the use of genetically engineered plants, this research 
continues to show promise as a means of oral vaccine production 
for both animals and humans, especially in the area of the 
diagnosis and treatment of the hepatitis B and C viruses 
involving glycoprocessing inhibitors.
    Hepatitis B vaccinations for adolescents.--The Committee is 
aware that, while the Hepatitis B Vaccination has been 
available nationwide for several years, a small number of 
states currently have laws requiring HBV vaccinations as a 
requirement for middle school admission. To accelerate this 
process and address the public health threat, the CDC is urged 
to support adolescent health coordinators in each state to work 
with physicians, nurses, public health care providers, schools, 
State legislators and others to increase the rate of compliance 
with the HBV vaccination program.
    Hepatitis A vaccinations.--The Committee notes the Advisory 
Committee on Immunization Practices recent recommendation for 
increased efforts to reach children for Hepatitis A 
immunizations in 11 states where the rate of Hepatitis A 
exceeds 20 cases per 100,000 population. The Committee urges 
CDC to support the local and state health departments in these 
states.
    Hepatitis among prisoners.--The Committee is aware of the 
Department's finding that the health care issues of prison 
inmates is a growing concern. In particular, the high rates of 
the known strains of hepatitis among the prison population is a 
public health concern. It has been brought to the Committee's 
attention that the high rates of hepatitis could pose a threat 
to the general population since it has been estimated that 
eighty percent of inmates will leave prison and return to their 
respective communities. The agency is urged to address the 
special health needs of this population in order to mitigate 
the risk to the public at large, including vaccination efforts 
and prevention interventions.
    Alaska.--The Committee urges CDC to increase section 317 
grant support for infrastructure development and purchase of 
vaccines for the State of Alaska's universal immunization 
program. It has been brought to the Committee's attention that, 
according to a 1996 survey, Alaska ranked 48th out of the 50 
states, with only 69 percent of Alaska's 2-year olds receiving 
basic vaccines. The Committee supports Alaska's request for 
sufficient funding for the purchase of vaccine needed for 90 
percent of Alaskan children and to provide infrastructure 
support needed to support delivery of these vaccines at the 
community level.

Infectious diseases

    The Committee's recommendation includes $165,610,000 for 
infectious disease activities. Of the amount provided, 
$98,274,000 is for program activities, which is $27,974,000 
above the 1999 level and is the same as the administration 
request. For salaries and expenses within this category of 
activities, $67,336,000 has been provided, which is the same as 
the 1999 level and $16,316,000 below the administration 
request.
    These activities focus on: national surveillance of 
infectious diseases; applied research to develop new or 
improved diagnoses; prevention and control strategies; working 
with State and local departments and private health care 
providers, to transfer application of infectious diseases 
prevention technologies; and strengthening the capability to 
respond to outbreaks of new or reemerging disease.
    Emerging infections.--The agency has proposed a $15,000,000 
increase to accelerate its efforts to combat emerging and re-
emerging pathogens that may arise domestically or 
internationally. Of this increase, CDC aims to use $5,000,000 
to initiate a national hepatitis C prevention campaign.
    Foodborne diseases.--The agency has proposed a $10,000,000 
increase to implement a national food safety initiative that 
would include the expansion of the interagency foodborne 
disease surveillance program, analysis, training, and 
technology/standards development.
    The Committee requests that CDC prepare and disseminate 
annual summaries of information on foodborne illness, including 
outbreak summaries, surveillance findings, and study results. 
Such summaries would better inform the public on the current 
state of knowledge on the burden of illness, the nature of such 
outbreaks, and thus raise consumer awareness concerning the 
handling and preparation of foods.
    Bioterrorism surveillance.--The agency has proposed a 
$20,000,000 increase to establish a national laboratory network 
that would be utilized for both bioterrorism response and 
overall public health readiness to disease and pathogen 
outbreaks.
    Lyme disease.--The Committee has been made aware that there 
are concerns about the CDC surveillance criteria for Lyme 
disease and urges the agency to consider re-evaluating the 
current surveillance criteria to more accurately track and 
evaluate the prevalence of Lyme disease. The Committee has 
received expressions of concern over the possible mismatched 
use of surveillance criteria for clinical diagnostic use and 
urges the CDC to educate the medical and scientific community 
about this distinction.
    Hepatitis C.--The Committee is aware of the research 
recommendations made by the March 1997 Hepatitis C (HCV) 
Consensus Development Conference and the impact on the program 
responsibilities of the CDC. These recommendations included 
continued monitoring of the epidemiology of acute and chronic 
HCV and the development of strategies to educate at-risk groups 
concerning transmission of the disease. The Committee urges the 
Hepatitis Council of the American Liver Foundation and the CDC 
to work together in developing these research initiatives.
    Hepatitis C lookback.--The Committee continues to be highly 
interested in supporting the Secretary's lookback initiatives 
regarding screening and counseling for people who may have been 
infected with hepatitis C through blood transfusions before 
1992. The Committee is aware that CDC is supporting an 
evaluation of the adequacy of ongoing efforts to screen and 
counsel these individuals and believes it is critical that such 
an assessment be made at least quarterly and made public. The 
Committee again calls upon CDC to assure that those potentially 
infected receive appropriate counseling and screening, and 
encourages CDC to develop a centralized national screening 
program supported by a toll-free telephone number-based 
operation, involving risk assessment, convenient screening and 
counseling. Under this program, person receiving lookback 
notification letters would be advised of the hotline service 
that provides education and telephone counseling and 
coordinates convenient testing.
    The Committee is aware of the critical importance of 
prevention and detection of individuals at high-risk for 
Hepatitis C (HCV) and HIV/AIDS, and strongly urges the 
Department to evaluate and support new more efficient testing 
technologies such as at-home tests and rapid tests.
    Cooley's anemia.--The Committee notes that patients differ 
in their use of blood and blood products, depending upon the 
nature of their illnesses. Patients with Cooley's anemia, for 
example, rely on blood but not blood products, and may undergo 
30 to 35 transfusions per year. Such patients may be able to 
lend valuable assistance in monitoring the blood supply. The 
Committee encourages the agency to recognize these differences 
when implementing its improved blood safety plans and to work 
with the Cooley's Anemia Foundation in efforts to protect and 
monitor the nation's donated blood supply.
    Activity centers.--The Committee is pleased with the work 
of CDC's centers of excellence in infection control focusing 
upon the problem of antibiotic resistance and encourages CDC to 
continue to support these applied research efforts and to 
expand the scope of the program.
    The Committee notes CDC's efforts to coordinate public 
health surveillance and communication on infectious and 
emerging infectious diseases including tuberculosis, and 
commends CDC's proposal to include emerging infectious diseases 
in its National Electronic Disease Surveillance Network 
Initiative (NEDSNI).
    Hemophilia and other bleeding disorders.--The Committee is 
encouraged by CDC's collaborative efforts with the National 
Hemophilia Foundation to reduce hospitalization and morbidity 
among persons with hemophilia through its chronic disease 
management and patient outreach activities. The Committee urges 
the agency to accelerate efforts geared toward the prevention 
of the complications of hemophilia and other bleeding and 
clotting disorders, including von Willibrand and other women's 
bleeding disorders. Additional efforts are also needed to 
strengthen collaboration between CDC and the Food and Drug 
Administration in monitoring and investigating any possible 
contamination of blood and blood products.

Tuberculosis elimination

    The Committee's recommendation provides $125,185,000 for 
CDC's activities to prevent or control tuberculosis. Of the 
amount provided, $120,000,000 is for program activities, which 
is $5,223,000 above the 1999 level and $7,853,000 above the 
administration request. For salaries and expenses within this 
category of activities, $5,185,000 has been provided, which is 
the same as the 1999 level and $2,630,000 below the 
administration request.
    CDC provides support for the control and elimination of TB. 
This is accomplished in large part through awarding cooperative 
agreements to State, territorial, and large city health 
departments to strengthen their control and elimination 
programs.
    The Committee is aware that tuberculosis (TB) is a leading 
threat to health throughout the Americas. The Committee further 
understands that a recent report by the U.S. Agency for 
International Development on cross-border TB has highlighted 
the special burdens of controlling TB within U.S. border 
States, particularly California and Texas, where incidence 
rates are well above the national average. With the growing 
incidence of drug resistant strains of TB, the Committee urges 
the agency to intensify its efforts in key border states 
vulnerable to an influx of TB-infected individuals. The CDC 
Office of Global Health is further encouraged to enjoin in this 
effort. The Committee commends the Global Health Council for 
its efforts in this area.

Chronic and environmental disease prevention

    The Committee's recommendation includes $318,375,000 for 
chronic disease prevention activities. Of the amount provided, 
$260,364,000 is for program activities, which is $18,986,000 
above the 1999 level and $10,000,000 above the administration 
request. For salaries and expenses within this category of 
activities, $58,011,000 has been provided, which is the same as 
the 1999 level and $17,568,000 below the administration 
request.
    This level includes an additional $500,000 above the 
individual administration requests for autism activities and 
for oral health activities.
    In many instances, premature death, avoidable illness, and 
disability are caused by personal behavior, exposure to toxic 
substances, and/or natural disasters. Prevention of the 
occurrence and progression of chronic diseases, therefore, is 
based on reducing or eliminating behavioral risk factors, 
increasing the prevalence of health promoting practices, 
detecting disease early to avoid complications, assessing human 
risks from environmental exposures, and reducing or eliminating 
exposures to environmental hazards. The focus of the programs 
in this activity includes diabetes, cardiovascular diseases, 
developmental disabilities, tobacco use, comprehensive school 
health, teen pregnancy, birth defects, fetal alcohol syndrome, 
spina bifida, chronic fatigue syndrome, prostate cancer, 
women's health, cancer registries, oral health, skin cancer, 
arthritis, and epilepsy.
    Chronic fatigue syndrome.--The Committee is exceptionally 
concerned over the audit and report by the HHS inspector 
general's office that revealed the agency had not spent funds 
for chronic fatigue syndrome as intended by Congress. The IG 
report noted that the agency did not have in place adequate 
controls to assure compliance with the established financial 
plan, in particular assigned direct costs. As a result, costs 
of other activities were assigned to the chronic fatigue 
syndrome program without appropriate analysis, documentation, 
or justification. The IG report suggests that as much as half 
of the $23,400,000 budgeted for chronic fatigue syndrome 
between 1995 and 1998 may have been diverted to research on 
other diseases. The laxity of oversight has resulted in the 
diversion of a significant portion of appropriated funds 
Congress intended for chronic fatigue syndrome.
    The Committee is disappointed that a confluence of factors 
has resulted in an unfortunate outcome that has strained the 
reputation of a leading public health agency. Since the 
agency's creation, the Committee has appropriated billions of 
dollars to combat and prevent maladies adversely affecting 
domestic and global health, and depends upon the goodwill and 
trust of the agency's professionals to attain the goal of 
better health for all. It is regrettable that certain actions 
taken has clouded that relationship between Congress and the 
agency.
    Because of the tangible consequences of the diversion of 
funds, namely less money available for chronic fatigue syndrome 
activities, the Committee directs the agency to begin to 
restore the estimated $12,900,000 in CFS funds diverted to 
other activities. The additional funds should be spent on the 
following priority CFS activities: public education programs, 
efforts to educate primary care providers about the detection, 
diagnosis and treatment of CFS, surveillance projects on 
children and adolescents with CFS, and an interdisciplinary 
reassessment of the case definition for CFS. Furthermore, the 
Committee expects the director of the agency to directly 
oversee the CFS program budget and the implementation of the 
above activities until such time the Committee is satisfied 
that appropriate reforms have been made to assure that 
Congressional intent for the program will be followed.
    The Committee also expects that the current CFS research 
program will remain in the Division of Viral and Rickettsial 
Diseases until it is clear to the Committee that a transfer 
will materially and substantially enhance accomplishment of the 
program's key objectives, specifically: the determination of 
the pathogenesis of CFS; estimation of incidence and prevalence 
of CFS in the U.S.; elucidation of the natural history of CFS; 
identification of risk factors and diagnostic markers; the 
development of control strategies; and education of the public 
and health professionals. Prior to any major reorganization 
involving the CFS program, the Committee expects to receive an 
explanation outlining full details regarding the transfer or 
changes to assets and/or personnel. The Committee further urges 
that the department's CFS coordinating committee consider 
making recommendations regarding the future direction and 
structure of CFS activities at CDC and expects the agency to 
provide a representative to the committee.
    Diabetes.--The incidence of diabetes affects more than 16 
million persons in America. Research has demonstrated that 
controlling blood sugar levels prevents diabetes-related 
complications. While the CDC supports local diabetes prevention 
and control programs in all States, additional support could 
further reduce the number of diabetes complications. The 
Committee supports this work and has included sufficient funds 
to enable the CDC to expand its diabetes prevention effort. 
Funds are provided as proposed in the request to: establish 
comprehensive State diabetes prevention programs; implement the 
public health components of the National Diabetes Education 
Prevention Program; develop and implement public health 
surveillance systems; and conduct applied prevention research.
    The Committee remains acutely concerned that the high 
incidence of diabetes within the native American, Native 
Alaskan and native Hawaiian populations. The Committee urges 
the CDC to continue to develop a targeted prevention and 
treatment program for these culturally unique yet similar 
groups. The Committee encourages the CDC to continue to work 
with native Americans and native Hawaiians to incorporate 
traditional healing and develop partnerships with community 
centers as a safety net during program development. The 
Committee is pleased with CDC's efforts to work with the 
leadership of native Hawaiian and Pacific Basin Islander 
communities in these efforts.
    The Committee continues to be supportive of a cooperative 
diabetes prevention research and demonstration pilot to link 
regional Veterans Administration medical centers with CDC 
prevention centers located within schools of public health. The 
Committee is pleased that discussion is underway between VA and 
CDC that may lead to a memorandum of understanding to maximize 
the resources of both agencies. The Committee understands that 
there is interest from both agencies and the schools of public 
health to expand this cooperative effort to include 
hypertension and other cardiovascular diseases. The Committee 
urges CDC to select the prevention centers best suited to carry 
out these demonstrations based on its knowledge of each 
center's expertise in the chronic disease area identified by VA 
as most beneficial to the veterans population.
    The Committee notes the work of the National Diabetes 
Prevention Center in establishing working relationships with 
Native Americans and health providers, and continues to support 
its work in this account. These relationship include a rigorous 
process for selecting scientifically accurate evaluation 
methods for current and new diabetes prevention programs. The 
Center is focusing on the successful dissemination of diabetes 
prevention and control programs to other tribes and to other 
minority groups. The agency is gathering information about 
traditional and new ideas for the culturally appropriate 
prevention and control of diabetes at any stage. New tribally-
based research designs are being reviewed for funding, and will 
be implemented through the NDPC in Gallup, New Mexico. The 
Committee urges CDC to continue its work in enhancing tribal 
abilities to design and disseminate successful diabetes 
prevention models.
    The Committee is aware of the effort by Virginia 
Commonwealth University and the University of Puerto Rico to 
conduct research on the impact of diabetes in the Hispanic 
population.
    Fetal alcohol syndrome.--The Committee recommends that the 
Secretary give priority to projects that will promote the 
development of a national strategy for the prevention of 
alcohol-related birth defects and for the provision and 
coordination of appropriate interventions for affected 
individuals and their families. The Committee urges the 
Secretary to target the funding to areas that demonstrate 
significant need and a high incidence or risk of alcohol-
related birth defects. Special consideration should be given to 
Native American entities and individuals. The Committee further 
urges the agency to develop a comprehensive, regional approach 
to preventing, detecting, and treating fetal alcohol syndrome 
and effects in South Dakota, North Dakota, Minnesota, and 
Montana. The Committee is aware of the efforts by the Northern 
Plains Consortium for Fetal Alcohol Syndrome Policy Development 
and Implementation.
    The Committee also encourages the agency to work with the 
state of Alaska to develop a comprehensive statewide strategy 
to prevent, detect and treat fetal alcohol syndrome and notes 
that Alaska has the highest rate of fetal alcohol syndrome in 
the nation.
    Traditional healing.--Native Hawaii's indigenous 
populations continue to experience significant health problems, 
to include phenomenally high incidences of diabetes and asthma. 
The Committee appreciates the leadership of the CDC in 
examining how the systematic utilization of native Hawaiian 
healing expertise might effectively impact their health status 
with diseases such as diabetes and asthma. The Committee also 
urges the use of community-based health centers as a foundation 
for this initiative.
    Volcanic emissions.--The Committee remains quite concerned 
about the public health hazard posed by volcanic emissions in 
Hawaii and, therefore, encourages CDC to continue work with the 
NINR and NIEHS in determining the environmental, physical, and 
mental effects of volcanic emission that might result in 
increased levels of cancer, asthma, and other serious 
illnesses. The Committee is pleased with the progress made thus 
far in examining this environmental hazard on native Hawaiian 
health.
    Liver disease surveillance.--The Committee is aware that 
there is currently no surveillance system in the United States 
to determine trends in chronic liver disease. This information 
is needed to assist the CDC, NIH, and other public health 
agencies to better target their research and other public 
health efforts. The Committee urges that the CDC give priority 
to developing the necessary epidemiological information 
regarding trends in chronic liver disease. The Committee is 
also pleased that the CDC has entered into a cooperative 
agreement for further support and expanded efforts of a private 
nonprofit national voluntary health organization to meet the 
need for public information on hepatitis and other liver 
diseases. The Committee urges the continuation and expansion of 
support for this effort.
    Teenage smoking.--The Committee is aware of the 
collaborative efforts between the University of Pennsylvania 
and the University of Hawaii schools of social work to develop 
models for curtailing teenage smoking as a mechanism for 
decreasing the number of teens in the juvenile justice system. 
The Committee urges full and fair consideration be given for 
proposals submitted by these schools.
    Cancer.--Prostate cancer, and its disproportionate impact 
on minority males, continues to be a major concern of the 
Committee. The Committee continues to encourage the CDC to 
enhance its prostate cancer awareness/outreach program targeted 
at high-risk populations through collaborations with public and 
private nonprofit organizations with expertise in cancer 
education.
    The Committee has provided sufficient funds to continue the 
Cancer Registries Program. The information gleaned from these 
registries are important for planning, implementation, and 
evaluation of public health practices in cancer prevention and 
control at the State and national levels.
    Safe drinking water.--The Committee encourages CDC-
supported evaluations and interventions regarding the health 
effects from inadequate provision of safe drinking water in 
remote arctic communities. The Committee recommends the CDC 
consider building upon existing cooperative agreements with 
State departments of health in the region when undertaking this 
initiative.
    Sudden infant death syndrome.--The Committee again notes 
the work of the CDC, the National Institute of Child Health and 
Human Development, and the Health Resources and Services 
Administration in developing a model guideline for death scene 
protocol for sudden infant death syndrome in a variety of 
locales. The Committee encourages continued development and 
publication of these guidelines.
    Birth defects.--The Committee recognizes that birth defects 
are the leading cause of infant mortality in the United States 
and are also the leading cause of childhood disability. The 
Committee has provided funds for the CDC to expand its efforts 
to research, survey, and prevent birth defects. The Committee 
is especially interested in CDC's efforts to prevent spina 
bifida and anencephaly through the promotion of increased 
consumption of folic acid among women of reproductive age. The 
agency is further encouraged to establish an information 
clearinghouse that would assemble, analyze, and disseminate 
national data on birth defects.
    The Committee expects the Centers for Disease Control to 
build upon the work of leading States in expanding the types of 
data collected in the State Birth Defect Demonstration Projects 
to include developmental disabilities. Assessment of the 
usefulness and feasibility of including neonatal biological 
samples for birth defects registries and the tracking of 
specific birth defect categories for monitoring exposures to 
environmental contaminants is also recommended. The Committee 
also asks that the CDC report its progress in these areas by 
February 1, 2000.
    Tobacco.--The Committee supports CDC's Office of Smoking 
and Health, and encourages continued public health prevention 
and cessation activities. The Committee continues to strongly 
support efforts to reduce youth tobacco use and is very 
concerned about reports of increasing use.
    The Committee is aware that tobacco use is the single most 
preventable cause of death and disease in the country. It is 
estimated that tobacco contributes to more than 400,000 deaths 
in the United States annually.
    The Committee transferred funding of the American Stop 
Smoking Intervention Study [ASSIST] from the National Cancer 
Institute to the CDC in fiscal year 1999. The Committee 
encourages the CDC to increase funding for the current IMPACT 
States over the next several years to a level comparable to 
that of the ASSIST States. The Committee further urges that 
tobacco control funding be awarded to public health entities 
directly responsible for tobacco control and urges that 
minorities be appropriately targeted for smoking reduction 
efforts.
    The Committee is aware of the value of developing 
community-based public awareness programs aimed at prevention 
and cessation of smoking during pregnancy and to inform the 
public about the potential consequences of smoking during and 
after pregnancy. The Committee urges the agency to help 
translate into practice the recent findings on effective 
prenatal and postnatal smoking prevention and cessation 
programs and further support research on diagnostic methods, 
treatment, and prevention of prenatal and postnatal smoking and 
its effects.
    The Committee is concerned about reports of increased use 
of bidis among American teenagers. Bidis are small, flavored, 
filterless cigarettes. It has been brought to the Committee's 
attention that a city-wide survey in San Francisco found that 
58 percent of teenagers had tried bidis at least once, and 31 
percent considered themselves ``bidis smokers.'' In addition, 
20 percent of these teens believed bidis caused no health risk, 
and 50 percent believed bidis could not cause cancer. 
Information is available that indicates that bidis are just as 
likely as regular cigarettes to cause cancer and have seven to 
eight times the nicotine and twice the tar contained in regular 
cigarettes. The Committee urges the agency and the Office on 
Smoking and Health, to examine the health risks posed by bidis, 
and the prevalence of bidis use among American teenagers and to 
inform the Committee of its findings. In addition, the 
Committee urges the agency to work with federal, state and 
local partners to conduct a public information campaign about 
the dangers of bidis use.
    The Committee is encouraged by the Department's development 
of the ``SmokeFree Kids and Soccer'' program. This is an 
important collaborative strategy of promoting tobacco control 
through physical activity and of integrating adolescent health 
risk reduction and supportive youth development. The Committee 
believes that expanding SmokeFree Kids and Soccer through 
partnership and cooperative agreements with community-based 
soccer organizations and traditional public health groups, will 
be an effective method of broadening support and effectiveness 
of community-based tobacco control, particularly with respect 
to addressing the risk factors that influence smoking among 
adolescent girls. Within the increase provided for tobacco 
control activities at the agency, the Committee makes available 
$500,000 to enable CDC to support the Department's efforts to 
expand the program in at least 10 states and to measure its 
impact against similarly funded tobacco control strategies. The 
Committee expects these efforts to be carried out in 
collaboration with the HHS Office of Public Health and Science, 
which is to be commended for developing and overseeing the 
program since its inception in 1996.
    Disabilities prevention.--The Committee continues to 
strongly support the CDC disabilities prevention program which 
provides support to States and academic centers to reduce the 
incidence and severity of disabilities, especially 
developmental and secondary disabilities.
    Health information center.--The Committee is aware that CDC 
has funded an external evaluation of the C. Everett Koop 
Community Health Information Center and that preliminary 
results of this evaluation are encouraging. Within the amount 
provided, funds are available to implement the recommendations 
of the evaluation, to strengthen the center, and to disseminate 
the results of its evaluation to professional medical societies 
throughout the country.
    Newborn screening.--Recent advances in genetic screening 
for newborn infants allow identification at birth of underlying 
conditions which can cause or contribute to disease, 
disabilities, and death. Funds are again available for policy 
development and for research and development efforts to 
facilitate the translation of scientific advances into newborn 
screening programs. Fragile X syndrome and cystic fibrosis are 
among those diseases that ought to receive a high priority. The 
Committee again urges the agency to coordinate with the Health 
Resources and Services Administration in translating the 
results of these efforts into guidance for public health 
programs, including State newborn screening programs.
    Iron overload illnesses.--Hereditary hemochromatosis is 
among the most common genetic disorders, which results in 
excess iron accumulation, tissue damage, and systemic organ 
failure.
    The Committee recognizes hereditary hemochromatosis as one 
of the most common genetic disorders. The Committee notes CDC's 
efforts and encourages their continued progress in this area.
    Radioactive iodide study.--The Committee has included 
sufficient funds to continue the followup study of the Utah 
cohort exposed to fallout from the Nevada Nuclear Weapons Test 
Site. The Committee further expects that administrative costs 
charged to this project be minimized.
    An important tool for understanding the causes of, 
incidence of and death from cancer is having sufficient and 
consistent data. Many states have cancer registries, supported 
in part by CDC. It has been brought to the Committee's 
attention that states are not now required to report cancer 
data to CDC and that data across registries may not be 
consistent enough to allow in-depth analysis. The agency is 
requested to identify potential steps that may be taken to 
correct this deficiency.
    Limb loss prevention.--The Committee recognizes the 
importance of rehabilitation information in improving outcomes 
among persons with limb loss and the role of the National Limb 
Loss Information Center (NLLIC) in addressing this need. To 
date, the Center has received thousands of requests for 
information.
    Immune deficiency outreach.--The Committee remains 
concerned about the incidence of the 80 primary immune 
deficiency diseases. While 500,000 cases have been diagnosed, 
the Committee is particularly concerned about the additional 
estimated 500,000 cases that remain undiagnosed or 
misdiagnosed. While these cases have a significant impact on 
our health care system and waste precious resources, early 
intervention and effective treatment can save pain, suffering 
and millions of dollars in the future. The Committee expects 
CDC to expand its commitment of personnel and initiative a 
commitment of resources to the education and awareness campaign 
established by the National Institute of Child Health and Human 
Development, the National Institute of Allergy and Infectious 
diseases and the Jeffrey Modell Foundation.
    Oral health.--Oral diseases impose significant economic and 
health burdens to the public, much of which could be prevented 
with appropriate interventions. Sufficient funds are available 
to target efforts with public and private partners, to 
implement proven prevention programs to reduce dental decay and 
the health burden from oral cancer, gum disease and related to 
health conditions with links to oral health, such as diabetes 
and heart disease and to expand community fluoridation, 
targeted sealant programs, and oral health surveillance.
    The Committee is concerned with the dental health care of 
children and has therefore provided funding to provide greater 
access to health promotion and disease prevention activities 
for the oral health of indigent children. The Committee urges 
that these funds be used to reach high-risk children through 
school based programs supported by linkages with health care 
professionals and other dental partners in the community.
    Thyroid cancer.--Sufficient funds are available to continue 
the next phase of a study on radioactive Iodine-131 and thyroid 
cancer.
    The Committee has also learned of concerns in the North 
Slope area of Alaska over the impact of radioactive iodine-131 
and possible higher rates of thyroid cancer on residents of 
that area and encourages the agency to work with the state of 
Alaska and the North Slope Borough on the design of a possible 
study to examine this problem in greater depth.
    Birth defects.--Sufficient funds are available for expanded 
birth defects prevention programs, existing centers for birth 
defects research and prevention, and a significantly-expanded 
folic acid education campaign.
    Arthritis.--The Committee is pleased with CDC's 
collaboration with the Arthritis Foundation, states and other 
partners to develop the National Arthritis Action Plan and has 
provided funding to further implement this plan for additional 
public health programs in states to reduce the arthritis 
burden, better defining the burden of the disease, and 
identifying modifiable risk factors.
    Autism.--Sufficient funds are available to continue the 
work underway at the Marshall University autism training center 
at the amount provided in the last fiscal year.
    It has been brought to the Committee's attention that Brick 
Township, New Jersey, may have a higher than average incidence 
of autism. The agency is encouraged to examine the feasibility 
of establishing a presence in the area to conduct 
epidemiological studies.
    Lyme disease.--The Committee urges the agency to give 
priority to proposals aimed at reducing the deer tick 
population, which is the prime vector for Lyme Disease. The 
Committee further recommends that CDC consider proposals that 
seek to reduce deer ticks through environmental and 
economically sound means.
    Folic acid.--The Committee is aware that folic acid is a 
key dietary factor in the prevention of spina bifida but that a 
fraction of child bearing women take folic acid supplements 
correctly. The Committee encourages the agency to develop a 
comprehensive public education and awareness initiative to 
improve the numbers of prospective mothers who use supplements 
judiciously with medical advice. Health professionals should 
also be a primary audience for an education campaign.
    Developmental disabilities.--It has been brought to the 
Committee's attention that serious developmental disabilities 
occur in about 2 percent of school-age children and require 
life-long assisted care. Additional efforts could be done to 
understand more about the prevalence in the U.S., what causes 
these disabling conditions and preventive interventions. Within 
the increase provided to chronic illnesses, sufficient funds 
are available to establish a regional center for developmental 
disabilities, prevention, and research. The Committee 
encourages a population-based surveillance model for 
developmental disabilities including autism, cerebral palsy, 
hearing impairment and other neuro-developmental disorders.
    SIDS.--The Committee recognizes the work of the agency, the 
National Institute of Child Health and Human Development, and 
the Health Resources and Services Administration in developing 
a model guideline for a death-scene protocol for sudden infant 
death syndrome. The Committee encourages CDC to implement 
projects to demonstrate the effectiveness of the death-scene 
protocol in a variety of settings throughout the country.
    Cardiovascular diseases.--It has been brought to the 
Committee's attention that heart attacks, strokes and other 
cardiovascular diseases remain the number one cause of death of 
men and women, across all racial and ethnic groups in the 
United States. Recently eight states received federal funding 
to develop programs for prevention and control of 
cardiovascular diseases. The Committee is encouraged by CDC's 
work with state and national health organizations to develop an 
integrated and comprehensive national cardiovascular disease 
program and encourages its continued efforts to broaden the 
scope and scale of the program.
    The Committee is encouraged by the agency's continued work 
with numerous health organizations to develop an integrated and 
comprehensive national cardiovascular disease program. CDC 
should seek to expand programs with existing grantee states and 
identify additional states and localities for future expanded 
efforts in cardiovascular disease risk reduction, surveillance, 
and laboratory capacity.
    The Committee is aware that despite improved detection and 
treatment of cardiovascular disease over the past two decades, 
severe hypertension is prevalent throughout the Southeastern 
United States, with recent data suggesting that the death rates 
from cardiovascular disease in this region remain significantly 
above the national average. The Committee is aware of the work 
of the Southeastern Centers of Cardiovascular Excellence 
Program at the Wake Forest University School of Medicine in 
addressing this problem.
    National program of cancer registries.--Cancer registries 
monitor trends in cancer, by site of the cancer, age and 
ethnicity of the patient, geographic region, and treatment 
outcome. Enhancing statewide cancer registries and providing 
national support for quality assurance and reporting standards 
ensures that information on cancer trends and outcomes is 
available. The Committee recognizes that increased support is 
needed to enable States to more aggressively utilize State 
cancer data by integrating the registries into their cancer 
prevention and control programs. CDC should work with States 
and national organizations and report back to the Committee in 
three months the steps necessary to aggregate individual State 
data into national data set to analyze the cancer burden in the 
United States on a regional and national basis.
    Minority cancer rates.--The Committee remains very 
concerned about the high incidence of prostate cancer and its 
disproportionate impact on African-American males. Prostate 
cancer is the second leading cause of cancer death in men, and 
African-American males are 66 percent more likely to be 
stricken with the disease. The Committee continues to encourage 
CDC to expand its prostate cancer awareness/outreach program 
targeted at high-risk populations through collaborations with 
public and non-profit organizations with expertise in cancer 
education.
    Asthma.--The Committee is pleased with the work that CDC 
has done to address the increasing prevalence of asthma. 
However, the increase in asthma among children, particularly 
among inner-city minorities, remains alarming. The Committee 
urges CDC to expand its outreach aimed at increasing public 
awareness of asthma control and prevention strategies, 
particularly among at risk minorities populations in 
underserved communities.
    Inflammatory Bowel Disease.--It has been brought to the 
Committee's attention that up to one million people in the 
United States suffer from Crohn's disease or ulcerative 
colitis, collectively known as inflammatory bowel disease. The 
Committee recognizes the need for enhanced epidemiological 
research in this area, especially in light of recent 
advancements in treatment for these diseases and the increased 
risk that IBD patients have for developing colorectal cancer. 
The Committee encourages CDC to work to further our 
understanding of the prevalence of these diseases through 
appropriate epidemiological and surveillance activities.
    Colorectal cancer.--The Committee understands that 
colorectal cancer is the third most commonly diagnosed cancer 
for both men and women in the United States, and the second 
leading cause of cancer related deaths. When colorectal cancer 
is detected and treated early, survival is greatly enhanced. 
However, despite the availability of proven screening tests, 
only a fraction of patients are diagnosed while the disease is 
still in a localized stage. The Committee is pleased with the 
efforts of CDC's National Colorectal Cancer Roundtable in 
promoting the availability and advisability of screening to 
both health care providers and the general public. The 
Committee encourages CDC to expand its partnerships with state 
health departments, professional and patient organizations, and 
private industry to combat this devastating disease.
    Blood screening.--It has been brought to the Committee's 
attention that non-invasive blood screening technology could 
improve the safety of the blood donation and distribution 
process as well as enhance the comfort of blood donors. The 
Committee encourages the agency to consider testing promising 
technologies that could be tested for efficacy and cost 
effectiveness.
    Minority and medically underserved populations.--The 
Committee encourages efforts to link the infrastructure of 
screening programs with that of states, tribes and community 
health organizations, cancer prevention and treatment programs 
to build capacities to translate and deliver federal cancer 
research, control, prevention and education, and prevention 
trials to local communities through public-private 
partnerships. The Committee encourages the efforts of the 
National Health Nutritional and Examination

Survey (HANES) ethnic minority and medically underserved 
populations.
    Alcohol abuse prevention.--It has been brought to the 
Committee's attention that recent data continue to highlight 
underage alcohol use and abuse as a significant and widespread 
public health problem. The Committee encourages the agency to 
begin developing a prevention strategy that incorporates an 
underage drinking prevention media effort. To the extent 
possible, CDC's should develop an effective message and message 
strategy designed to prevent children and adolescents from 
drinking and to encourage parents to discuss the dangers of 
underage drinking with their children. The agency should 
consult with the Office of the Surgeon General, the National 
Institute on Alcohol Abuse and Alcoholism, the Department of 
Justice Underage Drinking Program, and other federal agencies 
with expertise and experience in this area. This effort should 
strive to present a unified message about avoiding alcohol and 
other drugs.
    Epilepsy.--The Committee calls upon CDC to enhance its 
efforts in the field of epilepsy, with a focus on expanding 
disease surveillance; increasing public awareness activities; 
public and provider education; prevention research; and to more 
aggressively address the stigma often associated with the 
disorder. Furthermore, the Committee is aware of the recent 
commitment by CDC to partner with a national voluntary health 
organization dedicated to assisting persons with epilepsy and 
encourages CDC to work with this organization and other 
consumer groups in implementing this public health initiative.
    Pest control.--The Committee encourages the public health 
pesticide data collection program to promote research on public 
health pests, such as insects and vermin, which may pose 
particular health risks to children and the elderly.
    Environmental research center.--The Committee is aware of 
the efforts by the University of Mississippi and Tulane 
University to establish a center for environmental medicine and 
toxicology at the University of Mississippi Medical Center in 
Jackson, Mississippi.
    Health information.--The Committee notes that sufficient 
funds are available to continue and expand direct support of 
the C. Everett Koop Community Health Information Center.

Lead poisoning

    The Committee recommendation includes $37,205,000 for lead 
poisoning prevention activities. Of the amount provided, 
$30,457,000 is for program activities, which is $1,000,000 
below the 1999 level and is the same as the administration 
request. For salaries and expenses within this category of 
activities, $6,748,000 has been provided, which is the same as 
the 1999 level and $1,000,000 below the request.
    Since its inception in fiscal year 1990, the CDC program 
has expanded to about 40 project areas that encompass States, 
local areas, and numerous communities and screens an estimated 
1,750,000 children annually.
    The Committee is aware of a General Accounting Office 
report estimated that more than 400,000 children have 
undetected harmful levels of lead in their blood. The Committee 
understands that the Food and Drug Administration had given 
final approval to a portable, easy to use lead screening device 
developed with the support and participation of CDC. Such 
advances could hold great promise for increasing childhood 
screening rates in underserved communities.

Breast and cervical cancer mortality prevention

    The Committee's recommendation includes $167,051,000 for 
breast and cervical cancer mortality prevention activities. Of 
the amount provided, $157,071,000 is for program activities, 
which is $7,980,000 above the 1999 level and $10,000,000 above 
the administration request. For salaries and expenses within 
this category of activities, $9,980,000 has been provided, 
which is the same as the 1999 level and $2,020,000 below the 
request.
    Activities supported within this account include the 
National Breast and Cervical Cancer Early Detection Program, 
which guides public health programs in formulating an 
aggressive response to these cancers. CDC further supports the 
delivery of screening services to underserved women, quality 
assurance, referral and follow-up services, surveillance, and 
partnership development.
    The Committee also continues to be pleased with the 
progress of CDC's Wisewoman Program. This demonstration program 
provides low-income women participating in the national breast 
and cervical cancer early detection program with additional 
preventive screenings and medical referrals. The Committee 
encourages CDC to continue its planned expansion of the 
Wisewoman initiative, and notes that sufficient funds are 
available to expand the successful Wisewomen demonstration 
program to Iowa and Pennsylvania. The Committee intends to take 
action in the coming years to expand this program nationwide.
    The Committee is aware of the accomplishments of the 
National Breast and Cervical Cancer early detection program and 
urges strengthened support for this important screening 
program, and has included sufficient resources to enhance the 
program. The Committee understands that there is concern 
regarding the purported lack of treatment provided to 
individuals screened through the program and then determined to 
have cancer. The Committee expects the department to examine 
whether cancer patients screened through the program receive 
adequate treatment and follow-up care.

Injury control

    The recommendation by the Committee includes $82,819,000 
for injury control efforts. Of the amount provided, $63,994,000 
is for program activities, which is $25,238,000 above the 1999 
level and $14,500,000 above the administration request. For 
salaries and expenses within this category of activities, 
$18,825,000 has been provided, which is the same as the 1999 
level and $2,179,000 below the administration request. The 
recommendation includes an additional $6,000,000 from the 
violent crime reduction trust fund for domestic violence 
activities authorized by the Violence Against Women Act. This 
is the same level as the 1999 appropriation. These funds will 
continue to support community program demonstrations on 
domestic violence.
    The Center is the lead Federal agency for injury prevention 
and control. Programs are designed to prevent premature death 
and disability and reduce human suffering and medical costs 
caused by: fires and burns; poisoning; drowning; violence; lack 
of bicycle helmets, seatbelts, and baby seats; and other 
injuries. The national injury control program encompasses 
nonoccupational injury and applied research in acute care and 
rehabilitation of the injured. Funds are utilized both for 
intramural and extramural research as well as for assisting 
State and local health agencies in implementing injury 
prevention programs. The Committee recognizes the important 
role that CDC provides as a focal point for all Federal injury 
control activities.
    Youth violence initiative.--Recent incidents of school 
violence highlights the need for a long-term response that 
incorporates prevention of problem issues for youth before they 
become manifested in violent behavior. The Committee has 
allocated $12,500,000 above the request to initiate a national 
strategy. Of the increase provided, the Committee has included 
$10,000,000 to support the establishment of ten national 
centers of excellence at academic health centers that will 
serve as national models for the prevention of youth violence. 
These centers should: (1) develop and implement a 
multidisciplinary research agenda on the risk and protective 
factors for youth violence, on the interaction of environmental 
and individual risk factors, and on preventive and therapeutic 
interventions; (2) develop and evaluate preventive 
interventions for youth violence, establishing strong linkages 
to the community, schools, and social service and health 
organizations; (3) develop a community response plan for youth 
violence, bringing together diverse perspectives, including 
health and mental health professionals, educators, the media, 
parents, young individuals, police, legislators, public health 
specialists, and business leaders; and (4) develop a curriculum 
for the training of health care professionals on violent 
behavior identification, assessment, and intervention with high 
risk youth, and integrate this curriculum into medical, 
nursing, and other health professional training programs.
    Furthermore, the Committee has included $2,500,000 to 
establish a national resource center on youth violence 
prevention. This center would establish a toll free number, 
bilingual in English and Spanish, and an internet website, in 
coordination with existing Federal website resources, to 
provide accurate youth violence prevention and intervention 
information produced by the government and linked to private 
resources. This resource center will provide a single, user-
friendly point of access to important, potentially life-saving 
information about youth violence, an explanation about 
preventing youth violence, and intervention strategies. The 
center would also be responsible for lending technical 
assistance on how to establish programs in communities around 
the country using local resources.
    Violence against women initiative.--The agency budget 
request includes $11,000,000 for additional services, research, 
public education geared toward the reduction of violence 
against women nationwide.
    SAFE U.S.A. initiative.--The agency budget request includes 
$1,900,000 in additional funding to support an array of 
activities intended to foster collaboration and cooperation 
between CDC and organizations working in injury control.
    Sufficient funds have been provided to enable the Center to 
support and expand effective prevention programs for traumatic 
brain injury consistent with the Traumatic Brain Injury Act. 
The Committee is supportive of a science-based process that 
identifies the most practical and effective steps communities 
can undertake to prevent suicide in high-risk populations.
    Suicide prevention.--Suicide and suicidal behavior is a 
major public health risk, particularly for the elderly, 
adolescents, and young adults. The Committee recommendation 
includes funds for the Center to sustain suicide prevention 
research and intervention.
    The Committee encourages CDC to establish a national 
suicide prevention resource center. This center would provide 
technical assistance to states and communities to identify and 
implement effective programs for those at significant risk for 
suicide, including African American males, American Indians/
Alaska Natives, young adolescents, and the elderly.
    The Committee recognizes CDC's contribution to national 
efforts to reduce violence and prevent domestic violence. With 
over 1 million children a year the victims of abuse and 
neglect, the Committee again recommends the Center give 
consideration to extending its focus on violence by supporting 
an initiative directed to the prevention of physical and 
emotional injuries associated with child maltreatment and 
neglect. The Committee encourages the NCIPC to collaborate with 
relevant national organizations and with academic institutions, 
including schools of social work, in the development and 
implementation of this initiative.
    The Committee recommendation maintains the proviso included 
in the House bill prohibiting the use of funds to advocate or 
promote gun control.
    The Committee is aware of a proposed study to determine the 
cost effectiveness of trauma care by comparing the functional 
outcomes of patients provided care by trauma center and 
nontrauma center facilities. The Committee urges CDC to 
consider initiating this activity and encourages it to consider 
a cooperatively determined methodology from the managed care 
industry, the American Trauma Society, and participating 
agencies, including the Institute of Medicine.
    The Committee urges CDC to review and implement the 
recommendations of the Hawaiian conference for the integration 
of brain injured individuals into the community.
    The Committee urges CDC to initiate process and outcome 
research to evaluate the efficacy of various school and 
community violence prevention strategies and programs and to 
disseminate the findings nationally. Funds should also be made 
available to support a national surveillance system of uniform 
data collection and monitoring of injuries, deaths, and 
behavioral risk factors in school and community violence.
    The Committee is aware of the contribution of the West 
Virginia University injury control training and demonstration 
center. Sufficient funds are available to continue its 
activities at the same level provided in the previous fiscal 
year.
    Injury Control Research Centers.--The Committee recognizes 
the outstanding achievements of the ICRCs in multiple research 
areas such as rural injuries, trauma, traffic injuries and 
falls among the elderly. Based at universities across the 
Nation, the ICRCs have excelled in discovering what prevention 
and treatment measures work and in disseminating these measures 
to State and community injury prevention programs. The 
Committee expects CDC to continue using an independent peer-
review process for any new research projects funded from this 
amount. Funds remain available to expand the program level of 
the existing ICRCs.
    The Committee is aware of the efforts of the City of 
Waterloo, Iowa for the Fire PALS program which teaches children 
in schools the skills necessary to protect themselves and their 
families when confronted with a fire or life safety hazard. The 
Committee encourages that full and fair consideration be given 
to funding the expansion of this program to additional schools 
for injury prevention education.
    The Committee continues to be pleased with the efforts of 
the National Program for Playground Safety and the level of 
public interest that has been generated by this program. 
Sufficient funds are available to continue to implement the 
action steps described in the National Action Plan for the 
Prevention of Playground Injuries, which includes activities 
aimed at enhancing playground safety, gathering of relevant 
statistics, research, and training. The Committee urges the 
agency to consider establishing a model playground for children 
ages 0 to 3 to advance research on early developmental 
experiences for children in this age group.
    The Committee is aware of the Institute of Medicine study 
that recommends the creation of a uniform trauma surveillance 
data system. Sufficient funds are available to initiate a 
trauma information and exchange program. The Committee is 
further aware that the American Trauma Society is in a unique 
position to develop a national clearinghouse on statistics, 
data, and other information critical to determining trauma 
needs.
    The Committee is aware of the provision of the Health 
Professionals and Education Act that specifies an Institute of 
Medicine study on the training needed by health professionals 
to help identify and refer victims of family or acquaintance 
violence to appropriate services. The Committee understands 
that the IOM study is underway but funds are needed to complete 
the study. Within the increase provided to this account, 
sufficient funds are available to complete this study.
    Farm health and safety.--The Committee has included funding 
to continue the farm health and safety initiative at its 
current level. This important initiative, begun in fiscal year 
1990, has a primary focus of reducing the incidence of fatal 
and nonfatal injuries and occupational diseases among the 
millions of agricultural workers and their families in the 
United States. The Committee is particularly pleased with the 
research being undertaken by the agricultural research centers.

Occupational safety and health

    The Committee's recommendation includes $215,000,000 for 
the National Institute for Occupational Safety and Health 
[NIOSH]. Of the amount provided, $93,744,000 is for program 
activities, which is $15,000,000 above the 1999 level and 
$6,329,000 above the administration request. For salaries and 
expenses within this category of activities, $121,256,000 has 
been provided, which is the same as the 1999 level and 
$3,178,000 below the administration request.
    The National Institute for Occupational Safety and Health 
[NIOSH] in CDC is charged with conducting a national program of 
occupational safety and health research and information 
dissemination to ensure safe and healthful working conditions 
for American working men and women. Occupational injuries occur 
at twice the rate of injuries in the home or in public places. 
Severe occupational trauma is second only to motor vehicle 
incidents as a cause of unintentional death in the United 
States. The majority of all of these deaths and injuries are 
preventable.
    To prevent work-related hazards, NIOSH conducts applied 
research with a corps of occupational safety and health 
professionals operating in multidisciplinary teams comprised of 
engineers, epidemiologists, industrial hygienists, physicians, 
and toxicologists. Intramural efforts are complemented by 
grants, contracts, and cooperative agreements to form a 
comprehensive and integrated program consisting of four 
components: Identification of hazards; research on causes and 
prevention of occupational injuries and illnesses, 
dissemination of research findings and recommendations; and 
training of those involved in preventing disease and injury at 
work.
    The Committee has allocated funds above the administration 
request to strengthen the activities of the NIOSH mining 
research laboratories near Pittsburgh, Pennsylvania, in 
priority areas that have been endorsed by the national 
occupational research agenda, including funds to support a 
mining hazard surveillance program and a new personal 
protective equipment research program. The latter program could 
have broad applications, particularly in the area of equipment 
associated with weapons of mass destruction prevention 
capabilities.
    The Committee believes that significant work is needed to 
better protect first responders from biological and chemical 
terrorism exposures. Emergency medical personnel and police, 
fire fighters and other on-site workers need reliable detection 
devices, personal protective equipment such as respirators, and 
protective clothing to be able to effectively help victims in 
case of exposure to biological or chemical terrorist agents. 
Within the amount provided for NIOSH and for bioterrorism 
funding contained in the administration request for CDC 
infectious disease activities, sufficient funds are available 
to NIOSH to carry out research, testing and related activities 
aimed at preparing and protecting workers to respond to public 
health needs in the event of a terrorist incident.
    The Committee commends the work of the university-based 
Education and Resource Centers (ERCs) and the smaller single 
discipline training project grants and has included sufficient 
funding to fund an additional ERC.
    The Committee is encouraged with the progress by NIOSH on 
implementing the National Occupational Research Agenda [NORA]. 
The Committee is supportive of NIOSH's efforts to further its 
partnerships with the occupational safety and health community 
and the broader public and private public health research 
community, and believes these partnerships will be important in 
the implementation phase. The Committee urges NIOSH to work 
with its partners to augment resources available to the 
Institute for NORA research. In particular, the Committee 
strongly encourages NIOSH to continue partnering with the 
National Institutes of Health to cosponsor and fund extramural 
research in relevant NORA priority areas.
    The Committee recognizes that a broad-based network of 
public and private partnerships now exists in occupational 
safety and health research, because of the efforts of NIOSH to 
create and implement NORA. The Committee notes that NORA is 
investing research funds in areas with the highest likelihood 
of reducing the still significant human and economic toll of 
workplace injury and illness. The Committee continues to be 
supportive of NIOSH efforts to leverage research funds by co-
sponsoring extramural NORA research with those of NIH and other 
public and private organizations.
    The Committee understands that workers who are employed in 
outdoor occupations are at substantial risk for developing skin 
cancer from unprotected exposure to sunlight and future 
cataracts. The Committee encourages NIOSH to work with OSHA to 
undertake a joint survey in different regions of the country to 
determine what measures are currently being taken to protect 
workers in certain industries and activities, such as 
construction and agriculture.
    The Committee is encouraged with the progress that NIOSH 
has made in its program directed at occupational injuries and 
illnesses in the building and construction industry. The 
Committee understands that NIOSH will develop a new focus 
within NORA on active intervention to prevent occupational 
injury and illness in the construction industry. The Committee 
continues to be concerned with the continued high fatality rate 
in the industry and has provided sufficient funds to continue 
the NORA program at its current levels.
    The Committee has included sufficient funds to meet the 
request for intramural research and staffing on work-related 
diseases at the new laboratory in Morgantown, WV.
    The Committee is aware of recent evidence that excessive 
ultraviolet radiation exposure from sunlight, both in 
recreational and occupational settings, generates an increased 
risk for skin cancer, which is preventable. The Committee is 
further aware that no governmental standards exist concerning 
exposure protection for outdoor workers. The Committee urges 
the Director to give consideration to supporting this area of 
research.
    The Committee encourages the agency to develop enhanced 
motion controllers for improved simulation of human movement. 
With this simulation capability, critical strides can be made 
in improving machinery design, enhancing safety, and improve 
worker training.
    The Committee is pleased that the National Transportation 
Safety Board and NIOSH have taken an aggressive approach to 
address the recent rash of injuries and deaths from aircraft 
accidents in Alaska. It supports the joint interagency 
initiative which involves the Federal Aviation Administration, 
the National Weather Service, the NTSB, and the National 
Institute of Occupational Safety and Health. The Committee 
encourages NIOSH to implement the Board's recommendations to 
improve aviation safety in Alaska.

Epidemic services

    The Committee's recommendation includes $81,349,000 for 
epidemic services. Of the amount provided, $25,865,000 is for 
program activities, which is $4,567,000 below the 1999 level 
and is the same as the administration request. For salaries and 
expenses within this category of activities, $55,484,000 has 
been provided, which is the same as the 1999 level and 
$3,699,000 below the administration request.
    The objectives of the epidemic services activity are to: 
provide for the investigation, prevention, or control of 
epidemics, develop, operate, and maintain surveillance systems, 
analyze data, and respond to public health problems when 
indicated; train public health epidemiologists [EIS]; carryout 
quarantine regulations; reduce the importation of disease from 
developing countries; publish the morbidity and mortality 
weekly report; develop, coordinate, and provide efficacious, 
effective, and economic prevention strategies; and assist in 
the improvement of State infrastructure.
    The Committee is aware of the benefits of community-based 
interventions in improving productivity, functionality and 
overall outcomes among persons who have incurred disabilities 
as a result of contact with antipersonnel land mines. 
Recognizing the importance of focusing additional resources on 
the delivery of post-traumatic interventions to landmine 
survivors in severely mine affected countries, the Committee 
encourages CDC to support the development and testing of a 
model network to be implemented by an organization with 
demonstrated capacity to address the needs of landmine 
survivors in such affected regions overseas.
    Complementary and Alternative Medicine.--The Committee is 
pleased with the CDC's efforts to use quantitative policy 
methods to improve public health decision-making to ensure that 
public health and health care programs and policies deliver the 
greatest possible improvement in human health and quality of 
life and has included funds for CDC to expand these efforts. 
Such activities will include national surveillance of CAM 
utilization and health outcomes, support for academic research 
centers, such as the Prevention Research Centers, to assess the 
determinants and outcomes of CAM prevention practices.

Health statistics

    The recommendation of the Committee includes a program 
level of $109,573,000 to be provided from PHS 1 percent 
evaluation and set-aside funds. This is the same as the 
administration request and $15,009,000 higher than the fiscal 
year 1999 program level.
    CDC's National Center for Health Statistics [NCHS] is the 
Nation's principal health statistics agency, whose mission is 
to provide statistical information that will guide actions and 
policies to improve the health of the American people.
    The increase provided is for the national health and 
nutrition examination survey [NHANES]. This is the same as the 
request and will provide for full funding of this important 
component of the Nation's health information strategy. When 
fully implemented, NHANES provides unique information from 
direct physical examinations, biochemical measures, interviews, 
and nutritional analysis from a large, representative sample of 
persons. This survey is the only national source of objectively 
measured health status data, and is essential to interpreting 
information from other survey components.
    U.S. public health index.--The national health care system 
and the Public Health Service would be well served by the 
development a public health index that would serve as a 
benchmark for the overall progress of the nation's health 
status. Current proxy indicators of national health, such as 
infant mortality, are helpful but do not capture the impact of 
the current health care system on the nation as a whole. Such 
an index would enable policymakers to gauge the effectiveness 
over time of the national public health infrastructure, 
ascertain critical shortcomings, and help guide future resource 
allocations. The Committee calls upon the center to begin 
feasibility studies on the establishment of a national index 
and to report to the Committee within six months of the bill's 
enactment. Such a report should include, but not be limited to, 
a discussion on possible methodologies, potential data to be 
used, applicability to the States and other national health 
systems, and a cost estimate of implementing the differing 
options.
    Primary immune deficiency diseases.--The Committee notes 
that more than 80 primary immune deficiency diseases have been 
identified to date. Patients require regular infusions of 
immune globulin intravenous (IGIV), supplies of which have been 
sporadic and unpredictable. Given the serious public health 
problems caused by the shortage, the Committee encourages CDC 
to initiate an epidemiological study of the primary immune 
deficient population to further understanding of prevalence 
rates and other key information.

Human immunodeficiency virus

    The Committee recommendation includes $662,276,000 for HIV/
AIDS activities. Of the amount provided, $540,240,000 is for 
program activities, which is $5,276,000 above the 1999 level 
and is the same as the administration request. For salaries and 
expenses within this category of activities, $122,036,000 has 
been provided, which is the same as the 1999 level and 
$4,120,000 below the administration request.
    The mission of the agency's HIV prevention program is to 
avert HIV infection and to reduce the incidence of HIV-related 
illness and death, in collaboration with community, state, 
national, and international entities.
    HIV-status awareness campaign.--The agency budget proposes 
an increase of $9,500,000 for a national outreach effort 
intended to increase the numbers of individuals who know their 
HIV status and to enhance referral networks and intervention 
activities.
    The Committee is aware of efforts by the Swope Parkway 
Health Center in Kansas City, Missouri, to create a Center of 
Excellence for Eliminating Racial Disparities in Health. This 
project could demonstrate the effectiveness of an established 
urban health care center in developing model programs and 
interventions focused on decreasing health disparities among 
African-Americans in the areas of: HIV/AIDS and other sexually-
transmitted diseases, infant mortality, cancer screening and 
management, cardiovascular disease, diabetes, and 
immunizations.
    The Committee urges that racial minorities be more fully 
targeted and included in HIV prevention efforts. The Committee 
directs the CDC to consider allocating increased resources to 
address the HIV-related health disparities in ethnic and racial 
minority populations. In particular, the CDC should consider 
increased support of minority community-based organizations and 
minority regional and national organizations including 
education, technical assistance, infrastructure, capacity 
building, community development, and public health initiatives.
    The Committee is aware of the agency's efforts related to 
correctional health care, particularly for surveillance, needs 
assessment, continuity of care, and efforts targeting minority 
communities disproportionally affected by HIV/AIDS and sexually 
transmitted diseases. The Committee urges the agency to expand 
such efforts within the budget provided.
    The Committee notes the agency's efforts to address HIV/STD 
transmission in rural areas of the country. The Committee 
encourages CDC to sustain the Rural Center for AIDS and STD 
Prevention in order that it may continue its efforts in rural 
communities through prevention specialists.

Building and facilities

    The Committee recommendation includes $39,800,000 for 
repair and renovation of CDC facilities, the same as the 
administration request and $22,000,000 above the fiscal year 
1999 appropriation. Funds are provided for the most needed 
repair and improvement projects as facilities age and programs 
change.

Prevention research

    For this activity, the Committee has provided $15,000,000 
for prevention research activities. Of the amount provided, 
$12,000,000 is for program activities, which is $5,000 above 
the 1999 level and is the same as the administration request. 
For salaries and expenses within this category of activities, 
$3,000,000 has been provided, which is the same as the 1999 
level and the administration request.
    This function seeks to discern the causative factors of key 
illnesses and diseases that may be addressable through 
intervention or education. Activities supported include 
community-based research, training of health professionals, 
research conducted by individual investigators, and guideline 
development.

Office of the Director

    For the Office of the Director, the Committee recommends 
$32,322,000, which is $2,000,000 above the President's request 
and $1,186,000 above the fiscal year 1999 appropriation. This 
line item includes amounts previously attributed to program 
management activities.
    The ``Program management'' account primarily supports the 
activities of the Office of the Director of the CDC. The vast 
majority of administrative costs are captured throughout the 
program accounts within the CDC.
    The recommendation includes bill language providing the 
Director with authority to transfer funds available from the 
sale of surplus vaccine from the vaccine stockpile to other 
activities within the jurisdiction of the Centers for Disease 
Control and Prevention. In the event the Director exercises 
this transfer authority, the Committee is to be notified 
immediately.
    Electronic commerce.--The Committee is aware of the 
efficiencies garnered in the private sector from the use of 
electronic commerce [e-commerce] in procurement, information 
and data processing, and other key administrative and 
operational functions. The opportunity exists for heightened 
productivity and cost savings from the use of e-commerce 
technologies such as online real-time markets. The Committee 
expects the agency to begin to conduct procurements of goods 
and services in the coming fiscal year utilizing such e-
commerce technology that currently exists in the marketplace to 
demonstrate the potential for higher productivity and cost 
savings.
    Self-care and preventive medicine.--The Committee is aware 
of the unique opportunities in research and training from self-
care techniques that integrate mind-body approaches to health. 
Such approaches hold outstanding promise in the prevention of 
certain illnesses such as depression and help to reinforce or 
complement existing conventional medical therapies. The 
Committee urges the agency to establish a sustainable pilot 
program that would begin an interdisciplinary approach to mind-
body medicine and to assess their preventive health impact. The 
Committee is aware of the effort by Harvard Medical School-
affiliated organizations to establish such a program and extend 
their collaborations with other academic centers.
    Hanford.--The Committee is aware of the Hanford Health 
Information Network and its communication and health 
information efforts. With Federal funding, the network can 
continue to offer client services through the next fiscal year.
    Mercury toxicity.--It has been brought to the Committee's 
attention that the agency issued a toxicity profile for 
mercury. To address differences between the mercury human 
consumption reference dosages that have been maintained by EPA 
and FDA, the fiscal year 1999 omnibus appropriations bill 
directed that the National Academy of Sciences [NAS] conduct a 
short-term study to recommend a reference dose for mercury. To 
avoid additional confusion among the public or among the states 
about a safe reference dose for this toxin, the Committee urges 
ATSDR to provide the information used to develop its profile to 
the NAS for consideration in its study.
    Minority health.--The Committee understands that the agency 
is acting to improve the health status of minority and 
disadvantaged individuals and urges expansion of these efforts, 
including the coordination of preventative health care, 
substance abuse treatment, and HIV.
    Biosecurity program.--Last year, the conferees included 
bill language providing resources to the Johns Hopkins 
University and the Chemical and Biological Arms Control 
Institute to initiate analyses regarding bioterrorism. The 
Committee continues to be supportive of the efforts of these 
two organizations but is disappointed with the length of time 
the agency undertook to fund the entities. The Committee notes 
the discrepancy between the agency's call for urgent action 
regarding biosecurity and bioterrorism issues and the excessive 
delay in funding key priorities. In the future, the Committee 
expects a higher degree of responsiveness by CDC in meeting 
bill language requirements. The Committee further urges the 
agency to support the efforts of Hopkins and CBACI in fiscal 
year 2000.

Health disparities demonstration

    The Committee has included $35,000,000 for the new 
demonstration projects to address racial health disparities. Of 
the amount provided, $31,697,000 is for program activities, 
which is $22,300,000 above the 1999 level and is the same as 
the administration request. For salaries and expenses within 
this category of activities, $3,303,000 has been provided, 
which is $2,703,000 above the 1999 level and is the same as the 
administration request. These funds will support research 
demonstration projects which address six identified areas of 
health disparities--infant mortality, cancer, heart disease, 
diabetes, HIV infections, and child and adult immunizations. It 
is the Committee's understanding that CDC was only able to 
provide planning funds to approximately 30 communities in 
fiscal year 1999. CDC received more than 200 applications for 
this initiative, the majority focusing on cardiovascular 
disease and diabetes, the leading causes of death among racial 
and ethnic populations. The Committee urges CDC to provide 
planning funds to additional communities to reduce disparities 
in cardiovascular disease and diabetes. These funds and 
additional sites will enable CDC to support the full 
implementation phase of these projects.
    Older minority Americans are disproportionately at risk for 
preventable chronic infectious diseases and disease-related 
disabilities than non-minority older Americans. In addition, 
morbidity and mortality rates associated with diseases that are 
prevalent among minority elders are worse than rates for the 
general population. The Committee expects that CDC will use 
funds to partner with the Administration on Aging to provide 
culturally appropriate prevention activities aimed at minority 
elders.
    The Committee is aware of efforts by the Swope Parkway 
Health Center in Kansas City, Missouri, to create a center of 
excellence for eliminating racial disparities in health. The 
Committee urges CDC to work with community-based organizations 
such as Swope Parkway in addressing issues of racial 
disparities in health outcomes.
    The Committee recognizes the essential role that community 
and rural health centers play in preventing diseases in local 
communities. The Committee encourages CDC to collaborate with 
Missouri's health centers to develop and implement prevention 
strategies to reduce disparities in cardiovascular disease and 
diabetes.
    The Committee is encouraged by the agency's commitment to 
improving the health status of minority and disadvantaged 
individuals. The Committee is aware of the effort by the Center 
Point organization in San Rafael, California, to undertake 
coordination of preventative care with substance abuse 
treatment.
    The Committee is aware of a proposal by the Baltimore City 
Health Department to establish a center for health care 
delivery, epidemiology, and cancer to study health costs and 
delivery systems in Baltimore and other states, conduct cancer 
and other serious health epidemiological studies among minority 
populations, and develop approaches for cost effective health 
care delivery in Baltimore. Baltimore City has the highest 
incident rate of cancer in Maryland. The Committee encourages 
the agency to work with Baltimore City's Health Department to 
meet these goals and provide technical assistance.

Violent crime reduction trust fund

    The Committee recommendation includes $51,000,000 from the 
violent crime reduction trust fund which is $16,000 above the 
fiscal year 1999 level and the same as the budget request for 
activities authorized by the Violence Against Women Act in the 
crime bill. Included is $45,000,000 to augment rape prevention 
services supported by the States through the preventive health 
and health services block grant and $6,000,000 for grants to 
public and private nonprofit organizations to support community 
programs to prevent domestic violence.
    The funds for rape prevention and services will be used by 
States to expand support for rape crisis centers and State 
coalitions, to support rape crisis hotlines, victim counseling, 
professional training of police officers and investigators, and 
education programs in colleges and secondary schools.
    The Committee is concerned with the distribution of funds 
for rape prevention and education that are provided with funds 
from the violent crime reduction trust fund and sent to the 
States through the preventive health and health services block 
grant. States should comply with the statutory language and 
congressional recommendations accompanying the use of these 
funds. Funds should be used to supplement rape crisis centers 
and State sexual assault coalition's rape prevention and 
education efforts and not to supplant funds from other sources.
    It is the Committee's expectation that the Centers for 
Disease Control and Prevention take the lead in a collaborative 
effort between CDC and the Department of Justice in researching 
the behavioral and psychosocial factors relating to violence 
against women.
    The Committee urges CDC to ensure that States receiving 
funds from the grants for assistance to victims of sexual 
assault support State sexual assault coalitions and community-
based rape crisis centers whose work is focused on ending 
sexual violence, operating hotlines for victims of sexual 
violence and their families, and those who provide crisis 
intervention, advocacy, and self-help services to victims. The 
Committee also urges that similar nongovernmental nonprofit 
agencies show a demonstrated effectiveness in carrying out the 
work achieving these goals in order to receive funds. The 
Committee further encourages CDC work to have States devote 
adequate resources from their allocation for rape prevention 
and education for middle, junior, and high school youth in both 
school and nonschool settings.
    The Committee urges CDC to take the lead in a collaborative 
effort between CDC and the Department of Justice in researching 
the behavioral and psychosocial factors relating to violence 
against women, especially as they seek health care.
    The Committee is aware of the approach by the University of 
Pennsylvania School of Social Work to develop models for 
curtailing teenage smoking as a mechanism for reducing the 
number of teens in the juvenile justice system.

                     National Institutes of Health

    The measure of a great nation is its commitment to the 
well-being of its most precious resource--its people. And as a 
nation the U.S. can take justifiable pride in its contributions 
towards improving the overall health status of society. Since 
the Second World War, the life span of the average American has 
risen from 65 to almost 76 years. Many infectious diseases that 
once plagued society have been all but eliminated. Incidence 
and death rates for heart disease and some types of cancer have 
begun to decline. And because of new drugs and surgical 
techniques, millions of Americans are living longer, more 
productive lives. Fundamental discoveries in science have been 
the root source of these achievements, opening the way to new 
methods of detecting, preventing and treating disease. At the 
same time, medical and behavioral research has spawned new 
sources of growth for U.S. industries, created new jobs for 
American workers, and contributed immeasurably to this 
country's economic dominance in world markets. It has also 
cultivated a network of world-class universities, medical 
schools and nonprofit research institutes which, in turn, 
supply the pipeline of tomorrow's scientists and physicians.
    But remarkable as they are, past accomplishments pale in 
comparison to the promise medical research embodies for the 
future. It holds the key to declining disability rates and to 
lessening the fiscal burden on Medicare and Medicaid. It will 
lead to a better understanding of human biology at the 
molecular level, substituting genetically engineered 
pharmaceuticals for invasive surgery and intensive care units. 
Robotic chemistry, new screening techniques and bioinformatics 
will speed the development and testing of promising new 
treatments for disease and illness. Nevertheless, tomorrow's 
hopes are challenged by today's problems. New, potentially 
deadly pathogens are emerging, while micro-organisms once 
thought to have been conquered are becoming resistant to 
traditional antibiotics. The U.S. infant mortality rate still 
compares poorly to other nations. And the mounting tide of 
aging baby boomers shoulders its way into old-age under the 
growing shadow of Alzheimer's disease, stroke and osteoporosis.
    Research is the bridge that supports the continuum of 
scientific progress--from inventive ideas to practical 
application. The keystone of that bridge is the National 
Institutes of Health.
    The Committee is disappointed over the administration's 
failure to recognize that medical and behavioral research 
demand a steady and sustained commitment of resources. In order 
to fulfill that commitment--as well as the Senate's goal of 
doubling NIH over 5 years--the Committee is recommending that 
NIH funding be increased by $2,000,000,000 in fiscal year 2000 
to $17,613,470,000. This level of funding will support a total 
of approximately 10,000 new and competing research grants, or 
approximately 900 more than were supported in fiscal year 1999.

Research priority-setting

    Earlier this year, the Committee convened a special hearing 
on the subject of disease-specific research. Specifically, the 
hearing addressed concerns raised by some over the criteria 
employed by NIH when determining funding priorities. The fact 
that priority-setting has emerged in the context of medical 
research funding, regrettably, is a by-product of fiscal 
pressures that bear no relation to the valuable contributions 
medical research has made to society. At issue is not which 
disease is more painful or more prolonged. Nor is it a question 
of which is more costly. The Committee rejects any approach 
that would essentially reduce medical research funding to a 
competition pitting one disease against another. Except in rare 
circumstances, research priorities reflect a collective 
judgment that should take into account health factors, disease 
burden, public input and scientific opportunity. By and large, 
the Committee has turned to the scientific experts at NIH and 
elsewhere for guidance in that regard. Ultimately, however, 
this Committee bears the responsibility for determining how 
taxpayers' dollars are spent and will maintain vigorous 
oversight over the NIH's stewardship of appropriated funds.

                       NATIONAL CANCER INSTITUTE

Appropriations, 1999....................................  $2,902,375,000
Budget estimate, 2000...................................   2,972,919,000
Committee recommendation................................   3,286,859,000

    The Committee recommends an appropriation of $3,286,859,000 
for the National Cancer Institute [NCI]. This is $313,940,000 
more than the budget request and $384,484,000 more than the 
fiscal year 1999 appropriation. The comparable amounts for the 
budget estimate include funds to be transferred from the Office 
of AIDS Research.
    Mission.--The NCI conducts and supports basic and applied 
cancer research in prevention, early detection, diagnosis, 
treatment, and rehabilitation. NCI provides training support 
for research scientists, clinicians, and educators, and 
maintains a national network of cancer centers, clinical 
cooperative groups, community clinical oncology programs, 
cancer prevention and control initiatives, and outreach 
programs to rapidly translate basic research findings into 
clinical practice.
    The Committee continues to regard scientific investigation 
into the cause, cure, prevention, and treatment of cancer as 
one of the Nation's top priorities. Research offers the only 
hope for putting a stop to a disease that wastes precious human 
resources and contributes to spiraling health care costs. The 
Committee was pleased to learn of recent studies documenting a 
reduction in death rates and improved rates of cancer morbidity 
and mortality as a result of smoking cessation. While a 
testament to past investments in research, those findings 
should not be taken as a sign that the problem is solved. In 
fact, the incidence of many types of cancer con-

tinues to rise, and progress has not been seen across all 
populations, such as African-Americans.
    Imaging systems technologies.--The Committee is encouraged 
by the recent conference held by NCI on biomedical imaging and 
urges NCI to take a leadership role with the Food and Drug 
Administration and the Health Care Financing Administration to 
avoid duplicative reviews of new imaging technologies which may 
prevent their benefits from reaching patients on a timely 
basis. The Committee is aware of the great potential for 
improved patient care and disease management represented by 
molecular imaging technologies, especially positron emission 
tomography (PET) through its ability to image the biology of 
many kinds of cancer and other diseases. The Committee supports 
NCI's increased emphasis on examining the molecular basis of 
disease through imaging technologies such as PET and MicroPET. 
The Committee encourages the large scale testing of women for 
breast cancer and of men for prostate cancer to demonstrate and 
quantify the increased diagnosis and staging capabilities of 
PET relative to conventional diagnostic and staging 
technologies including mammography.
    The Committee is aware of the striking advances in high-
resolution imaging technologies of functional magnetic 
resonance imaging and spectroscopy, and optical coherence 
tomography for detecting small abnormalities in tissues and for 
solving the structure of important cellular molecules. Given 
the recent data showing a high rate of false-positive diagnoses 
of breast cancer from current mammographic technologies, the 
Committee believes there is a critical need to bring these 
important new technologies to full development for the 
diagnosis of breast cancer at earlier stages than currently 
exists. Therefore, the Committee urges favorable consideration 
for funding accelerated development and implementation of these 
advanced imaging systems and processing technologies.
    The Committee encourages large-scale testing of women to 
demonstrate and quantify the increased detection capabilities 
of digital mammography relative to conventional film processes. 
Because of the rapid advances being made in the technological 
development of mammography systems, the Committee is concerned 
that the newest generation of digital mammography systems be 
used to implement this large-scale testing. The Committee 
encourages the National Cancer Institute to be prepared to 
report to the Committee during the fiscal year 2001 hearing, 
the feasibility of conducting large-scale testing that includes 
provisions for the use of the most current digital scanning 
technologies.
    Research affecting women and girls.--The Committee believes 
that health services research involving and affecting women and 
girls, particularly minorities, has not received adequate 
attention. The Committee urges NCI to identify and examine the 
critical nonfinancial barriers to the utilization of vital 
preventive health services. In addition, the Committee 
encourages the Institute to develop and evaluate behavioral 
interventions for health promotion and disease prevention among 
minority women and girls. These include, but are not limited 
to, changing diet and exercise; smoking cessation; and the 
impact of psychosocial factors on the primary prevention of 
cardiovascular disease and breast, cervical and ovarian cancers 
in African-American women. The Institute is also encouraged to 
evaluate the significant role played by psychosocial 
interventions in the treatment and recovery from cardiovascular 
disease and breast, cervical, and ovarian cancers.
    Prostate Cancer.--Prostate cancer is the single most common 
form of cancer in men in the United States. An estimated 
179,000 men will be diagnosed with prostate cancer and 37,000 
men will die from prostate cancer in 1999. The Committee urges 
the NCI and other institutes to aggressively increase efforts 
that will lead to the development of new treatments, new 
preventives, and new interventions with the potential to 
improve or extend the lives of men touched by prostate cancer.
    Increased use of serum analysis for prostate-specific 
antigen (PSA), the primary method of screening for prostate 
cancer, has led to an increased detection rate for prostate 
cancer. However, only 30 percent of early stage disease will 
progress to clinically relevant disease within the lifetime of 
the patient. The Committee encourages NCI to develop methods to 
identify those patients at risk of progression who would 
benefit from aggressive therapy while sparing low-risk patients 
the morbidity resulting from aggressive treatment of slow-
growing disease. The Committee also encourages NCI to carry out 
clinical trials that will determine whether yearly screening 
for prostate cancer using the PSA blood test will decrease 
mortality from prostate cancer.
    The NCI has identified a need to restructure the clinical 
trials program to make it faster, more flexible, more easily 
accessible to patients, and more responsive to key therapeutic 
questions. The Committee encourages NCI to test new systems 
that will identify the best trials, improve trial planning, 
speed trial activation, and improve availability of trials to 
patients. The Committee encourages NCI to implement programs to 
assist investigators in academia and in small businesses in 
getting compounds with promise for treatment and prevention of 
prostate cancer into clinical testing using NCI's existing 
development resources. Several key treatment questions need to 
be addressed. The Committee urges NCI to initiate clinical 
trials that will optimize hormonal and chemotherapeutic 
approaches for the most common clinical presentations of 
prostate cancer.
    The incidence and severity of prostate cancer varies in 
different ethnic populations. African American men are more 
than twice as likely to die of prostate cancer than Caucasian 
men. In African American men, prostate cancer is also generally 
more advanced at the time of diagnosis. Chinese men living in 
China have incidence and mortality rates that are 3-10 times 
lower than U.S. men. Reasons for the large racial difference in 
risk are currently unclear. The Committee urges NCI to conduct 
studies to identify risk factors for prostate cancer in several 
populations, including African Americans and Chinese. The 
Committee also encourages NCI to study the associations of 
dietary patterns with prostate cancer, and variations in the 
role of diet in different racial and ethnic groups.
    The Committee is encouraged by NCI's collaborations with 
the Department of Defense in fighting this devastating disease, 
and urges NCI to continue to strengthen and expand its prostate 
cancer research portfolio. The Committee further expects the 
NCI to accelerate spending on prostate cancer, and consult 
closely with the research community, clinicians and patient 
groups to identify promising new avenues of basic and clinical 
research.
    Breast cancer.--Breast cancer continues to have a 
devastating impact on our country. In the United States, there 
are approximately 2.6 million Americans living with breast 
cancer. Each year, nearly 180,000 women are diagnosed with and 
nearly 44,000 women die of breast cancer. The Committee 
strongly urges the Institute to continue to expand breast 
cancer research and to devote the highest possible funding 
level to finding the causes and cures for this disease.
    Lymphoma.--Lymphoma currently has one of the highest 
incidence rates among all cancers in the U.S. It is estimated 
that approximately 64,000 Americans will be diagnosed with 
lymphoid cancer in 1999. While progress is being made in the 
treatment of many kinds of cancer, incidences of non-Hodgkin's 
lymphoma have nearly doubled since the early 1980's. The 
Committee encourages NCI to increase lymphoma research to 
promote new innovative research models based upon collaborative 
methods that maximize the results of ongoing lymphoma research 
at the NCI. The Committee also encourages NCI to collaborate 
with their counterparts at the NIEHS in exploring environmental 
factors that may contribute to the development of the disease. 
The Committee also recommends that NCI coordinate its research 
efforts with the CDC, and encourages NCI to consider 
exploratory research on incurable lymphomas such as log-grade 
and aggressive incurable lymphomas.
    Cancer coordination.--The Committee encourages NCI to 
continue its leadership role as coordinator of the National 
Cancer Program. As the facilitator of the nation's fight 
against cancer, the Committee specifically encourages NCI to 
continue to work in collaboration with private/voluntary sector 
organizations, the CDC, and other Federal agencies to address 
the coordination challenges outlined in the National Cancer 
Advisory Board's report entitled ``Cancer at a Crossroads.''
    Tobacco.--The Committee believes that NCI has an important 
role to play in tobacco-related research and is pleased that 
NCI is continuing to support research aimed at preventing and 
controlling tobacco use.
    Primary immune deficiency diseases.--The Committee is 
pleased to learn that NCI will participate in a symposium 
before the end of fiscal year 1999 to investigate the 
relationship between primary immune deficiency diseases and 
cancer with the goal of identifying areas of scientific 
research that can be enhanced through appropriate funding 
mechanisms. This symposium, conducted in conjunction with the 
Office of Rare Diseases, NICHD, NIAID and NHGRI, will bring 
together leading national and international experts in cancer, 
pediatrics, immunology, and genetics. The Committee looks 
forward to reviewing the report of the symposium prior to next 
year's hearings. The Committee is also supportive of NCI's 
interest in the creation of a trans-institute intramural clinic 
for the diagnosis and treatment of immune deficient patients.
    Cancer in minority populations.--The Committee remains 
concerned over recent statistics citing higher incidences of 
cancer among the native Hawaiian population. In comparison to 
other ethnic and racial groups, native Hawaiians have the 
highest incidence of the most common forms of cancer such as 
breast, colon, and lung cancer. The Committee encourages 
continued research in the areas of prevention and detection, 
utilizing nurse practitioners in community-based centers for 
screening and education for the underserved populations.
    Behavioral science research.--The Committee commends NCI 
for expanding its infrastructure to fund behavioral and 
population research in cancer prevention, treatment, and 
control. NCI is encouraged to expand its investigation of the 
effective provision of mental health services to improve the 
course of cancer treatment and to aid in the adjustment to 
cancer survivorship. NCI is also encouraged to build upon its 
collaborations with the National Institute on Drug Abuse to 
more thoroughly investigate issues of youth tobacco use. In 
particular, the Committee is interested in expanding health 
promotion research focused on children and youth, and 
interdisciplinary research on tobacco addiction and cessation. 
The Committee also encourages NCI to expand its research on 
adherence to treatment regimens and to health-promoting 
behaviors such as physical activity and healthy diet.
    Hepatitis C Consensus Development Conference.--The 
Committee is aware that several of the significant new research 
recommendations of the NIH-sponsored Hepatitis C (HCV) 
Consensus Development Conference impacts directly on the 
research portfolio of the NCI. This research includes the NCI 
recommendation that studies are needed regarding the mechanism 
of development of hepatocellular carcinoma in patients with 
HCV. The Committee encourages the NCI to increase research in 
this area.
    Neurofibromatosis.--Research into neurofibromatosis (NF) is 
a priority for the Committee. Significant advances continue to 
be made in NF research since the discovery of the NF1 and NF2 
gene, including the recent discovery that NF is involved with 
the c-AMP pathway affecting learning disabilities, in addition 
to its cancer-fighting tumor suppressor functions. NF research 
also has significant potential for other large patient 
populations since NF genes have been implicated in the 
signaling process that determines cell growth and cell 
differentiation. The Committee encourages NCI to intensify and 
expand its NF research portfolio in such areas as further 
development of animal models, natural history studies, 
therapeutic experimentation and clinical trials. The Committee 
encourages NCI to use all available mechanisms, including 
requests for applications, program announcements, and the 
national cooperative drug discovery group program. Progress in 
developing new technologies and enhancing the understanding of 
the fundamental process of cancer will also benefit specific 
disorders such as NF. The Committee urges NCI to continue to 
coordinate its efforts with NINDS and other Institutes and be 
prepared to report on the status of the NF research grant 
program at its fiscal year 2001 appropriations hearing.
    Sexually transmissible infections and cervical cancer.--
Several sexually transmissible infections (STI's) such as the 
human papillomavirus and herpes are associated with an 
increased risk of cervical cancer. The Committee urges NCI to 
expedite new and current vaccines aimed at preventing the 
transmission of sexually transmissible infections and reducing 
their oncogenic potential. The Committee also requests that 
additional clinical trials be established to advance testing 
for STI vaccinations for women.
    Ovarian and cervical cancer.--Ovarian cancer remains one of 
the deadliest cancers for women, in part due to the lack of 
effective early screening methods. According to 1998 estimates, 
25,400 new cases of ovarian cancer and 14,500 deaths from 
ovarian cancer are expected each year. The Committee strongly 
urges NCI to expedite current research on screening methods to 
detect, diagnose, and identify staging of ovarian cancer. The 
Committee believes that identification of a cost-effective 
screening strategy could result in earlier diagnosis for women 
and higher cure rates. Similarly, 15,000 cases of cervical 
cancer are diagnosed annually, and 5,000 women die from the 
disease. NCI is strongly urged to accelerate research in this 
area.
    Multiple myeloma.--The Committee encourages NCI to review 
its research portfolio and accelerate support for promising 
avenues into the causes of multiple myeloma. The Committee also 
encourages NCI to convene a scientific workshop to determine 
the state of MM research and to make recommendations to the 
Institute for further research. The Committee further 
encourages NCI to integrate epidemiological and occupational 
health research and data gathering activities relevant to MM to 
learn more about the molecular pathogenesis of the disease and 
its suspected agents.
    Head and neck carcinoma.--The Committee is aware that head 
and neck squamous cell carcinoma is the most common head and 
neck cancer. Moreover, it is understood that because of the 
immunologic unresponsiveness of this particular type of cancer, 
there is a need to study mechanisms of tumor-induced 
immunosuppression. The NCI is expected to increase funding for 
Specialized Projects of Oncology Research Excellence (SPORE) in 
order to study head and neck squamous cell carcinoma.
    Cancer and aging.--The Committee is concerned regarding 
recent projections regarding the incidence of cancer relative 
to the aging of our population. Based upon current incidence 
rates, the estimated new cases of cancer are expected to 
increase 29 percent and cancer deaths will increase 25 percent 
by 2010. The Committee recognizes that the resources provided 
to the Institute have enabled pursuit of some of the high 
priority initiatives outlined in the Bypass Budget. The 
Committee looks forward to hearing from the Institute at next 
year's hearing what steps should be considered in order to 
address the changing demographics of cancer in this country.
    DES.--The Committee continues to strongly support increased 
efforts to study and educate the public and health 
professionals about the impact of exposure to the synthetic 
hormone diethylstilbestrol [DES]. NCI and other Institutes, 
along with the Office of Women's Health have developed a plan 
for expanded research activities in this area. The Committee 
continues to expect NCI to carry out this plan either 
internally or through a contract with CDC and/or the Office on 
Women's Health. In addition, educational materials for 
consumers and health professionals have been developed as a 
result of a demonstration project funded by the Committee in 
previous years. The Committee in concerned with progress made 
with this and expects NCI to contract with CDC to undertake 
educational efforts targeting consumers and health 
professionals on a national basis. The Committee expects NCI 
and these other agencies to continue to consult with 
organizations representing individuals impacted by DES as they 
carry out DES research and education efforts.
    Complementary and Alternative Cancer Therapies.--The 
Committee expects NCI to work collaboratively with the National 
Center for Complementary and Alternative Medicine to support 
expanded research on promising complementary and alternative 
cancer therapies as well as on their integration with 
traditional therapies. Thousands of Americans are turning to 
these therapies and consumers will benefit from the rigorous 
scientific review of these therapies. The Committee would like 
to be briefed on the progress of the Institute's efforts prior 
to the next appropriations cycle.
    Outreach and public education.--The Committee commends the 
NCI's dedication to the National 5-A-Day Campaign. This 
campaign is an important facet of NIH's overall commitment to 
the prevention of nutrition-related disease. The practical 
value of research is dependent on the translation of that 
research into practice by the public. The Committee recognizes 
that a diet including a minimum of five servings of fresh 
fruits and vegetables is a critical factor in reducing cancer 
risk. The Committee encourages NCI to substantially increase 
its communications and communications research for the 5-A-Day 
Program from its previous levels and increase its research in 
fruit and vegetable nutrition.
    Pancreatic cancer.--The Committee is concerned that 
pancreatic cancer, the fourth leading cause of cancer deaths 
for men and women in the United States, is projected to claim 
the lives of nearly 30,000 Americans this year alone. The 5-
year survival rate for pancreatic cancer, 4 percent, is the 
lowest of all cancers. The Committee is concerned that 
pancreatic cancer is not diagnosed until advanced stages when 
treatment options are limited and largely ineffective. The 
Committee expects the NCI to be prepared to report at next 
year's hearing on the Institute's commitment to support the 
development of early detection methods, improved surgical 
techniques, effective chemotherapy, and new drugs for 
pancreatic cancer and to support public education efforts 
concerning pancreatic cancer.
    The Committee is concerned that given the aging of the 
American population, the United States will face an explosion 
of cancer cases and deaths by 2010. According to the Research 
Task Force of the September 1999 Cancer March, by 2010, there 
could be a 29 percent in cancer incidence and a 25 percent 
increase in cancer deaths, at a cost of over $200,000,000,000 
per year. This group of widely respected scientists recommended 
that cancer research be funded at $10,000,000,000 by 2005. The 
Committee looks forward to working with the cancer community 
and the NIH to increase funds for cancer research as 
recommended by the Research Task Force.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 1999....................................  $1,782,577,000
Budget estimate, 2000...................................   1,825,849,000
Committee recommendation................................   2,001,185,000

    The Committee recommendation includes $2,001,185,000 for 
the National Heart, Lung, and Blood Institute [NHLBI]. This is 
$175,336,000 more than the budget request and $218,608,000 more 
than the fiscal year 1999 appropriation. The comparable amounts 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The National Heart, Lung, and Blood Institute 
provides leadership for a national research program in diseases 
of the heart, blood vessels, lungs and blood, in transfusion 
medicine, and in sleep disorders through support of innovative 
basic, clinical, population-based, and health education 
research.
    Prevention and treatment.--The Committee continues to 
regard research into the causes, cure, prevention and treatment 
of heart attack, stroke and other cardiovascular diseases as 
one of the nation's top priorities. The Committee continues to 
believe that an intensive research program on cardiovascular 
diseases should be a top priority of the NHLBI and of the NIH. 
The Committee encourages the Institute to place a high priority 
on cardiovascular research, and encourages the Institute to 
support existing heart and stroke-related research and to 
invest in promising heart and stroke-related research 
initiatives.
    Emergency medical services.--The Committee strongly 
encourages NHLBI to develop a research initiative in EMS to 
include attention to pediatric needs.
    Behavioral sciences and cardiovascular disease.--The 
Committee commends NHLBI for its Task Force report on the 
contributions of the behavioral sciences to cardiovascular, 
pulmonary and blood research, and encourages NHLBI to adopt its 
recommendations. In particular, the Committee encourages the 
Institute to develop ways to foster interdisciplinary 
collaborations that have yielded some of the best behavioral 
cardiology research. The Committee urges NHLBI to promote the 
investigation of previously understudied populations (including 
women, ethic minorities, and the poor) by giving additional 
attention to appropriate behavioral methodologies and study 
designs. The Task Force also recommends that NHBLI expand 
research on adherence to treatment regimens and the long-term 
promotion of healthy behaviors. The Committee encourages NHLBI 
to increase its behavioral and social science portfolio in the 
areas of lung and blood diseases, particularly sickle-cell 
anemia, hemophilia, cystic fibrosis, and asthma.
    Genomic applications.--The Committee is pleased to note 
that NHLBI is initiating a new program in genomic applications 
for heart, lung, and blood diseases that will use data and 
technologies emerging from the Human Genome Project. The 
program, an essential next step in providing functional 
information about genes on a large scale, will relate 
biological functions to specific variations of the genome. The 
Committee urges NHLBI to use this project as a springboard for 
new research; to make available critical resources that are 
difficult or too expensive to develop in most individual 
laboratories; and to accelerate the development of new and 
better ways to diagnose, manage, prevent and treat heart, lung, 
and blood diseases.
    Gene therapy translation.--The Committee recognizes that 
gene therapy will revolutionize the practice of medicine in the 
next century. The leap from basic studies to practical 
application will require carefully designed clinical studies to 
evaluate the safety and efficacy of gene therapy in humans. The 
Committee also recognizes that clinical studies not only 
represent the practical implementation of basic discoveries, 
but also help to refine and define new questions to be 
addressed by non-clinical investigation. The Committee urges 
NHLBI to pursue an integrated program of basic and clinical 
studies in gene therapy to enable the rapid translation of new 
findings into human research.
    Pediatric Asthma Network.--The Committee recognizes that 
little is known about the optimal treatment for asthma in 
infants and young children. For example, the following issues 
still shroud the management of pediatric asthma: what the most 
effective dose and type of medicine for different types of 
asthma are; what the correct balance is between medical 
benefits and possible side effects; the best time to start 
different types of therapy; whether early therapy can prevent 
asthma from becoming more severe or even eliminate it as a 
child gets older; or the combination of therapies that will 
allow a child to participate fully in childhood activities. The 
Committee urges NHLBI to use the research amassed through the 
Pediatric Asthma Clinical Research Network to provide clearer 
choices for childhood asthma therapy, to encourage the 
development and dissemination of new therapies, and to identify 
optimum asthma management strategies for children.
    National Asthma Education and Prevention Program (NAEPP).--
The Committee recognizes that this year marks the 10th 
anniversary of the NAEPP and notes the many accomplishments of 
this national program. The Committee commends NAEPP for its 
leadership in helping to educate physicians, asthma patients, 
their families, and the general public regarding asthma and its 
management. The Committee urges NAEPP to enhance the role that 
its Advisory Committee plays in helping to coordinate asthma 
education throughout the United States. Furthermore, the 
Committee encourages NHLBI to continue to expand the role that 
NAEPP takes in stimulating partnerships among local asthma 
coalitions to implement asthma education activities at the 
community level.
    Congenital heart defects and specialized centers of 
research.--The Committee encourages the Institute to renew and 
establish additional specialized Centers of Research in 
Pediatric Cardiovascular Diseases and to continue research in 
emerging areas such as the use of genetic tools to identify 
genes that control heart development.
    Transfusion medicine.--It has come to the Committee's 
attention that polynitroxylated hemoglobin, a blood cell 
substitute, is being developed to provide oxygen carrying 
capacity and adequate blood flow to the critically injured. The 
Committee urges the Institute to expand research and 
development efforts in this area.
    Congestive heart failure.--The Committee encourages the 
Institute to devote more research into understanding how and 
why congestive heart failure occurs and how it can be treated 
and prevented. The Committee encourages the Institute to expand 
the study of promising areas of treatment such as mechanical 
assist devices; animal hearts for transplant and 
transplantation of healthy heart cells; and the role of 
programmed cell death in the development of congestive heart 
failure. The Committee is encouraged by recent progress in 
identifying the specific genetic malformations responsible for 
familial cardiomyopathy and is hopeful that this may lead to 
better understanding of the mechanisms of this disease.
    Angiogenesis or stimulation of new blood vessel growth.--In 
the next century, many of the 21 million Americans with heart 
disease may be routinely treated with a genetically engineered 
therapy that stimulates growth of new heart blood vessels from 
existing ones--a ``natural bypass'' to help restore blood flow 
to hearts of people whose arteries are obstructed by fat-laden 
plaque. Angiogenesis may become an adjunct or an alternative to 
other therapies for heart disease, including surgical 
procedures of heart bypass surgery or angioplasty. The 
Committee encourages the Institute to support research to 
design approaches to translate knowledge of angiogenesis for 
use in preclinical studies and clinical applications.
    Advanced non-surgical imaging technology for heart disease 
and stroke.--Most of the 1.1 million heart attacks and 600,000 
strokes that Americans will suffer this year will be triggered 
by blood clots unleashed by plaque obstructions in their blood 
vessels. In 1998, scientists described preliminary findings on 
how magnetic resonance imaging (MRI) can detect these plaque 
obstructions. If this technology proves effective in 
identifying unstable plaque obstructions in the blood vessels, 
it will provide a new way for cardiologists to diagnose people 
at high risk of suffering a heart attack or stroke, and to 
start treatment to help stabilize the obstruction or reduce 
chances that a blood clot will form if a plaque ruptures. Other 
areas of cardiology could benefit from this technology, 
including guiding local injections for angiogenesis, tracking 
and delivering modified cells in the blood vessel system and 
performing biopsies. The Committee encourages the Institute to 
expand research on advanced imaging technology that could 
revolutionize the approach to patient care.
    Peri-operative cardiovascular disease.--An estimated 50,000 
patients have heart attacks after noncardiac surgery each year 
and about 20,000 of them die. Clearly, cardiac complications of 
noncardiac surgery comprise a major public health problem that 
often goes unrecognized. The Committee encourages the Institute 
to explore how best to address this issue.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. Diabetes is a leading risk factor for heart 
disease and stroke. The Committee understands that insulin 
resistance appears to be an important factor in development of 
macrovascular disease and therefore the integration of the 
influence of diabetes in vascular disease in general and the 
influence of diabetes-specific complications in vascular 
disease should become a primary responsibility of the 
Institute. The Committee urges the Institute to study vascular 
disease with a specific focus on the unique features associated 
with diabetes. Also, the Institute is encouraged to expand 
programs related to gene engineering, gene transfer, cell and 
tissue regeneration--which collectively have the potential to 
restore the secretion of insulin--to tackle problems specific 
to diabetes.
    Cooley's anemia.--The Committee is pleased with the 
progress that the Institute has made with regard to the 
creation of the Thalassemia Clinical Research Network that will 
facilitate research into Cooley's anemia, as recommended by 
several special emphasis panels. It is the Committee's 
understanding that a Request for Applications has been issued 
and that the Institute intends to establish the network during 
fiscal year 2000. The Institute should report to the Committee 
any changes in those plans.
    Neurofibromatosis.--Significant advances continue to be 
made in research on NF. Recent studies have documented the 
involvement of NF1 in valve formation which may open up a new 
area for future research in congenital heart disease. The 
Committee recognizes that understanding how NF1 deficiency 
leads to heart disease may help to unravel molecular pathways 
affected in genetic and environmental causes of heart disease. 
Therefore, the Committee encourages NHLBI to expand its NF 
research portfolio, to coordinate its efforts with other 
Institutes engaged in NF research, and be prepared to report on 
its research at its fiscal year 2001 appropriations hearing.
    Cardiovascular diseases.--The Committee continues to regard 
research into the causes, cure, prevention and treatment of 
heart attack, stroke and other cardiovascular diseases as one 
of the Nation's top priorities. Cardiovascular diseases remain 
America's No. 1 killer and a major cause of disability. Nearly 
60 million (1 in 5) Americans of all ages suffer from 
cardiovascular diseases at an estimated cost of 
$287,000,000,000 in medical expenses and lost productivity in 
1999, including more than $50,000,000,000 in direct Medicare 
and Medicaid expenditures. Recently published NHLBI figures 
show a funding decrease of 2.3 percent in constant dollars 
between fiscal year 1988 and fiscal year 1998 for the 
extramural Heart Program. The Committee continues to believe 
that an intensive research program on cardiovascular diseases 
should be a top priority of the NHLBI and of the NIH. The 
Committee encourages the Institute to place the high priority 
on cardiovascular research and to continue to support existing 
heart and stroke-related research and to invest in promising 
heart and stroke-related research initiatives.
    Heart attack, stroke and other cardiovascular diseases in 
women.--Cardiovascular diseases remain a leading cause of 
disability and the No. 1 killer of American females, killing 
more than 500,000 of its victims each year. Cardiovascular 
diseases kill more females than males. More than 1 in 5 women 
suffer from cardiovascular diseases. The clinical course of 
cardiovascular disease is different in men than in women and 
current diagnostic capabilities are less accurate in women than 
in men. Despite the seriousness of these diseases in women, 
they are largely unrecognized by both women and their doctors. 
The Committee encourages the NHLBI to expand research on 
cardiovascular diseases in women, including studies to develop 
safe, efficient and cost-effective diagnostic approaches for 
women, and to create informational and educational programs for 
female patients and health care providers on heart disease and 
stroke risk factors as authorized under Public Law 105-340, the 
Women's Health Research and Prevention Amendments of 1998.
    Pulmonary Hypertension.--Pulmonary Hypertension (PH) is a 
rare, progressive and fatal disease that affects predominantly 
women of all ages and races. This disease causes deadly 
deterioration of the heart and lungs and is a secondary 
condition in many other serious and fatal conditions such as 
scleroderma and lupus. The Committee views research in this 
area as a very high priority due to its deadly impact and its 
presumed relevance to many other diseases. These include other 
forms of hypertension, heart and lung diseases, and organ 
transplants. The Committee recognizes and applauds NHLBI's 
previous efforts to promote research of PH. The Committee urges 
the Institute to increase funding for basic research, gene 
therapy and clinical trials of promising pharmaceuticals, and 
to take appropriate measures to ensure the submission of high 
quality proposals in this area.
    Hemophilia.--The Committee has received the comprehensive 
hemophilia and blood safety research plan requested from the 
NIH Director and commends NHLBI in coordinating the development 
of this plan with NIAID, NHGRI, and NIDDK. The Committee 
understands that NHBLI, in collaboration with the other 
Institutes, will be implementing the research actions specified 
in the report, including expanded efforts in the areas of 
hemophilia gene therapy, hepatitis C treatment, and research to 
improve blood safety and the treatment of the complications of 
bleeding and clotting disorders. As such, the Committee 
requests a report by March 31, 2000 on the funding commitments 
that have been made in each of these areas.
    Medical devices.--The Committee encourages the Institute to 
support the development of new and innovative biomedical 
devices designed to improve human health and decrease mortality 
associated with cardiac disease.

         NATIONAL INSTITUTE OF DENTAL and craniofacial RESEARCH

Appropriations, 1999....................................    $238,318,000
Budget estimate, 2000...................................     244,106,000
Committee recommendation................................     267,543,000

    The Committee recommendation includes $267,543,000 for the 
National Institute of Dental and Craniofacial Research [NIDCR]. 
This is $23,437,000 more than the budget request and 
$29,225,000 more than the fiscal year 1999 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NIDCR supports research and research training 
to improve the oral health of the American people. The 
Institute emphasizes ways to prevent disease in high-risk 
groups, including the elderly, minority populations, and people 
with medical conditions and medications that compromise oral 
health. The research agenda includes studies of craniofacial 
genes and birth defects; bone and joint diseases; AIDS, other 
infections, and immunity; oral cancer; chronic pain; 
epidemiology; biomaterials; and diagnostic systems.
    Oral health.--The Committee commends the Institute for its 
multi-disciplinary approach to oral health promotion, 
particularly in its comprehensive Dental Health Centers. The 
Institute is encouraged to expand its behavioral research on 
reducing health disparities between majority and minority 
populations. In particular, the Committee encourages NIDCR to 
expand its investigation of effective dental care and oral 
cancer prevention programs in minority populations.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. Persons with diabetes are prone to severe 
periodontal disease. The Institute is encouraged to mount an 
effort in diabetes that addresses this problem aimed at 
prevention, early diagnosis, and therapies to help persons with 
diabetes who have periodontal disease. Also, the Institute is 
encouraged to support basic research on mucosal membranes to 
provide insights into the pathogenesis of diabetes, immunologic 
responses to environmental agents, and as a means of transport 
and distribution of therapeutic agents.
    Temporomandibular joint disorders [TMJ].--The Committee 
remains strongly interested in research on temporomandibular 
joint disorders [TMJ] and is concerned with continuing lack of 
resources applied to this area. Last year, NIDR convened a 
Technology Assessment Conference on the Management of TMJ. The 
Committee urges the Institute to significantly increase its 
efforts to implement this agenda. The Committee again calls on 
NIDR to form an inter-institute committee along with 
representatives of the Office on Women's Health, AHCPR, and CDC 
to develop short- and long-term research agenda and requests 
the agency be prepared to report on this agenda at next year's 
hearings. Further, studies of TMJ patients who are suffering 
craniofacial and systemic problems as the result of implants is 
recommended.
    Bone Disease.--Osteoporosis and related bone diseases 
affect millions of Americans. The number of Americans who 
suffer from these diseases will continue to grow as the 
population ages. The Committee encourages the Institute to 
increase its research on osteoporosis, Paget's disease of bone, 
fibros dysplasia, dentinogenesis imperfecta and other bone 
diseases with a special emphasis on further research on bone 
morphogenetic proteins and cartilage-derived morphogenetic 
proteins which is directed to the therapeutic regeneration of 
bone and joint tissues.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 1999....................................    $996,848,000
Budget estimate, 2000...................................   1,021,069,000
Committee recommendation................................   1,130,056,000

    The Committee recommends an appropriation of $1,130,056,000 
for the National Institute of Diabetes and Digestive and Kidney 
Diseases [NIDDK]. This is $108,987,000 more than the 
administration's request and $133,208,000 more than the fiscal 
year 1999 appropriation. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NIDDK provides leadership for a national 
program in three major disease categories: diabetes, 
endocrinology, and metabolic diseases; digestive diseases and 
nutrition; and kidney, urologic, and hematologic diseases. The 
NIDDK plans, conducts, fosters, and supports a coordinated 
program of fundamental and clinical research and demonstration 
projects relating to the causes, prevention, diagnosis, and 
treatment of diseases within these categories. The Institute 
also supports efforts to transfer the knowledge gained from its 
research program to health professionals, patients, and the 
general public.
    Digestive diseases.--Diseases of the digestive system 
continue to affect more than one-half of all Americans at some 
time in their lives. Serious disorders such as colorectal 
cancer, inflammatory bowel disease, irritable bowel syndrome, 
and viral hepatitis take a significant toll in terms of human 
suffering, mortality, and economic burden. The Committee 
continues to encourage NIDDK to strike an appropriate balance 
between conducting basic studies on digestive diseases and 
bringing those research findings to the bedside in the form of 
improved patient care.
    Crohn's disease.--The Committee has been encouraged this 
past year by discoveries related to Crohn's disease and 
ulcerative colitis, collectively known as inflammatory bowel 
disease (IBD). These extremely complex disorders represent the 
major cause of morbidity and mortality from intestinal illness. 
The Committee continues to encourage NIDDK to give priority 
consideration to the following areas of IBD research: 
investigation into the cellular, molecular and genetic 
structure of IBD; identification of the genes that determine 
susceptibility or resistance to IBD in various patient 
subgroups; and coordination and integration of basic 
investigations designed to clarify mechanisms of action and 
disease pathogenesis into clinical trials, as described in the 
research agenda developed by the scientific community entitled 
``Challenges in Inflammatory Bowel Disease''.
    Irritable bowel syndrome.--The Committee also remains 
concerned about the increasing frequency of irritable bowel 
syndrome (IBS), a chronic complex of disorders that malign the 
digestive system. These common dysfunctions strike people from 
all walks of life and result in tremendous human suffering and 
disability. The Committee encourages NIDDK to provide adequate 
funding for irritable bowel syndrome/functional bowel disorders 
research and to give priority consideration to funding IBS 
education/scientific symposia.
    Interstitial cystitis.--The Committee is aware of estimates 
reporting a much higher incidence of Interstitial Cystitis (IC) 
than had previously been reported. It is essential that 
accurate studies of the epidemiology of IC be planned and 
conducted. The Committee encourages the urology program of the 
NIDDK to consider supporting a comprehensive epidemiology study 
of IC that will include scientifically valid statistics of the 
incidence of the disease, the demographics, occurrence in 
minority populations, and the health care costs. The NIDDK 
Director should be prepared to report the status of this 
initiative during the fiscal year 2001 hearings. The Committee 
is pleased with the efforts the NIDDK has taken to expand 
research into the basic understanding of normal bladder 
function. The Committee, however, feels that this research must 
be translated into meaningful studies related to the 
pathogenesis and treatment of IC. Therefore, the Committee 
encourages the NIDDK to support research grants in IC-specific 
basic science research.
    Digestive Disease Centers.--The Committee recognizes the 
success of NIDDK's Digestive Disease Centers program in 
addressing a wide range of disorders that result in tremendous 
human suffering and economic costs. The Committee encourages 
NIDDK to expand this important program with an increased 
emphasis on inflammatory bowel disease.
    Bladder diseases.--Diseases of the bladder afflict more 
than 35 million Americans. Incontinence affects up to 25 
million people in this country, with one-half of all women 
experiencing the condition at some point of their lives. 
Serious and painful diseases such as interstitial cystitis (IC) 
and bladder cancer cause significant human suffering and 
mortality. The number of doctor visits for urinary tract 
infections is second only to respiratory infections, and as 
many as 7 million children suffer from enuresis.
    The Committee is very concerned that the NIDDK is not 
sufficiently addressing either the clinical or basic research 
aspects of bladder disease. Therefore, the Committee urges the 
Institute to substantially enhance its research efforts on 
bladder disease through all available mechanisms, as 
appropriate, including a series of requests for applications 
specifically for basic bladder research, interstitial cystitis 
and incontinence in fiscal year 2000, and the development of 
multi-center research initiatives. The Committee also requests 
that NIDDK prepare a forecast of the amount of funding to be 
spent in bladder diseases in fiscal year 2001 with a 
justification of the dollars spent in relationship to the 
burden of the disease, and be prepared to discuss findings 
during next year's hearings.
    Hepatitis C.--The Committee is pleased that NIDDK 
leadership was provided for a trans-institute RFP to address 
several significant research opportunities regarding Hepatitis 
C. The Committee is also pleased that NIDDK has awarded a 
contract to study the natural history of Hepatitis C and the 
long-term consequences of various therapies. The Committee 
urges additional funding for research focused on ancillary 
studies to supplement the trans-institute award and the natural 
history and long term therapy contract. The Committee also 
urges additional research on the disease complications and 
issues of special populations with Hepatitis C, especially 
minority and indigent populations, those with no insurance, 
individuals within prisons and those with HIV. Further the 
Committee urges adequate funding be provided for the 
establishment of two liver research centers in fiscal year 2000 
to focus on necessary HCV and other liver disease research.
    Toxicity of drugs.--The Committee notes that the most 
common cause of acute liver failure is the reaction to various 
prescription and over-the-counter drugs. The Committee 
therefore recommends the NIDDK to consider sponsoring a 
workshop on the toxicity of drugs and follow up with expanded 
funding for drug toxicity research. The Committee also urges 
additional research on pediatric liver disease and liver 
disease caused by exposure to iron.
    Pediatric kidney disease.--The Committee last year called 
attention to the alarming number of children and adolescents 
suffering from kidney disease, many of whom are minorities. In 
calling for greater research emphasis on this vulnerable 
segment of our population, the Committee notes that chronic 
kidney failure among young people results in particularly 
severe consequences. Normal growth and development are 
impaired, and many scientists believe that chronic kidney 
failure has a profound effect on the developing brain, often 
causing learning disabilities and mental retardation. The 
Committee was pleased to learn that NIDDK convened a number of 
experts in the field of pediatric nephrology to craft a 
research plan for addressing this problem, NIDDK is also 
encouraged to collaborate with NICHD on this effort. As a next 
step, NIDDK is encouraged to focus additional resources to help 
meet this challenge, with particular emphasis on diseases that 
injure the kidney in childhood and eventually lead to 
devastating illness in adulthood, such as diabetes and 
hypertension.
    Behavioral and social science research.--The Committee 
notes that the portion of the NIDDK research portfolio devoted 
to behavioral and social sciences research is significantly 
lower than the NIH average. The Committee urges the NIDDK to 
fund promising behavioral social sciences research. 
Additionally, the Committee urges favorable consideration of 
research in the area of behavioral and social science factors 
relating to the adherence to medical recovery regimes, exercise 
and weight reduction programs.
    Liver and biliary diseases strategic plan.--In March 1998, 
the NIH submitted the liver and biliary diseases strategic plan 
to the Committee, outlining the most significant research 
opportunities to prevent, treat and cure liver disease. The 
Committee applauds the leadership of the NIDDK and requests 
that the Institute be prepared to report at next year's hearing 
regarding progress to meet the research agenda.
    Diabetes.--Diabetes affects 16 million Americans and is 
estimated to cost $100,000,000,000 annually. Diabetes research 
has been underfunded in the past and should be expanded 
substantially at NIDDK and other NIH institutes. To those ends, 
the Committee recommends that the Institute develop a plan to 
incorporate the recommendations of the Diabetes Research 
Working Group's report into the Institute's diabetes research 
plans. Specifically, the Committee recommends that the 
Institute incorporate the recommendations outlined in the DRWG 
report beginning with: beta cell replacement strategies 
(including clinical trials); basic research in beta cell 
biology to develop a replenishable supply of insulin-producing 
cells; research into both microvascular and macrovascular 
complications of diabetes; and the establishment of a National 
Consortium for the Study of the Genetics of Diabetes to create 
a coordinated effort into analyzing the role of genetics in 
diabetes and complications.
    Vascular proliferation is an important aspect of both the 
micro and macrovascular complications of diabetes. The 
Institute is encouraged to coordinate studies to achieve the 
maximum benefit and applicability of research findings that 
lead to control of angiogenesis. Also, the Committee urges NCI 
to support research that will adapt present technologies--such 
as those used with stem cell transplantation and bone marrow 
transplantation--to aid persons with diabetes who lack beta 
cell biology and cannot secrete insulin.
    Diabetes in native American populations.--The Committee 
recognizes the Institute's interest in studying the incidence 
of diabetes in native American, Hawaiian, and Alaskan 
populations, and encourages NIH to include native Hawaiian and 
Alaskan populations, the Mississippi Band of the Choctaw 
Indians, and the Eastern Band of the Cherokee Indians in its 
diabetes studies.
    Diabetes in Puerto Rican and Hispanic Populations.--
Hispanic Americans, particularly those of Puerto Rican and 
Mexican heritage, are disproportionately affected by diabetes 
with over 1.8 million Hispanic Americans diagnosed with the 
disease. The Committee encourages the Institute to undertake 
efforts to include this population in NIH studies and to expand 
research to understand why diabetes disproportionately affects 
this population.
    Cooley's anemia.--The Committee has long supported research 
in the area of Cooley's anemia. Due to the numerous red blood 
cell transfusions that patients receive, iron accumulates in 
the major organs, particularly the heart and liver. The 
effective removal of this iron by chelating drugs requires an 
accurate assessment of iron levels in the patient. Accuracy is 
impeded by the lack of a high quality, non-invasive test to 
measure iron levels. In addition, compliance with treatment 
regiments could be enhanced by the development of a safe and 
effective iron chelator drug that can be taken orally, rather 
than infused. The Committee is pleased that NIDDK, in 
collaboration with NHLBI, has issued a Request for Applications 
for both basic and clinical research in areas related to 
understanding the biological consequences of iron overload and 
improving methods of therapy, leading to removal of excess 
iron. The Committee looks forward to learning of the progress 
made in this field in next year's hearings.
    Polycystic kidney disease.--Polycystic kidney disease 
affects more than 600,000 Americans, and although not widely 
known is a life-threatening genetic disease that usually 
results in end-stage renal disease requiring dialysis or 
transplantation. The cost of caring for patients totals over 
$2,000,000,000 annually. The Committee applauds the action of 
the NIDDK in its recent issuance of a request for applications 
for four new multidisciplinary research centers targeting PKD. 
Last year, the Committee strongly urged increased funding for 
these centers and is deeply concerned with the amount of 
dollars proposed to be allocated both for this effort and basic 
research. The Committee is aware of the growing evidence from 
the scientific community, including the NIH, that the 
opportunity exists to make dramatic progress toward a cure for 
PKD. Therefore, the Committee urges NIDDK to make every effort 
to expand PDK research and further urges that the 
recommendations of the strategic planning workshop be fully 
implemented on an expedited manner.
    Prostatitis.--The Committee is concerned that although 
prostatitis is recognized as a major urological disease by the 
NIH they have made no successful effort to determine the 
economic and social impact of the disease. The Committee urges 
the NIDDK to develop and be prepared to report to the Committee 
during the fiscal year 2000 hearings, on the Institute's plan 
to collect accurate data. The Committee is pleased the NIDDK 
has initiated a multi-center study to determine the most 
effective methods of diagnosing and treating chronic 
prostatitis. The Committee is concerned, however, that because 
of the limited number of participating centers and the limit on 
the number of patients to be enrolled, the results will not be 
representative of the general population. The Committee 
encourages the Institute to increase in the number of centers 
in areas that will increase the representative sampling of all 
groups including African Americans, Native Americans, 
Hispanics, Alaskan, and Pacific Islanders. Efforts should be 
made to coordinate efforts for these new centers with the VA 
and the DOD. Research should also be increased to determine if 
there is a link between prostate cancer and prostatitis.
    Bone disease.--Osteoporosis, Paget's disease of bone, 
osteogenesis imperfecta, multiple myeloma and other bone 
diseases collectively strike over 30 million Americans causing 
pain, disability, loss of independence and even death. The 
Committee encourages the Institute to increase its basic 
biomedical research and training related to osteoporosis, 
Paget's disease of bone, primary hyperparathyroidism, 
osteogeneis imperfecta, myeloma and other bone diseases.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 1999....................................    $899,119,000
Budget estimate, 2000...................................     920,970,000
Committee recommendation................................   1,019,271,000

    The Committee recommends an appropriation of $1,019,271,000 
for the National Institute of Neurological Disorders and Stroke 
[NINDS]. This is $98,301,000 more than the budget request and 
$120,152,000 more than the fiscal year 1999 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NINDS conducts and supports a broad range of 
research and research training on the normal function of the 
brain, spinal cord, and peripheral nerves, and on neurological 
and neuromuscular disorders. Neurological research includes 
epidemiology studies to identify risk factors for disease; 
laboratory studies to examine the structure and function of 
nerve cells; and brain imaging studies to understand how the 
brain is affected by disease and how it operates to carry out 
tasks such as learning and memory. New approaches for the 
diagnosis, treatment, and prevention of brain disorders are 
evaluated in studies with patients and those at risk for brain 
disorders.
    Alzheimer's disease.--The Committee is pleased that NINDS 
continues to regard Alzheimer's disease as one of its top 
research priorities. Today, an estimated four million Americans 
suffer from Alzheimer's, at an annual cost of more than 
$100,000,000,000. Given the rate at which the population is 
aging, as many as 14 million will fall victim to this disease 
in the coming decades. Elsewhere in this report, the Committee 
notes these demographic imperatives and urges NIH to expand the 
current investment in Alzheimer's research. The Committee 
encourages NINDS to continue its close collaboration with the 
National Institute on Aging and the National Institute of 
Mental Health, and to expand its investment in research into 
the basic mechanisms of the disease, identifying risk factors 
and striving to determine how its progression can be slowed or 
stopped altogether.
    Epilepsy.--The Committee seeks continued and intensified 
efforts by the Institute to create breakthroughs in the 
prevention, treatment and eventual cure of epilepsy. The 
Committee encourages the Institute to target additional 
resources specifically to intractable or uncontrolled epilepsy, 
a disorder which affects approximately 750,000 of the nearly 3 
million individuals with epilepsy. This devastating disorder, 
which most often begins in childhood, is strongly associated 
with cognitive dysfunction, apparently because of the impact of 
uncontrolled seizures on the developing brain in its pediatric 
victims. During the fiscal year 2001 appropriations hearings, 
NINDS should be prepared to present information about the 
implementation of its plan to direct more resources toward 
epilepsy research, and future plans for advancing research in 
these important areas.
    The Committee was encouraged by testimony from the NINDS 
Director indicating that opportunities abound for progress 
against neurodegeneration, with Parkinson's disease leading the 
way. This progress is driven by new scientific understanding 
about the specific neuron populations affected by disease, by 
knowledge of the brain circuits and drug targets involved, and 
by technological breakthroughs including deep brain stimulation 
and stem cell biology. It is now evident that nerve cells 
degenerate. The Committee commends the Institute for its 
efforts, notably the establishment of additional Morris K. 
Udall Centers of Excellence. Capitalizing on these 
opportunities and resources will require a coordinated effort 
on the part of all NIH components concerned with Parkinson's 
disease as well as other agencies and private groups whose 
support has been so important to progress thus far. The 
Committee encourages NINDS to establish mechanisms such as a 
Neurodegenerative Disease Program Office to spearhead a public/
private partnership to conquer neurodegenerative disease, and 
would appreciate a report on the status of these efforts prior 
to the fiscal year 2001 hearings.
    Batten's Disease.--The Committee is very concerned over the 
slow pace of research in Batten's disease. The Committee 
believes that the Institute should actively solicit and 
encourage quality grant applications and take the steps 
necessary to assure that a vigorous research program is 
pursued. The Committee further urges the Institute to 
significantly increase funding for research on Batten's disease 
over the previous year's research level.
    Neurodegenerative diseases.--The Committee was pleased to 
see that the Institute has identified neurodegeneration as a 
target for emphasis in its strategic planning process. 
Neurodegenerative diseases exact a terrible toll across the 
lifespan and have been largely resistant to treatment. 
Fortunately, new understanding of the neurodegenerative process 
and promising new technologies, including genetic approaches, 
long-term brain stimulation, and innovative cellular implant 
strategies, offer hope to patients and their families. The 
Committee encourages NINDS to continue its efforts to study 
neurodegeneration across the life span from birth to old age. 
The Committee also continues to support research investigating 
the role of neurotransmitters in neurodegenerative disorders.
    Dystonia.--The Committee has been pleased with the 
extramural research initiatives that NINDS has conducted in 
dystonia-specific research and the increased funding it has 
allocated to dystonia research in the past several years. The 
Committee continues to en-

courage NINDS to work with the dystonia community, particularly 
in the study of the DYT1 gene for early on set dystonia. The 
Committee is pleased that NINDS will be supporting an 
epidemiological study on dystonia, and also encourages NINDS to 
explore the opportunities for increased professional and public 
awareness.
    Intramural research.--The Institute has made significant 
strides in its intramural program, including the recruitment of 
several outstanding scientists. The Committee understands that 
the NINDS, in collaboration with NIMH and other neuroscience 
institutes, is working toward the development of an integrated 
neuroscience program that will promote collaboration across 
organizational lines.
    Ataxia-Telangiectasia.--The Committee supports increased 
NIH support for research on the multi-system disease Ataxia-
Telangiectasia (A-T). The Committee encourages additional 
research to increase the understanding of this terrible 
childhood disorder, particularly because of the critical role 
of the ATM protein, which may provide a significant opportunity 
to elucidate the pathogenesis of more common diseases, such as 
cancer. The Committee urges the NINDS to stimulate diverse 
areas of neuroscience to develop new translational approaches 
to understanding and treating the neurodegenerative facet of A-
T in a clinical setting, in addition to supporting basic 
neurobiological research on A-T. The organizing and full 
funding of a multidisciplinary workshop focused on A-T and 
attended by physician-scientists is also merited to encourage 
new collaborations and new research strategies.
    Neurofibromatosis.--The Committee seeks intensified and 
expanded efforts by NINDS to conduct research into the causes 
and prevention of NF. Of those affected by NF, nearly one-half 
have no prior family history of this often devastating 
neurological disorder. Moreover, the disorder has no 
demographic predilections. It affects both genders, and all 
races and ethnic groups equally, with the result being that the 
entire population is a risk for NF. Recent advances in NF 
research have linked NF to cancer, brain tumors, and learning 
disabilities. NF research therefore holds great promise for 
research in cancer and brain tumors. Because of the common 
neurological dysfunctions, both cognitive and behavioral, that 
are often seen in NF, research also has broad implications for 
a better understanding of learning and memory. The Committee 
therefore encourages NINDS to strengthen its NF basic and 
clinical research portfolio through all available mechanisms, 
including requests for applications and program announcements. 
The Committee urges the Institute to continue to coordinate its 
efforts with NCI and other Institutes and be prepared to report 
on the status of the NF research grant program at its fiscal 
year 2001 appropriations hearing. The Committee also encourages 
the Institute to continue to work with the NF research 
community, including patient advocacy groups, in identifying 
and pursuing scientific opportunities that will ultimately 
allow for the development of effective treatments for NF.
    Stroke.--The Committee continues to regard research into 
the causes, cure, prevention, treatment and rehabilitation of 
stroke as one of the Nation's top priorities. Stroke remains 
the third leading killer, a leading cause of permanent 
disability and a major contributor to late-life dementia. The 
Committee continues to believe that an intensive research 
program on stroke should be a top priority of the NINDS and of 
the NIH. Opportunities to improve prevention and to treat 
stroke in progress have never been greater. The Committee 
encourages the NINDS to place high priority on stroke research 
to allow the Institute to expand its stroke education program 
and to initiate and continue innovative approaches to improve 
stroke diagnosis, treatment, rehabilitation and prevention.
    Decade of the Brain.--The Committee notes that the Decade 
of the Brain has been very successful in stimulating the 
development of new basic information about the brain. The 
Committee urges the Institute to continue to translate the 
basic research information to clinical research issues that can 
influence the prevention, understanding, diagnosis and therapy 
of neurological disorders.
    Charcot-Marie-Tooth Disorder.--The Committee urges the 
Institute to expand research in Charcot-Marie-Tooth Disorder. 
One of the most common inherited nurological disorders, CMT 
affects approximately 150,000 individuals. Its victims slowly 
lose normal use of their hands and feet as nerves to the 
extremities degenerate.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. The Committee was pleased to learn that the 
Institute is planning to support research focusing on 
understanding the mechanisms and consequences of hypoglycemia 
on the brain in individuals who take insulin. The Committee 
views this as a critically important area as more people with 
diabetes attempt tight blood-glucose control. Also, the 
Committee is aware that research on diabetic neuropathy, which 
can lead to severe and debilitating pain, loss of sensation, 
and amputation in persons with diabetes, is severely 
underfunded when compared to its incidence and the impact that 
it has on persons with diabetes. The Committee understands that 
NIDDK is interested in substantially increasing research in 
this area and encourages the allocation of funding to speed 
expansion in this area.
    ALS (``Lou Gehrig's Disease'').--Amyotropic Lateral 
Sclerosis (ALS) is a progressive, fatal neurological disease 
for which no cure exists. The disease strikes all demographic 
and age groups, and 85 percent of those diagnosed succumb 
within two to three years. Diagnosis is difficult, and can take 
years; there is no simple test for the disease. At the same 
time, over the course of this decade, there have been a number 
of research breakthroughs: the identification of a defective 
gene responsible for some cases of ALS and a better 
understanding of how that defective gene may lead to ALS; FDA 
approval of the first drug treatment of ALS; and the 
development of new tools for studying ALS and potential 
therapies for ALS. Findings with respect to ALS can lead to 
methods for prevention and treatment of many other 
neurodegenerative disorders, including Parkinson's, 
Alzheimers's, Huntington's, and multiple sclerosis. The 
Committee applauds the Institute for its emphasis on research 
into identification of neurodegeneration. The Committee 
encourages the Institute to consider a research planning 
workshop which would bring together ALS researchers and experts 
from other fields to foster new ideas and research directions 
that might lead to rapid advances in the understanding and 
treatment of ALS and related neurodegenerative diseases. The 
Committee also encourages the Institute to continue to expand 
and intensify its research efforts into ALS.
    Parkinson's disease.--The Committee is encouraged by 
continuing discoveries in the cause, pathophysiology and 
treatment of Parkinson's disease, and continues to seek 
intensified efforts by NINDS to speed the development of 
effective therapies for this devastating disorder. Several 
recent findings demonstrate a strong scientific foundation for 
a major new initiative in Parkinson's-focused research. The 
Committee also recognizes the benefits of research 
breakthroughs in this area on other disorders within the 
Institute's scope. The Committee acknowledges the 1997 
enactment of the Morris K. Udall Parkinson's Research Act as a 
timely recognition of the scientific potential in this field 
and a clear statement of intent by Congress to make Parkinson's 
research a priority. The Committee is pleased that the 
Institute has funded three of the ten authorized Morris K. 
Udall Research Centers, but it is concerned that these initial 
efforts do not fully reflect the Act's intent to expand 
Parkinson's-focused research. The Committee encourages the 
Institutes to provide sufficient funds to increase such 
initiatives, in coordination with other relevant Institutes, in 
order to carry out the full intent of the Act and fully fund 
its authorization for research focused on Parkinson's disease.
    Learning disabilities.--The Committee commends NINDS for 
the work conducted to explore the neurological aspects of 
learning disabilities. The Committee looks forward to learning 
the results of this work and encourage the Institute to 
continue to coordinate with other Institutes working on related 
activities.
    Spinal Cord injury.--The Committee is pleased to learn of 
the exciting scientific advances being made on several fronts 
which hold much promise for progress against the devastating 
and lifelong effects of spinal cord injury. Research to promote 
regeneration and restore function to the injured spinal cord is 
proceeding along two promising and complementary lines--
implantation of cells and modification of the injury site's 
environment to promote functional recovery. A particularly 
exciting approach involves the implantation of pluripotent, 
neural stem cells--undifferentiated progenitor cells with the 
potential to replace damaged components of the central nervous 
system. In addition to traditional funding mechanisms, the 
Committee understands that this area of research may benefit 
from efforts to promote new types of collaborations and to 
build on currently funded projects that could be expanded to 
include stem cell research. The Committee urges the NINDS to 
aggressively pursue and initiate studies that will hasten 
progress to restore function to the injured spinal cord and 
offer hope to victims of spinal cord injury and their families. 
The Committee requests NINDS to report on its progress in 
promoting research on cell replacement in spinal cord injury at 
its fiscal year 2001 appropriations hearing.
    Mucolipidosis Type IV.--Mucolipidosis Type IV (ML4) is a 
metabolic disease caused by a genetic defect. The defect is 
inherited recessively, thus, both parents are normal even 
though each carries one copy of the defective gene. Children 
with two copies of this defective gene do not develop normally, 
which causes brain abnormalities, rendering the child unable to 
walk, talk, feed themselves or perform many other motor 
functions. Sight is also impaired. The Committee urges the 
Institute to aggressively pursue and initiate studies that will 
hasten progress to find the defective gene.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 1999....................................  $1,576,104,000
Budget estimate, 2000...................................   1,614,450,000
Committee recommendation................................   1,786,718,000

    The Committee recommends an appropriation of $1,786,718,000 
for the National Institute of Allergy and Infectious Diseases 
[NIAID]. This is $172,268,000 more than the budget request and 
$210,614,000 more than the fiscal year 1999 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NIAID supports and conducts basic and 
clinical research and research training programs in infectious 
diseases, including AIDS, and diseases caused by, or associated 
with, disorders of the immune system. The NIAID is the lead NIH 
Institute charged with developing new and improved vaccines and 
supporting research on acquired immunodeficiency syndrome, 
tuberculosis, sexually transmitted diseases, and tropical 
diseases. The NIAID's research goal is to improve the health 
and quality of life of people by improving diagnosis, 
treatment, and prevention of diseases.
    Primary immune deficiency disease.--The Committee 
recognizes the quality of the research that has been funded by 
NIAID into this class of 80 related diseases, both individually 
and collaboratively with nonprofit organizations. The Committee 
continues to believe that the planned centers of Excellence in 
Immunology remain an excellent vehicle for further research and 
hopes that they will involve existing research centers as the 
quickest means of promoting this effort. Most importantly, the 
Committee feels strongly that NIAID must take steps to address 
the estimated 500,000 currently undiagnosed or misdiagnosed 
cases through substantive participation in an education and 
awareness campaign currently established among NICHD, CDC, and 
a non-profit Foundation and is pleased that it plans to do so.
    Hepatitis C.--The Committee is pleased that NIAID 
participated in the Trans-institute RFA for Hepatitis C, and 
urges additional research consistent with the recommendations 
made by the Hepatitis C Consensus Development Conference.
    Organ transplantation research.--The Committee is aware 
that the NIAID is the leading NIH institute for organ 
transplantation research and is pleased that NIAID has funded 
behavioral research to focus on the issues of organ donation. 
The Committee urges additional research in this area.
    Inflammatory Bowel Disease.--The Committee continues to 
note with interest a scientific research agenda for Crohn's 
disease and ulcerative colitis (collectively known as 
inflammatory bowel disease) entitled ``Challenges in 
Inflammatory Bowel Disease (IBD)''. This report identifies 
strong linkages between the immune system and IBD. The 
Committee encourages NIAID to support research focused on the 
immunology of IBD as well as the interaction of genetics and 
environmental factors in the development of the disease.
    Rabies.--It has been brought to the Committee's attention 
that the menace of rabies-infected bats has become a dangerous 
problem. During the past decade, a number of cases of human 
rabies have resulted in death, without known rabid animal 
exposure. The Committee urges the Institute to expand research 
in the area of contacts between bats and humans in order to 
devise adequate protection techniques for the future. The 
Committee further urges the Institute to expand studies of 
rabies virus variants and their hosts, which are necessary to 
predict trends in pathogenicity which may result from drifts in 
virus subpopulations and to devise new modalities to contend 
with the increasing threat posed by the bat rabies viruses.
    Lyme disease.--Lyme disease is a complex and debilitating 
disease that affects many systems of the body and requires long 
term treatment in some patients. The Committee is concerned 
about the development of sensitive, specific, and reproducible 
tests for the diagnosis of Lyme disease. The Committee urges 
the Institute to make the development of such tests a priority.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. The Committee is pleased with the progress the 
NIH Coordinating Committee for Autoimmune Disease Research has 
made in implementing fiscal year 1999 funds focused on a cure 
for autoimmune diseases. The Committee is particularly 
interested in the application of this research to the potential 
cure of Type 1 diabetes, and urges the Institute to continue 
such efforts in this area. In addition, the Committee 
encourages the Institute to focus additional resources on areas 
relating to stem cell biology and transplantation, clinical 
trials involving beta cell replacement, and immune modulation.
    AIDS.--AIDS is currently the leading cause of death among 
African Americans and Latinos between the ages of 25 and 44 and 
the second leading cause of death for all Americans in that age 
group. This year alone, at least 40,000 Americans have been 
infected with HIV--half of them under the age of 25. The 
Committee encourages the Institute to continue to expand AIDS 
research.
    The Committee commends the Institute for its support of a 
joint Uganda-U.S. study that identified a highly effective, yet 
simple and inexpensive drug regimen aimed at preventing 
transmission of HIV from an infected mother to her newborn. If 
implemented widely, this intervention potentially could prevent 
300,000 to 400,000 newborns per year from becoming infected 
with HIV. The Committee encourages the Institute to continue 
collaborations of this nature and applauds the NIH's continued 
commitment to research to develop new diagnostics, therapeutics 
and vaccines for HIV/AIDS.
    Foodborne disease.--The Committee encourages the Institute 
to expand its research to learn how best to identify those 
individuals who suffer from food allergies. While some progress 
has been made in this area, such as stimulating the production 
of antibodies that will bind with allergens to prevent 
reactions, the Committee encourages the Institute to expand 
their research efforts in this area.
    Malaria.--The Committee remains concerned about the global 
growth rate of malaria and the growing incidence of malaria 
outbreaks in the United States. Malaria results in 2 to 3 
million deaths every year. Given the staggering toll of this 
disease, the Committee urges NIAID to make malaria research and 
vaccine development one of its highest priorities. The 
Committee encourages NIAID to continue to pursue collaborations 
with other public and private sector partners and international 
organizations to leverage resources in the global effort to 
eliminate this disease.
    Hemophilia.--The Committee notes the significant role of 
NIAID in the NIH Director's report to the Committee on NIH's 
hemophilia research plan. As specified in the report, the 
Committee expects NIAID, through its on-going relationship with 
the national hemophilia leadership, to continue its work to 
address the needs of persons with hemophilia who are infected 
with HIV and hepatitis C.
    Postpolio Syndrome.--The Committee encourages the Institute 
to continue and expand research into postpolio syndrome, 
including providing rehabilitation alternatives for postpolio 
patients.
    Behavioral and social sciences research.--The Committee 
notes that the portion of the NIAID research portfolio devoted 
to behavioral and social sciences research is significantly 
lower than the NIH average. The Committee urges the NIAID to 
fund promising behavioral social sciences research. 
Additionally, the Committee urges favorable consideration of 
research in the area of behavioral and social science factors 
relating to the adherence to medical recovery regimes, exercise 
and weight reduction programs.

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 1999....................................  $1,197,597,000
Budget estimate, 2000...................................   1,226,698,000
Committee recommendation................................   1,352,843,000

    The Committee recommendation includes $1,352,843,000 for 
the National Institute of General Medical Sciences [NIGMS]. 
This is $126,145,000 more than the budget request and 
$155,246,000 more than the fiscal year 1999 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--NIGMS supports research and research training in 
the basic biomedical sciences. Institute grantees, working in 
such fields as cell biology, biophysics, genetics, 
developmental biology, pharmacology, physiology, and biological 
chemistry, study normal biological processes to better 
understand what goes wrong when disease occurs. In this way, 
NIGMS supplies the new knowledge, theories, and technologies 
that can then be applied to the disease-targeted studies 
supported by other NIH components. NIGMS-supported basic 
research advances also regularly find applications in the 
biotechnology and pharmaceutical industries. The Institute's 
training programs help provide the scientists needed by 
industry and academia to maintain U.S. leadership in biomedical 
science.
    Behavior Science Research and Training.--The Committee is 
concerned that NIGMS does not support behavioral science 
research training. As the only national institute specifically 
mandated to support research not targeted to specific diseases 
or disorders, there is a range of basic behavioral research and 
training that NIGMS could be supporting. The Committee urges 
NIGMS, in consultation with the Office of Behavioral and Social 
Sciences, to develop a plan for pursuing the most promising 
research topics in this area.
    Stress research.--The Committee is aware that NIGMS 
recently conducted a symposium on the Biology of Stress which 
highlighted numerous specific examples of the interaction of 
stress and various disease and recovery processes. The 
Committee urges the NIGMS to follow up the symposium with the 
issuance of RFAs to solicit research proposals in this subject 
area.
    Brain injury.--The Committee supports the recommendation of 
the Institute of Medicine's November 1998 report, ``Reducing 
the Burden of Injury'', that there be a greater focus on trauma 
research and training at NIH and that NIGMS elevate its 
existing trauma and burn program to the division level. To 
accomplish this goal the Committee further recommends the 
expansion of research and training grants and the formation of 
an NIH-wide mechanism for sharing injury research information 
and for promoting collaborations spearheaded by NIGMS.
    Minority scientists.--The Committee notes the Institute's 
training programs help provide the scientists needed by 
industry and academia and have a special focus on increasing 
the number of minority scientists through programs such as 
Minority Access to Research Careers (MARC) and Minority 
Biomedical Research Support (MBRS). The Committee encourages 
NIGMS to continue to support these training programs.

        NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Appropriations, 1999....................................    $753,406,000
Budget estimate, 2000...................................     771,713,000
Committee recommendation................................     848,044,000

    The Committee recommends an appropriation of $848,044,000 
for the National Institute of Child Health and Human 
Development [NICHD]. This is $76,331,000 more than the budget 
request and $94,638,000 more than the fiscal year 1999 
appropriation. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--NICHD is that component of the National 
Institutes of Health which is responsible for conducting and 
supporting research on maternal and child health, the 
population sciences, and medical rehabilitation. Research 
encompassed by these areas targets infant mortality; genetic 
diseases, including birth defects; mental retardation; 
contraceptive development and evaluation; pediatric, maternal, 
and adolescent AIDS; developmental biology; vaccine 
development; demographic and behavioral research; and 
restoration or enhancement of function in individuals 
experiencing physical disability due to injury, disease, or 
birth defect.
    Physical disability and medical rehabilitation.--The 
National Center for Medical Rehabilitation Research is 
responsible for basic and clinical research dealing with the 
causes of physical disability and medical rehabilitation 
interventions to reduce disability, and improve the quality of 
life for persons with disabilities. The NCMRR is one of the 
newest NIH entities and is at a critical juncture in its 
growth. The Committee supports the programs being developed at 
NCMRR for Centers of Excellence and a clinical research network 
to serve as a resource for experiments with new medical 
rehabilitation interventions. The Committee also is supportive 
of plans by NICHD and NCMRR to implement recommendations of the 
brain injury consensus conference and establish a pediatric 
trauma initiative.
    The Committee is pleased to learn that the NICHD is 
addressing the issue of medical rehabilitation through the 
establishment of regional medical rehabilitation research 
networks. The multidisciplinary approach in basic, clinical and 
applied research that will occur in these networks is long 
overdue in addressing the quality of life issues for people 
with disabilities through research. It is often the early 
interventions in the physically and mentally challenged 
population that can optimize improved quality of life in the 
long term. Therefore, the Committee encourages NICHD to ensure 
that at least one network has specific expertise in the care, 
research and management of children with disabilities which 
includes inpatient and day treatment services; outpatient 
services; home and community services; and school programs for 
children with disorders of the brain.
    Autism.--Autism is a developmental disability that 
typically appears during the first 3 years of life. Presently, 
there is no effective means to prevent the disorder, no fully 
effective treatment and no cure. The Committee is concerned by 
reports indicating an alarming rise in the incidence of autism 
and by the lack of concrete knowledge of the prevalence of this 
disability. Early intervention is critical for effected 
children to gain maximum benefit from current therapies but 
autism is easily misdiagnosed or undiagnosed. Therefore the 
Committee urges the Institute to develop a standardized and 
universal diagnostic criteria in autism to aid in earlier 
diagnosis and encourages the development and implementation of 
an awareness campaign for health professionals and for parents 
to learn to recognize and identify the early symptoms of 
autism. Noting the Director's April 1999 Report to Congress 
indicating an internal review to assess the need for autism 
awareness efforts, the Committee urges the Institute to work 
with NIMH and report to the Congress by January 1, 2000, on 
NIH's plan to implement such a program.
    The Committee is encouraged by the Institutes rapid 
response to conduct research on the hormone Secretin as a 
treatment for autism and is pleased with ongoing research 
efforts on the genetics of autism. The Committee notes however, 
that it has consistently recommended the establishment of a 
center-based approach, similar to the one used in research on 
Alzheimer's disease and expanding the resources allocated to 
autism research. The Committee is concerned that the 
institutes' current collaborative grant programs on autism are 
not comprehensive centers which consist of a network of sites 
for the conduct of basic and clinical research into the cause, 
diagnosis, early detection, prevention, control and treatment 
of autism. Comprehensive centers would also help to make 
individuals aware of opportunities to participate as subjects 
in research. Further, the Committee continues to encourage the 
NICHD to coordinate research efforts with the NIMH and other 
Institutes conducting autism research.
    The Committee recognizes that research into the genetics of 
autism is being supported by several Institutes at the NIH. 
Given the difficulty of recruiting multiplex families, the 
Committee urges that researchers be strongly encouraged to 
collaborate and share this important resource and notes that a 
collaborative autism gene bank is already in existence, the 
autism genetic resource exchange. To that end, the Committee is 
encouraged by the efforts of the NIMH to combine data sets and 
directs that all Institutes conducting autism research 
participate in that endeavor.
    The Committee encourages the interagency autism 
coordinating committee to continue to meet regularly and 
encourages that those meetings be made more meaningfully open 
to the public, and meaningfully inclusive of patient advocacy 
groups. The Committee requests that the Director be prepared to 
report to Congress on the goals set and progress made regarding 
autism research during the fiscal year 2001 hearings.
    Minority women and HIV.--The Committee believes that HIV-
related prevention, treatment and care needs of women, 
particularly minority women in underserved areas, should be a 
top priority in defining the HIV research agenda. The Committee 
encourages NICHD to continue to work in collaboration with 
NIAID, using nurse practitioners to educate women in the 
utilization of female controlled barrier methods of HIV 
prevention and treatment and use of psychologists to educate 
women in the mental health aspects of HIV/AIDS prevention and 
awareness.
    Behavioral and Social Sciences.--The Committee recognizes 
the NICHD's mission to study issues related not only to 
individuals but to families and distinct population groups 
within the United States. In furtherance of this mission, the 
Committee encourages NICHD to support projects that investigate 
family functioning and child rearing practices and their 
effects on child well being and success among cultural minority 
groups. The Committee remains interested in the impact of 
differential family and parental practices among Asians and 
Pacific Islanders and encourages NICHD's continued support of 
the work of the University of Hawaii Center on the Family's 
project on this important public policy issue.
    Child development and behavior.--The Committee commends 
NICHD for building an infrastructure to enhance research on 
child development and behavior. The Committee supports new 
initiatives to identify how behavioral roots of chronic 
diseases are established, and to help mediate critical 
behaviors that can lead to life threatening events such as 
automobile accidents, AIDS, and lung cancer. These include 
initiatives to prevent health risk behaviors and promote 
healthy behaviors in middle childhood.
    Adolescent health.--NICHD is commended for its innovative 
study of adolescent health and risk. The Institute is 
encouraged to fund a follow-up to that study to provide a 
fuller picture of the health, and health risks, of the young 
adults in the sample. The Institute is also commended for its 
innovative work on reading disabilities and the acquisition of 
reading skills. The Committee supports the Institute's plan to 
expand research on the types of reading instruction that work 
best for majority and minority populations.
    Minority women and girls.--The Committee recognizes that 
menarche sets the stage for significant decisions about sexual 
activity and contraception. As increasing numbers of adolescent 
women become sexually active, it is important that factors 
associated with young women's sexual decision making, 
particularly within an interpersonal context, be understood. 
The Committee encourages the Institute to focus attention on 
behavioral, social and developmental factors that contribute to 
sexual decision-making among minority women, particularly 
youth.
    Spina bifida.--The Committee is pleased that recent 
research findings in spina bifida research will enable many 
cases of this birth defect to be avoided through the use of 
folic acid supplements in women of child bearing age. Spina 
bifida is the most frequently occurring disabling birth defect, 
occurring in one out of every 1,000 newborns. The Committee is 
dismayed that current evidence demonstrates that less than 29 
percent of women of childbearing age utilize folic acid 
supplements as a preventative. The Committee is pleased to 
learn that the NICHD has recently held two workshops relative 
to birth defects, one on the environmental factors and the 
second on genetic mechanisms. The Committee looks forward to 
hearing from the Director at next year's appropriations 
hearings about the recommendations of these scientific meetings 
relative to spina bifida research needs and the specific 
resource requirements necessary to implement the important 
initiatives outlined in the conference report.
    Learning disabilities.--The Committee urges research on the 
outcome and effectiveness of primary and preventive health care 
for mothers to prevent learning disabilities in infants and 
children.
    Emergency medical medicine.--The Committee encourages NICHD 
to develop a research initiative on pediatric emergency 
medicine, including both pre-hospital and emergency care. To 
date, only minimal attention has been paid to addressing this 
costly and important aspect of children's health care. The 
Committee also encourages NICHD to work closely with HRSA in 
the development of national educational programs and 
conferences to encourage and support research in emergency 
medical services for children.
    Child development and behavioral research.--The Committee 
is pleased that NICHD is undertaking a number of initiatives to 
increase understanding of the behavioral and cognitive aspects 
of child development. The Committee encourages these efforts 
and looks forward to receiving updates on their progress.
    Small grants.--The Committee is pleased to learn that NICHD 
recently began promoting small grants as a way to attract new 
investigators to child development research. The Committee 
encourages the Institute to examine whether B/START small grant 
awards as used by other Institutes would encourage interest 
among NICHD investigators.
    Sudden Infant Death Syndrome.--The Committee is pleased 
with NICHD's continued efforts to extend the reach of its 
extremely successful ``Back to Sleep'' campaign to underserved 
populations and daycare providers. The Committee also commends 
NICHD's attempts to further its progress in SIDS research by 
initiating a third SIDS five-year research plan. This plan will 
continue the efforts of the past two five-year plans, which 
have been responsible for many of the research breakthroughs in 
the effort to reduce SIDS cases in the U.S.
    Neurofibromatosis.--Learning disabilities occur with high 
frequency (30 to 60 percent) in children with NF. The Committee 
recognizes that NF1 provides an opportunity to uncover a 
molecular basis for cognitive impairment and to identify a 
marker for brain dysfunction, and that research in 
understanding the cognitive deficits in NF1 patients possesses 
broad application to learning disabilities in the general 
population. NICHD is encouraged to expand its NF research 
portfolio, to coordinate its efforts with other Institutes 
engaged in NF research, and be prepared to report on the status 
of its NF research portfolio at its fiscal year 2001 
appropriations hearings.
    Pelvic floor dysfunction and incontinence in women.--The 
Committee is pleased that NICHD has made initial progress by 
convening a workshop to examine and determine future directions 
for research in the area of pelvic floor dysfunction (including 
prolapse) and incontinence in women. It is the Committee's 
understanding that a Request for Application (RFA) has been 
issued by NICHD for basic scientific studies in this area and 
that two additional research RFA's for translational and 
clinical research are in the process of being issued. The 
Committee is pleased with these efforts and encourages 
continued collaboration among NICHD, NIDDK, the NIA, and the 
Office of Research on Women's Health on these initiatives.
    Fragile X.--The Committee commends the NICHD for its 
research activities on Fragile X, the most common inherited 
cause of mental retardation. In its last two reports, the 
Committee has urged the NICHD to expand basic and applied 
research and testing of Fragile X. In 1998, the Committee 
recommended the convening of a colloquium of leading scientists 
to report on the most promising directions of future research 
and requested receipt of the recommendations emanating from the 
conference. The conference was held in December 1998. After due 
consideration of that report, the Committee urges the NICHD to 
implement the recommendations of the conference, especially the 
establishment of Centers for Fragile X research and long-term 
multi-center research collaborations. The Committee also urges 
NICHD to establish a loan repayment program for Fragile X 
research. The Committee urges that NICHD make funds available 
in fiscal year 2000 for this purpose.
    Carney's complex.--It has come to the Committee's attention 
that NIH has recently held a meeting to discuss research 
opportunities into Carney's complex, a familial disorder that 
causes tumors on the adrenal glands of children and young 
adults. The Committee encourages NIH to expand research in this 
area.
    Women's health research.--The Committee recommends that the 
Institute expand research directed toward women's health care 
throughout the life-span. There are many important areas that 
need to be studied, specifically the long-term consequences 
women suffer related to child-bearing--incontinence, uterine 
and rectal prolapse, and other disabling conditions.
    Ob-gyn research.--The Committee commends NICHD for 
providing grants to ob-gyn departments at selected U.S. 
universities and hospitals to establish women's reproductive 
health research career development centers. The Committee 
encourages the Institute to expand these centers. At these 
centers, newly trained ob-gyn clinicians are provided training 
and support to assist them in pursing research careers to 
address problems in women's obstetric and gynecological health.
    Preterm labor.--The Committee urges NICHD to intensify 
research efforts to identify risk factors and genetic 
influences on preterm labor to better diagnose, advise women of 
health risks, and prevent its occurrence. Preterm birth results 
in extremely costly neonatal intensive care and long term 
health complications. Preterm birth also accounts for about 75 
percent of newborn deaths unrelated to birth defects.
    Demographic research.--The Committee continues to place 
high priority on research which provides accurate information 
on population trends and problems. The Committee encourages the 
NICHD to continue its aggressive support for demographic 
research on fatherhood, early childbearing, health disparities, 
welfare to work transitions, and the causes and impact of 
migration within and across borders. NICHD is also encouraged 
to assure the adequate training and infrastructure support 
needed to sustain innovative demographic research in the 
decades to come.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. More than 120,000 children suffer from diabetes, 
making it the second most common chronic disease affecting 
kids. The Committee strongly encourages that NICHD place a 
greater priority on Type 1 diabetes research, and play the lead 
role with NIEHS, NIAID, and NIDDK in research related to 
understanding the genetics of Type 1 diabetes and discerning 
the environmental triggers and other factors that play a role 
in the immunopathogenesis of the disease. The Committee 
requests that the Director be prepared to report to the 
Committee in the fiscal year 2001 appropriations hearings on 
steps the Institute has taken to increase the number of Type 1 
diabetes grants supported by the Institute.
    Pediatric Research Initiative.--The Committee encourages 
the Institute to continue support for the pediatric research 
initiative. The Committee further encourages NICHD to expand 
extramural research directly related to the illnesses and 
conditions affecting children. Funds provided through the 
initiative will enable the NIH to encourage essential and 
promising areas of pediatric research; to assure the 
realization of the many opportunities for scientific 
advancement in caring for children; and to enhance the 
collaborative efforts across Institutes in the many areas where 
multi-disciplinary research is needed. The Committee also 
encourages the Institute to provide additional support for 
institutional and individual research training grants for 
medical schools' departments of pediatrics.
    Pediatric kidney disease.--The Committee supports the 
efforts of NICHD to discuss awareness of, and research on, the 
growing problem of kidney disease among children and 
adolescents. The Institute is encouraged to coordinate these 
efforts with NIDDK, especially where kidney disease is known or 
suspected of being an antecedent of serious adult disease, such 
as diabetes and hypertension.
    Vulvodynia.--Hundreds of thousands of women suffer from 
vulvodynia, a painful and often debilitating disorder of the 
female reproductive system. Despite its prevalence very little 
attention has been paid to the disorder by health professionals 
or researchers. In April of 1997, NIH convened an international 
symposium to exchange information and develop a research 
agenda. Since fiscal year 1998 the Committee has called on the 
NICHD to support research on the prevalence, causes and 
treatment of vulvodynia. To date, a program announcement has 
been published, but no request for proposal has been made. The 
Committee is very concerned with the lack of progress made in 
this important area. The Committee strongly urges expanded 
research on vulvodynia and again recommends NICHD to issue a 
request for proposals within the first quarter of the fiscal 
year and to take additional steps to encourage researcher 
interest in this area.
    Primary immune deficiency diseases.--The Committee is 
pleased with the comprehensive approach that NICHD has employed 
in it is efforts to address this improtant class of 80 
diseases. Its peer-reviewed research collaborations with non-
profit organizations have been highly successful. The Committee 
is also well aware of the leadership role the institute has 
taken with regard to the establishment of a national education 
and awareness campaign, in partnership with the NIAID, CDC and 
the Jeffrey Modell Foundation. The Committee encourages NICHD 
to continue and expand its commitment to and support for this 
collaboration.
    Infertility and contraceptive research.--The Committee 
continues to place high priority on research to combat 
infertility and speed the development of improved 
contraceptives. The Committee urges NICHD to continue 
aggressive activities in this area, including individual 
research grants and those of the infertility and contraceptive 
research centers.
    Learning disabilities.--The Committee is pleased that NICHD 
continues to place high priority on learning disabilities 
research. The efforts to address the special needs of children 
affected by a learning disability and improve literacy are 
showing promising results. The Committee encourages NICHD to 
continue to focus on reading disability and mathematics 
development research. Additionally, the Committee urges NICHD 
to lead a cooperative effort to collaborate on research efforts 
with other Institutes working on related activities. The 
Committee encourage cooperation in areas where work can be 
shared across Institutes on behalf of individuals with learning 
disabilities.
    Chromosome abnormalities.--The Committee urges NICHD to 
expand and intensify research into the treatment of mental 
retardation caused by chromosome abnormalities, especially the 
syndromes of chromosome 18.
    Osteogeneis Imperfecta.--The Committee encourages the 
Institute to increase its research on OI with special emphasis 
on further research into the mapping of gene markers associated 
with the disease and animal models. In addition, the Committee 
encourages research into rehabilitation techniques.

                         NATIONAL EYE INSTITUTE

Appropriations, 1999....................................    $396,896,000
Budget estimate, 2000...................................     406,539,000
Committee recommendation................................     445,172,000

    The Committee recommends an appropriation of $445,172,000 
for the National Eye Institute [NEI]. This is $38,633,000 more 
than the budget request and $48,276,000 more than the fiscal 
year 1999 appropriation. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NEI is the Nation's Federal resource for the 
conduct and support of basic and clinical research, research 
training, and other programs with respect to blinding eye 
diseases, visual disorders, mechanisms of visual function, 
preservation of sight, and the special health problems and 
needs of individuals who are visually impaired or blind. In 
addition, the NEI is responsible for the dissemination of 
information, specifically public and professional education 
programs aimed at the prevention of blindness.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. Despite recent advances in the prevention or 
delay in the onset of diabetic retinopathy, it remains the 
leading cause of new adult blindness. The Committee encourages 
NEI to play a leading role with NHLBI, NIDDK, and NICHD in 
funding additional research in this field focused specifically 
on novel therapies which could lead to the prevention or 
reversal of diabetic retinopathy and may have relevance to 
other forms of microvascular disease.
    Neurofibromatosis.--The Committee urges the Institute to 
consider the progress being made in research into the causes 
and prevention of neurofibromatosis and to determine whether 
such progress offers new research opportunities consistent with 
the Institute's mission.
    Low vision and the elderly.--As the size of the elderly 
population in this country increases, the number of people with 
age-related eye diseases and with low vision will increase 
dramatically. The Committee, therefore, supports the extension 
of the National Eye Health Education Program (NEHEP) activities 
to include low vision and its rehabilitation, in addition to 
its efforts concerning diabetic retinopathy and glaucoma.
    Autoimmune disease research.--The Committee is concerned 
that little is known about the factors that determine 
susceptibility to autoimmune diseases, and that associated eye 
diseases and conditions affect so many Americans. The Committee 
is pleased that NEI is a key participant with NIAID and other 
NIH Institutes in autoimmune disease research initiatives.
    Neuroscience.--The NEI is recognized as one of the leading 
neuroscience Institutes at NIH. The Committee is impressed by 
the quality of research being supported on the development of 
the nervous system, nerve rescue and regeneration, and also on 
the development of advanced non-invasive methods, to study 
visual processing in the brain such as functional magnetic 
resonance imaging. The Committee looks forward to hearing more 
about this exciting research.
    Retinal degenerative diseases.--The Committee appreciated 
the presentation by the NEI Director, on the current status of 
research on retinal degenerative diseases, including retinitis 
pigmentosa and macular degeneration. The social and economic 
impact of these diseases is extensive and increasing. Age-
related macular degeneration, in particular, will become an 
even greater public health problem in the years ahead. The 
Committee, therefore, strongly supports the Institute's 
decision to make retinal degenerative diseases one of its top 
research priorities.
    Learning disabilities.--The Committee commends NEI for the 
work conducted to explore the visual aspects of learning 
disabilities. The Committee looks forward to learning the 
results of this work and encourage the Institute to continue to 
coordinate with other Institutes working on related activities.
    The Committee is concerned that NIH is not devoting 
sufficient resources to fund promising scientific opportunities 
in the field of eye and vision research. Due to pressing eye 
and vision diseases in the aging community, the Committee urges 
the NIH to enhance the commitment to NEI research when 
assigning future priorities and resources.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 1999....................................    $388,477,000
Budget estimate, 2000...................................     397,912,000
Committee recommendation................................     436,113,000

    The Committee recommends an appropriation of $436,113,000 
for the National Institute of Environmental Health Sciences 
[NIEHS]. This is $38,201,000 more than the budget request and 
$47,636,000 more than the fiscal year 1999 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The mission of the NIEHS is to define how 
environmental exposures affect health; how individuals differ 
in their susceptibility to these effects; and how these 
susceptibilities change with time. This knowledge, coupled with 
prevention and communication programs, can lead to a reduction 
in environmentally associated diseases and dysfunctions.
    Environmental genome project and genetic susceptibility.--
The Committee encourages the NIEHS to extend its research 
program under the environmental genome project, especially as 
it relates to genetic susceptibility. Understanding the genetic 
basis for individual differences in susceptibility from 
environmental exposures will provide a better basis for the 
prediction of human health risks for children and adults. This 
information will revolutionize the diagnosis, treatment, and 
prevention of diseases resulting from environmental exposures. 
It also will provide the development of approaches to protect 
those individuals who are most susceptible to disease. The 
Committee encourages the NIEHS to continue to work with other 
Institutes and Federal agencies on the continuation of this 
important project.
    Waste treatment management.--The Committee urges NIEHS to 
study the issue of waste treatment management by indigenous 
native Hawaiians, and to explore the public health implications 
of this issue with organizations such as Partners in 
Development, which is implementing the living machines approach 
to waste management.
    Exposure assessment.--Inadequate information is available 
on the type, magnitude, and method of chemical exposures that 
humans encounter at work or play, and which of these exposures 
are relevant to specific diseases. The Committee is pleased to 
learn that the NIEHS is engaging in a new initiative to better 
understand the result of human exposure to chemicals and the 
impact on public health. The Committee understands that the 
NIEHS is sponsoring a major symposium to establish a research 
plan on how to best assess the role that chemical exposures 
play in the etiology of specific diseases and to develop 
approaches for effective prevention and intervention 
strategies. The Committee urges the NIEHS to take a leadership 
role in coordinating a Federal research effort in this area.
    Children's health.--The Committee is pleased to learn that 
the NIEHS, in collaboration with EPA, is supporting eight 
children's health centers focused on the environmental 
influences on asthma and other respiratory dysfunctions. The 
Committee urges the NIEHS, in a continuing collaboration with 
EPA, to support additional centers of excellence with a focus 
on disease end-points in children.
    Population-based studies.--The Committee recognizes the 
importance of the development of environmental cohorts to help 
understand disease risks as a function of environmental 
exposures and gender. The Committee urges the NIEHS to pursue 
the Sisterhood Study which would focus on breast cancer. This 
type of study will define the environmental components of 
breast cancer and other diseases.
    Research priority setting.--The Committee recognized 
NIEHS's strong commitment to seek public input in setting its 
research agenda, including the use of regional town meetings. 
The Committee is pleased to learn that the NIEHS has recently 
invited public input and advice about environmental health 
problems of concern to the American people in four regional 
town meetings across the country. The Committee urges NIEHS to 
continue the regional town meeting programs and encourages the 
Institute to work closely with minority communities and 
organizations to enhance the participation of special 
populations in setting the research agenda.
    Eliminating disparities in health outcomes.--The Committee 
recognizes that many of the populations disproportionately 
exposed to the impact of environmental factors are minority and 
disadvantaged groups. This exposure manifests itself in a 
variety of health problems such as asthma. The Committee 
appreciates the outstanding environmental justice programs of 
the NIEHS, which serve as models for addressing this issue. The 
Committee urges the Institute to continue this excellent 
program and encourages the Institute to work closely with 
minority communities and organizations to enhance the 
participation of special populations in biomedical research.
    Pediatric asthma.--The Committee applauds the joint 
collaboration between a major medical school and one of the 
nation's premiere environmental health, marine and atmospheric 
sciences schools to focus on pediatric respiratory diseases. 
This Florida-based partnership can further advance research 
underway on the increasing incidence of pediatric asthma and 
environmentally related respiratory diseases. The Committee 
encourages continued support for this initiative.
    Human diseases.--The Committee notes that human diseases 
are caused by both genetic and environmental factors, or by 
their interaction over the course of many years. In fact, it is 
highly likely that most chronic illnesses are caused by gene-
environment interaction. Thus, to prevent disease initiation 
and development, scientists must understand the role of both 
genes and the environment in the etiology of human illness. 
Moreover, if expression of disease susceptibility or 
predisposition genes are dependent on specific environmental 
triggers, as is generally believed to be the case, then 
investment in environmental health research represents the most 
humane and cost-effective approach to preventing the suffering, 
loss of life, and the economic consequences of chronic 
diseases. The Committee urges the Director to increase research 
into this area.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. Determining the underlying cause of Type 1 
diabetes could lead to improved strategies to delay or prevent 
the onset of the disease in the children and young adults who 
are impacted. The Committee is aware that most researchers 
believe that Type 1 diabetes is caused by the interaction of 
genetic, environmental, and other factors. The Committee urges 
the Institute to examine research into the environmental 
component of diabetes as a priority area.
    Lymphoma.--Lymphoma currently has one of the highest rates 
of incidence among all cancer in the U.S. The Committee 
encourages NIEHS to collaborate with NCI in an effort to better 
understand environmental factors that may contribute to the 
development of lymphoma.
    Endocrine disruptors.--Endocrine disruptors are compounds 
in the environment which may have an effect on the thyroid and 
reproductive function and development. Research to learn the 
nature and extent to which this is a human health problem is 
needed. Additionally, research is needed to learn whether fish 
neurons can be used as a bioassay for endocrine disruptors. The 
Committee urges NIEHS to continue to support research in this 
area.
    Parkinson's disease.--The Committee supports the 
Institute's increased emphasis on understanding the cause and 
pathophysiology of Parkinson's disease with a goal of 
prevention, effective treatment and a cure for this devastating 
disorder. A recent landmark finding that classic Parkinson's 
disease is primarily an environmental disorder joins a growing 
body of evidence linking Parkinson's and environmental 
exposures. The contributions of aging, genetics, and endogenous 
neurochemical factors in the disorder remain unclear, however, 
requiring further research before ultimate preventive and 
therapeutic solutions are developed. The Committee believes 
that a strong scientific foundation exists for research into 
the possible link between Parkinson's disease and environmental 
factors to better understand the cause and pathophysiology of 
Parkinson's disease. The Committee recommends NIEHS fund a 
major research initiative in this area and has provided 
sufficient resources for such an effort. The Committee requests 
that NIEHS report back to the Committee within 120 days on the 
design and scope of the initiative.
    Environmental health sciences centers.--The Committee 
continues to strongly support the Environmental Health Sciences 
Centers program and believes that a fully funded Centers 
program is critical to carrying out the expanding mission of 
NIEHS. The Committee expects these Centers to be funded at peer 
reviewed levels.

                      NATIONAL INSTITUTE ON AGING

Appropriations, 1999....................................    $600,136,000
Budget estimate, 2000...................................     614,717,000
Committee recommendation................................     680,332,000

    The Committee recommendation includes $680,332,000 for the 
National Institute on Aging [NIA]. This is $65,615,000 more 
than the budget request and $80,196,000 more than the fiscal 
year 1999 appropriation. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NIA conducts biomedical, behavioral, and 
social research related to the aging process to prevent disease 
and other problems of the aged, and to maintain the health and 
independence of older Americans. Research in aging over the 
last two decades demonstrates that aging should not be equated 
with inevitable decline and disease.
    Alzheimer's disease.--If left unchecked, Alzheimer's 
disease will become the epidemic of the 21st century, 
destroying the lives and savings of as many as 14 million 
Americans and their families. Annual costs will soar to at 
least $375,000,000,000, overwhelming our health care system and 
bankrupting Medicare and Medicaid in the process. However, if 
medical science can find ways to delay the onset of Alzheimer's 
disease for as little as 5 years, half of its potential victims 
will never be disabled by the disease. And the nation will save 
as much as $50,000,000,000 a year that would otherwise be spent 
on caring for Alzheimer's patients.
    Last year, the Committee heard compelling evidence 
indicating that Alzheimer's actually begins to attack brain 
cells years before the first symptoms of the disease appear. By 
that time it is too late to halt or reverse the damage. In 
light of this new evidence, the Committee challenged the NIH 
and the scientific community to launch a full-scale initiative 
that focuses on preventing or delaying the onset of Alzheimer's 
disease. In response, NIA recently announced the start-up of a 
3-year, multisite clinical trial to test the usefulness of two 
therapeutic agents to slow or stop the progression of mild 
cognitive impairment to Alzheimer's disease. The Committee is 
pleased by this action, and believes that the research 
infrastructure is in place to permit an acceleration of efforts 
to prevent Alzheimer's disease. The Committee is, therefore, 
urging that NIH-wide research on Alzheimer's be greatly 
expanded from the current $409,000,000 funding level in fiscal 
year 2000. To achieve this objective, the Committee has 
provided additional funds for NIA as well as the National 
Institute of Neurological Disorders and Stroke and the National 
Institute of Mental Health.
    Claude D. Pepper Older American Independence Centers.--The 
Committee continues to strongly support these successful 
centers which focus on developing innovative and cost effective 
ways to enhance the independence of older Americans. The 
centers also play the critical role of developing top level 
experts in geriatrics. The Committee urges NIA to expand these 
centers to include a school of nursing.
    Cognition and aging.--The Committee is pleased to learn 
that a study now underway at the Institute of Medicine is 
examining the current knowledge base in the area of cognition 
and aging in order to identify future directions for 
behavioral, cognitive, and neuroscience research in this area. 
The Committee urges NIA to use the IOM recommendations as a 
guide for expanding its portfolio in this critical area of 
research.
    Alzheimer's special care units.--NIA is commended for its 
innovative research on effective management of Alzheimer's 
disease patients through special care units and the needs of 
Alzheimer's care givers. The Committee also commends NIA for 
its efforts to plan and map promising topics in cognitive 
research and for its excellent public information materials 
encouraging older adults to exercise and stay physically 
active. NIA is encouraged to expand its research on health 
promotion interventions in aging populations.
    Cardiovascular aging research.--Heart attack, congestive 
heart failure, stroke, and other cardiovascular diseases remain 
America's No. 1 killer of older men and women and a main cause 
of disability. Of the Americans who die from cardiovascular 
diseases, about half are ages 65 or older. The number of deaths 
from cardiovascular diseases rise significantly with increasing 
age--as does the number of Americans suffering from these 
diseases. The Committee encourages the Institute to make 
cardiovascular research a priority to allow the Institute to 
support ongoing studies and to expand into innovative 
extramural and intramural cardiovascular research programs.
    Demographic research.--The Committee commends NIA for 
building and sustaining high quality data infrastructures 
needed to examine the changing patterns of old age, disease and 
disability. Implications of such data are critical in 
understanding the health and well-being of the elderly and 
their families. Federal responsibilities, such as Medicare and 
Social Security also depend heavily on such data. The 
Demography of Aging Centers are playing an important role in 
analyzing health disparities that persist among the elderly. 
The Committee looks forward to the induction of the oldest 
baby-boomers into the ongoing health and retirement study.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. Diabetes is one of the most common chronic 
diseases affecting the elderly. The Committee is very pleased 
that the Institute is focusing resources on examining the long-
term impact of living with chronic illnesses like diabetes, and 
also encourages the Institute to partner with other institutes 
to focus studies on the cure and prevention of the 
complications of diabetes which are more common in those who 
have had the illness for long periods of time. The Institute is 
encouraged to coordinate basic biology efforts--particularly in 
cell signaling and regulation, micro and macrovascular 
complications--with those aspects relevant to diabetes to 
maximize the potential clinical applications of their findings.
    Parkinson's disease.--The Committee recognizes that 
Parkinson's disease continues to exact a costly toll on the 
nation, both in human and financial terms. With the average age 
of diagnosis at 57 years, the demographic surge of the baby 
boomers will vastly increase this problem. The consequences 
will include not only incalcuable human suffering but a further 
strain on Federal entitlement programs. The Committee is 
encouraged, however, by continued discoveries in the cause, 
pathophysiology, and treatment of Parkinson's disease, and by 
growing opportunities for collaboration with Alzheimer's 
disease. Given the age-related impact and the tremendous 
potential for development of more effective treatments, the 
Committee is persuaded that there now exists a strong 
scientific and economic foundation for a major new initiative 
in this area. The Committee urges the Institute to develop 
programs to implement the 1997 Morris K. Udall Parkinson's 
Disease Research Act's authorized increases in Parkinson's-
focused research, in coordination with other relevant 
Institutes.
    Bone Disease.--The Committee urges the Institute to expand 
and intensify its research programs on osteoporosis and related 
bone diseases. The Committee also encourages the Institute to 
work with NIAMS to expand research on these often painful and 
disabling diseases. The Committee also encourages the Institute 
to increase research on non-Caucasian women and all men. 
Because the major body of knowledge about osteoporosis relates 
to Caucasian postmenopausal women, little information is 
available on which to base diagnosis and treatment of other 
populations.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 1999....................................    $307,284,000
Budget estimate, 2000...................................     314,750,000
Committee recommendation................................     350,429,000

    The Committee recommends an appropriation of $350,429,000 
for the National Institute of Arthritis and Musculoskeletal and 
Skin Diseases [NIAMS]. This is $35,679,000 more than the budget 
request and $43,145,000 more than the fiscal year 1999 
appropriation. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The NIAMS conducts and supports basic and 
clinical research and research training, and the dissemination 
of health information on the more than 100 forms of arthritis; 
osteoporosis and other bone diseases; muscle biology and muscle 
diseases; orthopedic disorders, such as back pain and sports 
injuries; and numerous skin diseases. The research agenda of 
the NIAMS addresses many devastating and debilitating diseases 
that afflict millions of Americans. These diseases of the 
joints, muscles, bones, connective tissues, and skin, in the 
aggregate, will affect nearly every American at some point in 
their lives, causing tremendous human suffering and costing the 
Nation billions of dollars in both health care and lost 
productivity. The research activities of this Institute serve 
the concerns of many different special populations, including 
women, minorities, children, and the elderly.
    Lupus.--Lupus is a widespread, devastating autoimmune 
disease that affects 1.4 million Americans, most of whom are 
women. Lupus is the prototypical autoimmune disease that, for 
reasons not fully understood, causes the immune system to 
become hyperactive and attack the body's own tissue. The 
disease affects the quality of life and can damage vital organs 
resulting in disability or death. Lupus and other autoimmune 
diseases are the fourth leading cause of disability in women. 
Gaining an understanding of the factors associated with the 
high prevalence of lupus in women and minorities and the 
development of new and innovative treatments should be a high 
priority. The Committee urges NIAMS to explore all available 
scientific opportunities that presently exist in lupus research 
and treatment.
    Osteoarthritis.--Early diagnosis of a disease is important 
to prevent or reduce long-term disability. For musculoskeletal 
conditions such as osteoarthritis, early diagnosis is hampered 
because of insufficient knowledge of the early stages of the 
disease. Osteoarthritis, which can completely destroy the 
joints of the hips and knees, affects over 20 million 
Americans, most often the elderly. With the aging of the 
population expected to double by the year 2020, a significant 
investment must be made now to reduce the burden of 
osteoarthritis later. If not, the dynamics of this condition in 
the aging population alone will generate an avalanche of costs, 
disability and suffering to the American people in the future. 
The Committee, therefore, encourages the Institute to assign 
osteoarthritis research a high priority.
    Centers on connective tissue research.--The Committee 
encourages the Institute to consider supporting peer-reviewed 
centers based at academic institutions that would focus on 
connective tissue research as it relates to biomaterials. Such 
research could focus on designing and developing new methods to 
use polymers in connective tissue repair, replacement and 
regeneration.
    Scleroderma.--Scleroderma is a chronic, degenerative 
disease which causes the overproduction of collagen in the 
body's connective tissue. It affects between 300,000 and 
500,000 Americans and is often life-threatening, yet it remains 
relatively unknown and under-funded. The Committee urges the 
Institute to provide additional resources to expand the 
research in this area and to work collaboratively with private 
research foundations to coordinate research findings.
    Osteoporosis.--The Committee urges NIAMS to fund additional 
specialized Centers for Research for osteoporosis. The 
Committee notes that these centers have made significant 
contributions to the progress of osteoporosis research and 
patient care and can help in reducing bone fractures and other 
complications from the disease.
    Behavioral and social science research.--The Committee 
notes that the portion of the NIAMS research portfolio devoted 
to behavioral and social sciences research is significantly 
lower than the NIH average. Therefore, the Committee urges the 
NIAMS to fund promising behavioral social sciences research. 
Additionally, the Committee urges favorable consideration of 
research in the area of behavioral and social science factors 
relating to the adherence to medical recovery regimes, exercise 
and weight reduction programs.
    Skin disease research.--The Committee has learned of the 
efforts by the skin disease researchers and patient advocate 
organizations to develop a comprehensive analysis of research 
opportunities and a research plan for further progress in 
finding cures and improving care for patients with these 
diseases. The Committee applauds this initiative and encourages 
NIAMS to publicize and support widespread use of these 
materials.
    Fibromyalgia.--Fibromyalgia syndrome (FMS) is a clinically 
diagnosed disorder which is poorly understood and difficult to 
treat. It is a syndrome of chronic, debilitating, widespread 
pain, fatigue, sleep disturbance, and other associated 
disorders. Research in the eight years following the American 
College of Rheumatology's case definition of fibromyalgia and 
four years since the first NIH awards on fibromyalgia has 
created a solid body of knowledge. The Committee urges the 
Institute to support two centers for research into 
fibromyalgia. These centers would conduct multi-disciplinary 
studies which have the potential to add significantly to 
science's understanding of this complex and disabling disease.
    Osteoporosis Public Education Campaign.--Osteoporosis is a 
major public health problem affecting 28 million Americans who 
either have the disease or are at risk of the disease. It 
causes an estimated 1.5 million fractures annually costing 
$13,800,000,000 in direct medical costs. It is a preventable 
disease in most cases and not a necessary part of aging. A task 
force convened by the Office of Public Health Services on 
Women's Health at the Department of Health and Human Services 
and the National Osteoporosis Foundation has determined that a 
public education campaign on osteoporosis is needed. The first 
phase of this program was launched in 1999 and is focused on 
adolescent girls, ages 9 to 18. The task force recommended that 
in the second phase the campaign should focus on the 45 to 64 
year old age group. This is an important time to evaluate their 
bone health and that of their immediate family. The Committee 
strongly urges the Institute to provide the funding and support 
necessary for the NIH Osteoporosis and Related Bone Diseases-
National Resource Center to carry out a comprehensive public 
education campaign.
    Ehlers-Danlos Syndrome.--Ehlers-Danlos Syndrome (EDS) is a 
heterogeneous group of heritable connective tissue disorders, 
characterized by articular hypermobility, skin extensibility 
and tissue fragility. This rare disease oftentimes goes 
undiagnosed because of the difficulty caused by multi-system 
involvement. The Committee urges the Institute to conduct 
specific research on EDS to identify improved diagnostic tools 
and treatment. Specifically, the Institute is encouraged to 
create a registry of patients with EDS to help facilitate 
accurate diagnosis and treatment.
    Cushing's Syndrome.--Cushing's Syndrome is a hormonal 
disorder caused by prolonged exposure of the body's tissues to 
high levels of the hormone cortisol. Sometimes called 
``hypercortisolism'', it is relatively rare and most commonly 
affects adults aged 20 to 50. An estimated 10 to 15 of every 
million people are affected each year. The Committee encourages 
the Institute to conduct specific research on Cushing's 
Syndrome, to increase awareness of the disease and improve 
diagnostic tools and treatment.
    Duchenne muscular dystrophy.--The Committee continues to 
seek intensified efforts by the National Institutes of Health 
to develop effective therapies for this catastrophic muscle 
disease, which affects one of every 3,500 male children born 
worldwide.
    The Committee has been pleased to note some modest funding 
increase in recent years, but much remains to be done to 
improve the outlook for affected patients of this most lethal 
genetic childhood disorder. Therefore, the Committee encourages 
NIAMS, in collaboration with other NIH institutes, to increase 
public awareness of this disease, increase support for basic 
and clinical research on Duchenne Muscular Dystrophy, and 
convene a scientific workshop to explore promising research 
efforts.
    Bone disease.--Over 30 million Americans suffer from some 
form of bone disease. The Committee encourages the Institute to 
increase its research on diseases such as osteoporosis, Paget's 
disease of bone, osteogenesis imperfecta, multiple myeloma and 
other bone diseases with a special emphasis on the role that 
proteins such as Cbfa-a and parathyroid hormones play in the 
growth and development of bone; and on its research and 
development of selective estrogen receptor modulators (SERMS) 
which offer promise in the prevention and treatment of 
osteoporosis and related bone disease. The Committee also 
encourages the Institute to increase research on non-Caucasian 
women and all men. Because the major body of knowledge about 
osteoporosis relates to Caucasian postmenopausal women, little 
information is available on which to base diagnosis and 
treatment of other populations.
    Reflex Sympathetic Dystrophy Disorder (RDS).--The Committee 
is aware of the debilitating effects of RDS. Currently, little 
is known about the cause of this disorder, which leads to 
frequent occurrences of misdiagnosis, and ultimately, the 
condition is mistreated or goes untreated. Given that early 
identification and prompt treatment are the keys to recovery, 
the Committee urges the Institute to consider enhancing its 
investigation into the cause of and most effective treatments 
for this condition.

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 1999....................................    $231,547,000
Budget estimate, 2000...................................     237,171,000
Committee recommendation................................     261,962,000

    The Committee recommends an appropriation of $261,962,000 
for the National Institute on Deafness and Other Communication 
Disorders [NIDCD]. This is $24,791,000 more than the budget 
request and $30,415,000 more than the fiscal year 1999 
appropriation. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The NIDCD funds and conducts research and 
research training in the normal and disordered processes of 
human communication, specifically in the areas of hearing, 
balance, smell, taste, voice, speech, and language. The 
Institute addresses the special biomedical and behavioral 
problems of people who have communication impairments or 
disorders; is actively involved in health promotion and disease 
prevention; and supports efforts to create devices that 
substitute for lost and impaired sensory and communication 
functions.
    Dysphonia.--The Committee continues to be pleased with 
NIDCD's research into spasmodic dysphonia, a voice disorder 
which makes speech difficult due to uncontrolled voice and 
pitch breaks. The Committee encourages NIDCD to enhance its 
intramural and extramural dysphonia/dystonia research 
portfolio.
    Neurofibromatosis.--The Committee urges the Institute to 
consider the progress being made in research into the causes 
and prevention of neurofibromatosis and to determine whether 
such progress offers new research opportunities consistent with 
the Institute's mission.
    National Multipurpose Research and Training Centers.--The 
Committee strongly supports the National Multipurpose Research 
and Training Centers (RTC) program at NIDCD, and is concerned 
about NIDCD's decision to discontinue the program after the 
current awards expire. This program has a proven track record 
of service to the community, providing valuable continuing 
education to physicians and outreach to those with 
communications disorders and their families in addition to 
conducting leading-edge research. Therefore, the Committee 
encourages the Institute to continue supporting competitive, 
peer-reviewed awards through the RTC program and expects NIDCD 
to be prepared to report to the Committee during the fiscal 
year 2001 hearings on the details of past program 
accomplishments as well as a strategic plan to ensure the 
program's continued viability. Furthermore, the Committee 
encourages NIDCD to accept applications from current RTCs in 
any future peer-reviewed competition.
    Patient-oriented clinical research.--The Committee is 
pleased to learn that NIH is committed to reinvigorating 
clinical research and understands that translating medical 
research into improved human health is dependent upon a healthy 
clinical research enterprise. The NIDCD has a mission of great 
importance to our nation's health, economic, and social well 
being. Thus, the Committee expects the institute to expand its 
support of patient oriented clinical research conducted by 
clinician-scientists, including physician-scientists. 
Particular attention should be given to supporting the Clinical 
Trial Cooperative Group program with emphasis on diagnostic and 
treatment of diseases related to communication disorders.
    The Committee requests at next year's budget hearings on 
how best to strengthen clinical research support through multi-
center clinical trials conducted by clinical trials cooperative 
groups.
    Learning disabilities.--The Committee is pleased that NIDCD 
continues to support research activities focused on speech 
processing and on the development of expressive and receptive 
language. The Committee encourage continued activity and look 
forward to learning the results of results of this work as they 
hold significant promise for individuals with learning 
disabilities. The Committee encourages the Institute to 
continue to coordinate with other Institutes working on related 
activities.
    Noise induced hearing loss.--The Committee continues to be 
concerned by the number of Americans suffering from noise 
induced hearing loss. Approximately 30 million Americans are 
exposed to dangerous levels of noise that can permanently 
impair their hearing. Ten million Americans have suffered 
irreversible noise induced hearing loss. The Committee has been 
pleased by the Institute's efforts to tackle this preventable 
health problem. The Wise Ears campaign has the potential to 
make significant inroads towards educating Americans of all 
ages. The Committee has included sufficient funds to expand 
this promising new initiative.
    Stuttering.--The Committee notes that the National 
Institute on Deafness and Communications Disorders continues to 
provide inadequate funding for the research into the causes and 
appropriate therapies for stuttering. Stuttering exists across 
all cultures, races, and socio-economic classes, affecting 
about one-percent of the global population and about three 
million Americans. Stuttering's causes remain largely a 
mystery, and therapies are often times expensive, ill-suited to 
their particular variant of the disorder, and often not covered 
by standard health insurance policies. Further and more focused 
research into the causes and features of stuttering 
(particularly ``chronic stuttering'') will lead to the 
development of preventive remedies; more accurate diagnoses of 
variants of stuttering; sounder identification of appropriate 
therapies for given subjects; the development of new therapies, 
potentially including neuropharmacological agents; and further 
insights about other communications disorders. Two new avenues 
of research hold great promise to understand the roots of 
stuttering: genetics and neuroimaging. The Committee urges the 
NIDCD to conduct a workshop early next year to explore these 
and other potential avenues of research; to make a significant 
and dramatic increase of effort, especially through cutting-
edge intramural research; and to issue a request for 
applications as soon as practicable.
    Training new investigators.--The Committee strongly urges 
NIDCD to support research initiatives for supporting new young 
investigators, because they represent the future of NIH.
    Developmental biology.--The Committee believes it is 
critical to support research in developmental biology and other 
areas related to inner ear hair cell regeneration. Data is 
needed on mechanisms of hair cell growth and activation, and 
cell differentiation into hair cells and supporting cells.
    The Committee recommends enhancing the focus and activity 
of ``translational research'' identifying promising basic 
interdisciplinary research findings (including molecular and 
genetic data) and developing the activities to bring them to 
clinical reality.
    Genetics of hearing impairment.--The Committee is 
encouraged by NIDCD's research into genetics of hearing 
impairment and other communication disorders: the relationship 
between the phenotype and the genotype. The Committee believes 
a high priority should be placed on NIDCD's support of 
collaborative research among geneticists, molecular biologists, 
physiologists, anatomists and behavioralists to identify, 
characterize and understand the function of all genes affecting 
the auditory and vestibular system, and on support of efforts 
in research that will enhance the feasibility of gene therapies 
in the future.
    Clinical trials.--The Committee is concerned that clinical 
research involving patients and treatment protocols is 
seriously underrepresented in the NIDCD portfolio. The 
Committee believes that support for randomized clinical trials 
to study treatment effectiveness is urgently needed. Because of 
the cost of clinical trials, special funding mechanisms and 
research on alternative research strategies should be explored. 
The Committee believes that NIDCD should also train 
investigators and reviewers in clinical trials methodology.
    Communication disorders.--The Committee is concerned that 
NIDCD is not adequately supporting work on cellular biology and 
integrative neuroscience of the central nervous system (CNS) 
auditory, olfactory, and taste pathways, and believes that this 
area of research requires considerably more attention. 
Understanding how the CNS process sensory information, CNS 
development and plasticity, and language processing by the CNS 
are key issues for understanding and eventual treatment of 
communication disorders.
    Inner ear disease.--The Committee recommends that the NIDCD 
expand and intensify research to study the efficacy of local 
therapies for the treatment of inner ear disease. This will 
lead to utilization of new molecules and delivery systems 
(cannulas, bipolymers, gene therapy) to locally intervene in 
the inner ear in order to prevent acquired hearing loss.
    Cochlear implantation.--The Committee remains committed to 
support work on intervention for hearing impaired people and 
encourages: research on methods to identify young children able 
to utilize a cochlear implant; research on optimal age for 
implantation; research data comparing efficacy of hearing aids 
and cochlear implants for children identified at birth with 
severe hearing loss; and, research on improving hearing aids 
and cochlear implants.

                 NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 1999....................................     $70,031,000
Budget estimate, 2000...................................      71,730,000
Committee recommendation................................      90,000,000

    The Committee recommends an appropriation of $90,000,000 
for the National Institute of Nursing Research [NINR]. This is 
$18,270,000 more than the budget request and $19,969,000 more 
than the fiscal year 1999 appropriation. The comparable amounts 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The National Institute of Nursing Research [NINR] 
supports clinical and basic research on biological and 
behavioral aspects of critical national health problems. The 
Institute's programs have established a scientific basis for 
research that seeks to reduce the burden of acute and chronic 
illness and disability for individuals of all ages; improve the 
quality of life by preventing and delaying the onset of disease 
or slowing its progression; and establishing better approaches 
to promoting health and preventing disease. The NINR supports 
programs essential to improving clinical environments by 
testing interventions which influence patient health outcomes 
and reduce costs and demands for care.
    New research opportunities.--The Committee encourages the 
NINR to take advantage of significant new research 
opportunities in the following areas: enhancing adherence to 
diabetes self management behaviors; biobehavioral research for 
effective sleep in health and illness; prevention of low 
birthweight minorities; improved care for children with asthma; 
collaborative clinical trials for adherence, decisionmaking, 
and managing symptoms in AIDS and cancer; and expanding 
opportunities for pre- and post-doctoral training in nursing 
research at schools of nursing across the country.
    Collaborative efforts.--The Committee is pleased with 
NINR's efforts to work collaboratively with other institutes 
and offices on joint program announcements and Requests for 
Proposals, demonstrating the integrative and supportive nature 
of nursing research to the mission of the other NIH institutes. 
The Committee recommends that NIH augment the NINR budget as 
necessary to facilitate interdisciplinary research.
    Wellness and health outcomes.--The Committee notes the 
significant contribution of nursing research to wellness and 
health outcomes and the disproportionately slow growth of NINR 
compared to NIH in general. Since 1986, NINR has received only 
0.5 percent of the total fiscal NIH growth. NINR is one of only 
two NIH institutes since 1995 that has received growing numbers 
of research proposals. The Committee urges NIH to increase 
funding in this area to permit NINR to take advantage of 
significant new research opportunities in self-management of 
diabetes, AIDS, and cancer, biobehavioral research, pediatric 
asthma, and low birthweight infants in minorities.
    Volcanic emissions.--The Committee continues to be 
concerned about the public health aspects of volcanic emissions 
(VOG) in Hawaii and urges the Institute to collaborate with the 
National Institute of Environmental Health Sciences in 
developing a multidisciplinary approach to this problem.
    Culturally sensitive approaches to health care.--NINR 
efforts to understand and reduce the burden of health problems 
in multiple socioeconomic, race, and age groups are 
particularly responsive to society's present needs. The 
Committee encourages that NINR's efforts in ethnic, rural and 
other special populations be expanded to include Native Alaskan 
and native Hawaiian populations. The Committee also calls 
attention to Malama, an innovative, culturally sensitive 
community partnership program which addresses the prenatal care 
needs of minorities in Hawaii.
    Behavioral changes and interventions.--The Committee agrees 
that research is needed to understand the complex relationship 
between behavior and the immune system. An area of importance 
in this initiative is the prevention of low birth-weight 
infants in underserved areas, such as rural areas of Alaska and 
Hawaii. The Committee strongly supports research initiatives by 
NINR to study modulation of immune functions by behavioral 
interventions.
    Telehealth.--The Committee encourages the Institute to 
explore the relationship among telehealth, nursing, and 
increased access to care for prevention and treatment, 
particularly in underserved areas of Hawaii. The Committee is 
aware that there is limited data on the efficacy of telehealth 
nursing interventions and encourages the NINR to partner with 
Tripler Army Medical Center in examining telehealth and nursing 
research issues.
    End-of-life issues.--The Committee understands that NINR 
has been designated as the lead Institute in a new NIH 
initiative that addresses health issues at the end of life. The 
NINR initiative emphasizes improved treatment for pain and 
improved diagnosis and treatment of behavioral symptoms such as 
cognitive problems, delirium, and depression. With its research 
in symptom management, decision making for patients, care 
giving, and optimal environments for critically ill patients, 
the Committee feels that NINR brings impressive experience to 
the lead role in end-of-life research and commends the 
Institute for its leadership in this area.
    Nurse scientists.--The Committee notes that NIH has 
established several innovative mechanisms to provide training 
in health research careers. The Committee strongly encourages 
collaboration between NINR and other Federal nursing agencies 
in developing innovative training opportunities for enhancing 
nursing research at the doctoral and postdoctoral level.
    Nursing Research Centers.--The Committee notes that the 
development of a strong field of nursing research depends on 
continued support of trainees and provision of research 
resources. The Committee agrees with the emphasis placed by the 
NINR on renewing its core centers program in 2000 and 
encourages the development of an additional center focused on 
the problems of rural populations, such as those residing in 
Alaska and Hawaii
    Nurse managed clinics.--The Committee encourages NINR to 
explore a collaborative relationship with the University of 
Hawaii School of Nursing for developing research projects that 
focus on the use of nurse practitioners and psychologists as 
primary care providers in nurse-managed community-based centers 
serving rural native Hawaiian populations.
    Pediatric emergency care.--The Committee strongly 
encourages NINR to develop a research focus on pediatric 
emergency care.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. Until a cure is found for diabetes, it is 
essential that new strategies and therapies are available to 
assist individuals who suffer from the disease in maintaining 
close to normal blood-glucose levels. The Committee encourages 
the Institute to support such research and, in particular, 
urges it to focus its resources on helping children who suffer 
from diabetes develop new strategies and therapies by which to 
live with the illness.

           National Institute on Alcohol Abuse and Alcoholism

Appropriations, 1999....................................    $259,202,000
Budget estimate, 2000...................................     265,497,000
Committee recommendation................................     291,247,000

    The Committee recommends an appropriation of $291,247,000 
for the National Institute on Alcohol Abuse and Alcoholism 
[NIAAA]. This is $25,750,000 more than the budget request and 
$32,045,000 more than the fiscal year 1999 appropriation. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NIAAA conducts biomedical and behavioral 
research for improving prevention and treatment and reducing or 
eliminating the associated health, economic, and social 
consequences of alcohol abuse and alcoholism. NIAAA provides 
leadership in the country's effort to combat these problems by 
developing new knowledge that will decrease the incidence and 
prevalence of alcohol abuse and alcoholism and associated 
morbidity and mortality. NIAAA addresses these questions 
through an integrated program of biomedical, behavioral, and 
epidemiologic research on alcoholism, alcohol abuse, and 
related problems. This broad-based program includes various 
areas of special emphasis such as medications development, 
fetal alcohol syndrome [FAS], genetics, and moderate drinking.
    Binge drinking.--Alcohol abuse, particularly ``binge'' 
drinking and drinking with the intent to get drunk, continues 
to pose significant problems for college communities. The 
Committee strongly supports the efforts of NIAAA's Advisory 
Council Subcommittee on College Drinking and encourages the 
Subcommittee to identify the context and consequences of 
college drinking and provide recommendations on the prevention 
and treatment of the problem.
    Behavioral research on alcoholism.--The Committee 
understands that research in behavioral science is an integral 
part of NIAAA's mission, reflecting the central role of 
behavior in all dimensions of alcohol abuse and alcoholism. The 
Committee commends NIAAA's expansion of its behavioral science 
portfolio to include basic research of the underlying 
psychological and cognitive processes involved in alcohol 
related behaviors and encourages the Institute's efforts in 
this area.
    Young Behavioral Science Investigators.--The Committee 
commends NIAAA's establishment of its Behavioral Science Track 
Awards for Rapid Transition (B/START-NIAAA), a program of small 
grants for young investigators in behavioral science research. 
The Committee views this as essential for ensuring the supply 
of scientists needed to examine the numerous behavioral factors 
that play a central role in alcohol abuse and alcoholism. The 
Committee would like a report by next year's hearings on the 
progress of this program.
    Alcohol abuse health services research plan.--The Committee 
understands that the National Advisory Council on Alcohol Abuse 
and Alcoholism has developed a comprehensive plan for health 
services research, improving the delivery of alcohol treatment 
and prevention services. The Committee views health services 
research as an essential part of alcohol treatment and 
prevention, and would like the Institute to report on its 
progress in implementing this plan at next year's 
appropriations hearings.
    Fetal alcohol syndrome (FAS).--Fetal Alcohol Syndrome (FAS) 
is the leading preventable cause of mental retardation and 
birth defects in the United States. The Committee anticipates 
productive results from the new RFA on the prevention of FAS 
and recommends that NIAAA sponsor additional research on the 
prevention of drinking during pregnancy and on effective 
treatments for children who have been exposed to alcohol during 
gestation. The Committee encourages NIAAA to provide leadership 
to improve the diagnosis of alcohol-related neurological and 
behavioral deficits and to conduct research to support the 
development of pharmacological interventions for the 
identification and treatment of deficits in early childhood. 
The Committee also commends NIAAA for leadership in chairing 
the Interagency Coordinating Committee on Fetal Alcohol 
Syndrome (ICCFAS). The Committee is pleased with the report of 
the ICCFAS and NIAAA's leadership of this initiative.
    The Committee urges the NIAAA to develop and support a 
National Clearinghouse on Alcohol-Related Birth Defects. FAS is 
caused by maternal alcohol use during pregnancy and is 
manifested in neurological and motor deficits, mental 
retardation, learning disabilities, and craniofacial 
malformations, among other symptoms. The societal cost of FAS 
is estimated at $3,400,000,000 annually. There is a strong need 
to fully inform women of child bearing age about alcohol-
related birth defects and to get the message to health 
professionals. The Clearinghouse should serve as a national 
resource to educate the public about dangers of drinking 
alcohol during pregnancy and to develop science-based 
prevention and education strategies to address this major 
preventable health problem.
    Genetics.--The Committee acknowledges research funded by 
NIAAA which demonstrates the role of genetic factors in 
alcoholism. The Committee is excited by the discovery of the 
NIAAA-funded Collaborative Study on the Genetics of Alcoholism 
(COGA) on areas of the genome that are potentially related to 
alcoholism. The Committee is aware that these data will be 
released to the scientific community this fall and encourages 
access to, and continuing analyses of these data by the broader 
scientific community.
    Neuroscience.--Neuroscience research funded by NIAAA 
continues to play an important role in determining the 
biological basis of alcohol-related behaviors. The Committee 
recognizes NIAAA's extensive neuroscience portfolio and 
supports continued research in areas such as neural circuitry, 
the action of alcohol on cell membranes and receptors, and the 
mechanisms of craving, reward, and reinforcement. The Committee 
anticipates the development of new medications for treatment of 
alcoholism and related disorders that will follow on this 
research.
    Medications development.--The Committee commends NIAAA's 
new initiative to develop medications based on the developing 
understanding of the neuroscience of alcohol. The development 
of medications and their testing in clinical trials are 
essential for expanding treatment options in this devastating 
disease. The Committee encourages NIAAA to continue research on 
methods for delivering drugs across the blood-brain barrier and 
on medications that target specific receptor subunits in the 
brain.
    Alcohol and hepatitis C.--Alcohol consumption in patients 
infected with hepatitis C virus markedly increases liver damage 
and worsens the prognosis of the disease. The Committee 
recognizes that nearly 4 million Americans are infected with 
hepatitis C, which causes an estimated 8,000-10,000 deaths per 
year. The Committee commends NIAAA for working with other NIH 
institutes to cosponsor a successful symposium and request for 
application (RFA) on hepatitis C. The Committee is also pleased 
by the new RFA that focuses specifically on alcohol and 
hepatitis C. The Committee urges further research and 
collaboration on this significant topic.
    Alcoholic liver disease.--The Committee recognizes that 
alcoholic liver disease (ALD) is a major cause of morbidity and 
mortality in this country. Developing effective interventions 
for this disease is of paramount importance. The Committee is 
pleased by the NIAAA-funded research on ALD, such as the role 
of cytokines in the inflammatory response, and recommends that 
NIAAA sponsor additional research on treatment.
    Research to Practice Forum.--The Committee commends NIAAA 
for cosponsoring the Research to Practice Forum with SAMHSA, 
the New York State Office of Alcoholism and Substance Abuse 
Services, the Association of Alcoholism and Substance Abuse 
Programs of New York State, and the American Society of 
Addiction Medicine. This event focused on bridging the gap 
between researchers and practitioners and translating 
scientific research into clinical applications. The Committee 
encourages NIAAA to support the implementation and evaluations 
of research-based services within the alcohol treatment system. 
Further, the Committee encourages NIAAA to further evaluate 
this work as a model for use with other states.
    Alcoholism in children and adolescents.--The Committee 
remains acutely concerned over the high incidence of alcoholism 
and alcohol abuse among children and adolescents of Native 
Alaskan and native Hawaiian descent. The Committee urges the 
NIAAA to work with existing native American and native Hawaiian 
organizations to assess and increase their effectiveness.

                    NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 1999....................................    $607,979,000
Budget estimate, 2000...................................     622,751,000
Committee recommendation................................     682,536,000

    The Committee recommends an appropriation of $682,536,000 
for the National Institute on Drug Abuse [NIDA]. This is 
$59,785,000 more than the budget request and $74,557,000 more 
than the fiscal year 1999 appropriation. The comparable numbers 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--Created in 1974, NIDA supports about 85 percent 
of the world's biomedical research in the area of drug abuse 
and addiction. The Committee commends NIDA for demonstrating 
through research that drug use is a preventable behavior and 
addiction is a treatable disease. NIDA's basic research plays a 
fundamental role in furthering knowledge about the ways in 
which drugs act on the brain to produce dependence, and 
contributes to understanding how the brain works. In addition, 
NIDA research identifies the most effective pharmacological and 
behavioral drug abuse treatments. NIDA conducts research on the 
nature and extent of drug abuse in the United States and 
monitors drug abuse trends nationwide to provide information 
for planning both prevention and treatment services. An 
important component of NIDA's mission is also to study the 
outcomes, effectiveness, and cost benefits of drug abuse 
services delivered in a variety of settings.
    Methamphetamine.--The Committee is very distributed by the 
explosion in methamphetamine abuse across the nation. The 
problem is essentially acute in Iowa and other Midwestern 
states. The Committee urges NIDA to expand its research on 
improved methods of prevention and treatment of methamphetamine 
abuse and expects to be briefed on these efforts by December 1, 
1999.
    Hepatitis C.--The Committee is pleased that NIDA 
participated in the Trans-institute RFA for Hepatitis C, and 
urges additional research consistent with the recommendations 
made by the Hepatitis C Consensus Development Conference.
    Behavioral sciences.--The Committee understands that 
behavioral intervention is a critical element in halting drug 
abuse. The Committee continues to support NIDA's expansion of 
its behavioral science portfolio and views NIDA as a model of 
how to approach its behavioral science and public health 
responsibilities.
    Clinical trials.--The Committee is pleased with NIDA's 
continuing progress in developing behavioral and 
pharmacological drug abuse treatments, and supports NIDA's 
initiative to establish a national drug abuse treatment 
clinical trials network. The Committee commends NIDA's 
leadership in forging strong partnerships with treatment 
researchers and community-based treatment providers to assure 
that new treatments are tested and incorporated into ongoing 
drug treatment programs.
    Neuroscience.--The Committee recognizes that basic 
neuroscience provides a foundation for NIDA's research 
portfolio. Basic neuroscience research has advanced the field's 
understanding of drug abuse and addiction. The Committee urges 
NIDA to continue its efforts to develop new areas of 
neuroscience research.
    Genetic vulnerability.--The Committee understands that both 
genes and environment influence drug abuse and addiction. The 
relationship between the two is complex, requiring continued 
research in areas of behavioral genetics, psychiatric and 
epidemiological genetics, molecular genetics, and population 
genetics. The Committee encourages NIDA to expand its 
development of this area of drug and addiction research.
    Children and adolescents.--Recognizing the devastating 
impact of drug addiction on children and youth, the Committee 
commends NIDA's children and adolescent research initiative. 
The Committee urges NIDA to expand its research portfolio in 
areas of co-occurring mental disorders, developmental 
consequences, prenatal exposure, genetic vulnerability, and 
environmental risk factors.
    Medications development.--The Committee encourages NIDA to 
study the development of anti-addiction medications, to clarify 
the neurological and behavioral benefits of the use of 
pharmacological agents, and develop an understanding of how 
best to use these medications.
    Nicotine research.--The Committee recognizes that the 
consequences of nicotine addiction are substantial to adults, 
children, and adolescents, and commends NIDA's support of 
research yielding effective replacement therapies and 
behavioral interventions. The Committee encourages NIDA to 
continue to develop research on the prevention and behavioral 
and pharmacological treatment of nicotine addiction. The 
Committee supports NIDA's ongoing research in the basic 
sciences, behavioral and medical treatments, genetic 
vulnerability, and epidemiology of nicotine use and abuse.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 1999....................................    $855,210,000
Budget estimate, 2000...................................     875,993,000
Committee recommendation................................     969,494,000

    The Committee recommends an appropriation of $969,494,000 
for the National Institute of Mental Health [NIMH]. This is 
$93,501,000 more than the budget request and $114,284,000 more 
than the fiscal year 1999 appropriation. The comparable amounts 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The research programs of the Institute lead the 
Federal effort to identify the causes of--and the most 
effective treatments for--mental illnesses, which afflict more 
than one in five Americans. Severe mental illnesses affect 2.8 
percent of the U.S. adult population annually, or approximately 
5 million people. These individuals suffer from disorders such 
as schizophrenia, manic-depressive illness, major depression, 
panic disorder, and obsessive-compulsive disorder. One result 
of the Federal research investment has been a growing awareness 
that undiagnosed and untreated mental illness, in all its forms 
and with all of its consequences, is as damaging as physical 
illness is to the Nation's well-being.
    A recent study by the World Bank, WHO, and Harvard 
University found that mental disorders currently account for 4 
out of 10 leading causes of disability in the United States for 
individuals above the age of 5. These alarming statistics make 
it clear that mental disabilities have a profound social and 
economic impact.
    Alzheimer's disease.--The Committee notes that NIMH's 
expanding neuroscience and behavioral research portfolios 
continue to play an instrumental role in advancing science's 
understanding of Alzheimer's disease. It was NIMH-supported 
researchers, for example, who found that a particular gene 
product, APO E-4, is associated with increased behavioral 
disturbances in Alzheimer's disease. NIMH is urged to continue 
its close collaboration with the National Institute on Aging 
and the National Institute of Neurological Disorders and 
Stroke, and to expand its investment in research on Alzheimer's 
disease.
    Behavioral research.--The Committee notes that NIMH has 
strengthened its infrastructure to manage more optimally both 
basic and applied research on behavioral processes. The 
Committee is pleased that the National Advisory Mental Health 
Council has now established a subgroup to improve connections 
between basic and behavioral research and clinical and applied 
issues. The Committee requests that the Institute be prepared 
to report on specific research and training initiatives during 
next year's hearing. The Committee commends NIMH for its 
initiative to increase the connections between academic 
departments of psychology and schools of public health with a 
goal of more research with a joint perspective in public health 
and behavioral research.
    Women and mental health.--The Committee contends that 
mental health services research involving and affecting women 
and girls, particularly among minorities, should receive 
increased attention. The Committee urges the Institute to 
identify and examine the critical barriers to the utilization 
of vital preventive health and mental health services. In 
addition, the Committee encourages the Institute to develop and 
evaluate behavioral interventions for health promotion and 
disease prevention among minority women and girls.
    Violence against women.--The Committee encourages NIMH to 
focus more attention on research into prevention, treatment and 
intervention and subsequently to pursue large-scale clinical 
trials of violence against women, including behavioral and 
psychosocial factors.
    Social work research and development.--The Committee 
commends NIMH for funding its eighth social work research 
development center, and encourages NIMH to consider expanding 
the number of centers.
    The Committee remains very supportive of NIMH's efforts to 
develop a cadre of Native Hawaiian mental health researchers, 
utilizing the expertise of their senior mentors. Native 
Hawaiians have historically experienced a disproportionate 
incidence of various mental health problems, including 
depression. In order to effectively address these issues in the 
long run, NIMH should establish a Native Hawaiian center of 
excellence in mental health.
    Emergency medical services.--The Committee commends the 
work supported by NIMH on mental health issues related to 
emergency medical services for children through the University 
of Tennessee, and also the collaboration of NIMH with HRSA in 
funding the National Congress on EMSC in 1998. The Committee 
encourages NIMH to enhance its support of EMSC-related projects 
and to continue to work with HRSA in educational programs on 
EMSC such as national conferences.
    Suicide.--The tragic suicide deaths of nearly 30,000 
Americans each year points up a national public health 
emergency. Research to solve this health crisis is constrained, 
however, by legal and ethical considerations necessary in 
planning treatment studies that would involve the participation 
of persons who are at high risk for suicidal behavior. Thus, 
the Committee looks forward to hearing from NIMH about the 
development of research networks fully informed of appropriate 
measures and protocols necessary to test treatments for persons 
at high risk for suicidal behavior. To accomplish this requires 
a consensus of suicidal behavior measurement and, in 
conjunction with the Office of Protection from Research Risks, 
the development of safeguards and ethical guidelines that will 
allow clinical trials (both treatment efficacy and 
effectiveness studies) that involve individuals at high risk 
for suicidal behavior.
    The Committee understands there is a need for NIMH research 
examining the extent to which improving the abilities of 
primary health care providers to recognize and treat major 
depression will prevent suicides among the nation's rapidly 
growing elderly population. The Committee is encouraged that 
NIMH, SAMHSA, HRSA, and the VA are collaborating on efforts to 
improve the tools and methods used for assessing suicidal 
behavior in evaluations that these agencies are conducting of 
approaches to treating later life mental and substance abuse 
disorders in primary care settings.
    Depression.--The Committee urges the NIMH to expand funding 
of research that will help explain depression, including the 
search for genes through which susceptibility is inherited, 
environmental risk factors that may interact with genetic 
factors, and biological changes in the brain associated with 
this prevalent disorder. The Committee is pleased with NIMH's 
emphasis on funding clinical research to develop new ways to 
treat children and adolescents for depression and to adequately 
test the effectiveness of adult medications being routinely 
prescribed for children. The Committee also supports NIMH's 
major clinical research effort in bipolar disorder, and its 
commitment to assess different treatments and therapies for 
treatment-resistant depression.
    Women and depression.--In the United States twice as many 
women as men are affected by a depressive disorder, such as 
depression, anxiety disorders, and eating disorders. More 
research is needed to understand, treat, and prevent these 
disorders in women, including the links between hormonal, 
psychological, social, and cultural factors. More research is 
particularly needed to identify risk and protective factors 
during girls' adolescent years and other populations of women. 
The Committee urges NIMH to expand research and therapeutic 
attention to women with depressive symptoms who do not meet 
criteria for major depression. The Committee applauds NIMH for 
its work on postpartum depression and urges the Institute to 
continue its work, particular on women who with a history of 
depression, prior to pregnancy.
    Autism.--Autism is a developmental disability that 
typically appears during the first 3 years of life. Presently, 
there is no effective means to prevent the disorder, no fully 
effective treatment and no cure. The Committee is concerned by 
reports indicating an alarming rise in the incidence of autism 
and by the lack of concrete knowledge of the prevalence of this 
disability. Early intervention is critical for effected 
children to gain maximum benefit from current therapies but 
autism is easily misdiagnosed or undiagnosed. Therefore the 
Committee urges the Institute to develop a standardized and 
universal diagnostic criteria in autism to aid in earlier 
diagnosis and encourages the development and implementation of 
awareness campaign for health professionals and for parents to 
learn to recognize and identify the early symptoms of autism. 
Noting the Director's April 1999 Report to Congress indicating 
an internal review to assess the need for autism awareness 
efforts, the Committee urges the Institute to work with the 
NICHD and report to the Congress by January 1, 2000, on NIH's 
plan to implement such a program.
    The Committee recognizes that research into the genetics of 
autism is being supported by several Institutes at the NIH. 
Given the difficulty of recruiting multiplex families, the 
Committee urges that researchers be strongly encouraged to 
collaborate and share this important resource and notes that a 
collaborative autism gene bank is already in existence, the 
autism genetic resource exchange. To that end, the Committee is 
encouraged by the efforts of the NIMH to combine data sets and 
urges that all Institutes conducting autism research to 
participate in that endeavor.
    The Committee encourages the interagency autism 
coordinating committee to continue to meet regularly and 
encourages that those meetings be made more meaningfully open 
to the public, and meaningfully inclusive of patient advocacy 
groups. The Committee requests that the Director be prepared to 
report to Congress on the goals set and progress made regarding 
autism research during the fiscal year 2001 hearings.
    Suicide in children and adolescents.--With regard to the 
tragic problem of suicidal behavior in children and 
adolescents, the Committee is pleased that NIMH is 
supplementing existing longitudinal studies of young people at 
risk, to add measures and analyses of suicidal behavior. More 
accurate information about risk factors for such behaviors 
should lead to more targeted suicide prevention trials in 
youth.
    Clinical research.--The Committee supports NIMH's 
commitment to supporting major new clinical research efforts in 
treatment resistant depression, bipolar disorder, psychotic 
disorders and in depression in children and adolescents. The 
Committee expects that the knowledge that will be developed by 
these studies will have significant impact on the incidence of 
suicidal behavior in all age groups.
    Diabetes.--The Committee urges the Institute to review and 
implement the recommendations of the Diabetes Research Working 
Group report. Also, the Institute is encouraged to support 
research into assisting children who suffer from diabetes by 
developing strategies appropriate for children in maintaining 
normal blood glucose levels. In addition, the Institute should 
support research in helping children cope with living with 
chronic illnesses like diabetes and avoid the depression, risky 
behavior, and eating disorders that are common side effects of 
the disease.
    Gambling.--The Committee recently held a hearing and 
received testimony regarding gambling from scientists, members 
of the public, and members the National Gambling Impact Study 
Commissions. In the Commission's final report, recommendations 
were made calling for additional support of investigator-
initiated peer-reviewed research that would lead to a better 
understanding of the underlying mechanisms involved in 
pathological gambling behavior. The Committee is aware that the 
National Institute of Mental Health [NIMH] has issued a program 
announcement to encourage research grant applications in this 
area, and encourages NIMH to reissue this announcement to 
permit funds to be used to supplement existing research grants 
to support peer-reviewed research, especially in the areas 
identified by the Commission. The Committee further encourages 
collaboration with other NIH institutes.
    Youth violence.--The Committee is deeply concerned about 
the recent wave of school shootings across the country, and 
believes that the NIH has an important role to play in helping 
policy makers understand and respond to the causes of such 
violent antisocial behavior. The Committee encourages NIMH as 
well as other institutes to increase support for behavioral 
research relating to violence, and to provide ways to better 
understand how to apply the knowledge from this research when 
designing effective treatment and prevention programs.
    Fragile X.--Fragile X is the most common inherited cause of 
mental retardation, first manifesting during childhood, but 
also affecting large numbers of adults. Fragile X is also the 
most common single-gene neuropsychiatric disease known, and as 
such is of vital interest to NIMH. Fragile X is potentially 
important as a research model for neuropsychiatric disorders 
such as schizophenia, mood disorders, and autism. Individuals 
with fragile X constitute a remarkably homogeneous study 
population for advancing our understanding of these disorders.
    Recent years have seen a convergence of research in 
psychiatry and molecular biology which are now beginning to 
help researchers understand the biological basis of human 
behavior and intelligence, as well as mental illness, on an 
increasingly more detailed level. Yet very few studies have 
utilized the most recent and advanced psychiatric research 
techniques to examine fragile X. The Committee urges the NIMH 
to promote increased awareness of this disorder among 
psychiatrists who treat adults with fragile X for the 
psychiatric manifestations of this disease. NIMH is also 
encouraged to promote rigorous scientific study of the 
currently available treatments commonly employed in fragile X 
patients, and to investigate promising new psychopharmacologic 
interventions.
    Patient protection.--The Committee notes the NIMH's 
leadership role in developing procedures and safeguards to 
improve the protection of people with cognitive disabilities 
when they volunteer to participate in research. At times, some 
of these individuals may lack the capacity to fully understand 
the purposes of the research and to give their informed consent 
to participation. Advances in genetics also have created new 
ethical questions for researchers. The Committee supports 
NIMH's range of internal and external activities focused on 
ethical concerns related to research, including research on 
informed consent, and its efforts to work closely with other 
government agencies in this regard.
    Children's mental health.--The Committee is aware of NIMH's 
focus on funding additional research on children's mental 
disorders, with a special emphasis on gaining a clearer 
knowledge of the extent of mental disorders in children. The 
Committee encourages this emphasis to continue, including 
NIMH's efforts to encourage more scientists to build careers in 
this field. Woefully little is known about mental illness in 
children, and there are far too few investigators in this area. 
In addition, little is known about the long-term effects of the 
medications that--although approved for adults--are also the 
front line of treatment for children. Psychiatric disorders are 
not easily recognized in children, yet in many cases the mental 
disorders of childhood are the precursors of adult, or 
lifetime, mental illnesses. It is now known that many children 
and adolescents suffer from depression, which in its most 
severe forms may underlie acts of violence, including the self-
inflicted violence of suicide. It is critical, therefore, that 
better understanding of the causes and the best interventions 
in these illnesses be a priority in order to prevent many cases 
of adult mental illness.
    Learning disabilities.--The Committee commends NIMH for the 
work conducted to explore the neurological and behavioral 
aspects of learning disabilities. The Committee looks forward 
to learning the results of this work and encourages the 
Institute to continue to coordinate with other Institutes to 
work on related activities.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 1999....................................    $269,086,000
Budget estimate, 2000...................................     275,622,000
Committee recommendation................................     337,322,000

    The Committee recommendation includes $337,322,000 for the 
National Human Genome Research Institute [NHGRI]. This is 
$61,700,000 more than the budget request and $68,236,000 more 
than the fiscal year 1999 appropriation. The comparable amounts 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The NHGRI coordinates extramural research and 
research training for the NIH component of the human genome 
project, an international effort to determine the sequence of 
the 3 billion base pairs of DNA which constitute the human 
genome and to develop research tools and technologies to 
identify the estimated 80,000 genes, characterize their 
function, and understand their influence on human disease. The 
division of extramural research supports research in genetic 
and physical mapping, DNA sequencing and technology 
development, data base management and analysis, and studies of 
the ethical, legal, and social implications of human genome 
research. The division of intramural research [DIR] focuses on 
applying the tools and technologies of the human genome project 
to understanding the genetic basis of disease and developing 
DNA-based diagnostics and gene therapies. Since its 
establishment in 1993, the intramural program has developed a 
strong research program and forged collaborative ties with 
several of the NIH research institutes to unravel the 
complexities of genetic diseases such as diabetes, breast and 
colon cancer, and melanoma.
    The Human Genome Project.--The Committee understands that 
during fiscal year 1999 all partners in the international Human 
Genome Project dramatically accelerated the production of the 
human sequence. The Project now estimates that the complete, 
highly accurate, finished human sequence will be done by 2003, 
two years ahead of the original projection. In addition, the 
Committee understands that a working draft sequence, comprised 
of 90 percent of the human genome, is expected to be completed 
by the Spring of 2000. All this sequence produced by the Human 
Genome Project is being deposited within 24 hours of completion 
into a public database that is freely accessible to any 
researcher with access to the Internet. The Committee believes 
that the rapid and free availability of the human sequence will 
be of great value to the research community and will greatly 
enhance investigators' abilities to understand, diagnose, and 
treat disease. The Committee encourages the Institute to 
maintain its commitment to this ambitious schedule.
    The Committee also comments the Institute for its 
activities examining the ethical, legal, and social 
implications (ELSI) of the Human Genome Project and of research 
involving human genetics. Addressing these issues is critical 
in order to ensure public confidence in, and access to, new 
genetic knowledge and technologies. In particular, the 
Committee supports the Institute's ongoing efforts to examine 
issues involving the privacy and fair use of genetic 
information, the clinical integration of genetic information 
and technologies, ethical principles in genetics research, and 
public and professional education.
    Diabetes.--The Committee encourages the Institute to review 
and implement the recommendations of the Diabetes Research 
Working Group report. Defining the specific genes involved in 
Type 1 and Type 2 diabetes is essential to preventing the 
disease and could lead to improved therapies. The Institute 
should work with NIDDK, NIAID, NIAMS, NICHD and other 
interested institutes on a project to create a consortium for 
the study of the genetics of diabetes.
    Microarray analysis technology.--The Committee encourages 
the Institute to consider establishing a research center that 
focuses on the less costly and less time consuming practice of 
utilizing microarray analysis technology on chickens to 
characterize gene functions. The Committee urges the Institute 
to explore microarray technology which could permit researchers 
to identify the function of several genes simultaneously, an 
approach which could prove to be more cost-ffective.
    Clearinghouse for rare disorders.--Approximately 6,000 of 
the 7,000 genetic disorders are rare disorders. Unfortunately, 
there is no centralized clearinghouse for the public and health 
professionals on these disorders. Accordingly, the Committee 
encourages NHGI, in collaboration with the Office of Rare 
Diseases, to establish an information center on rare and 
genetic disorders to disseminate information, knowledge and 
understanding of rare and genetic disorders.

                 NATIONAL CENTER FOR RESEARCH RESOURCES

Appropriations, 1999....................................    $554,643,000
Budget estimate, 2000...................................     568,119,000
Committee recommendation................................     625,988,000

    The Committee recommends an appropriation of $625,988,000 
for the National Center for Research Resources [NCRR]. This is 
$57,869,000 more than the budget request and $71,345,000 more 
than the fiscal year 1999 appropriation. The comparable amounts 
for the budget estimate include funds to be transferred from 
the Office of AIDS Research.
    Mission.--The NCRR develops and supports critical research 
technologies and shared resources that underpin research to 
maintain and improve the health of our Nation. The NCRR 
programs develop a variety of research resources; provide 
biomaterial and resources for complex biotechnologies, clinical 
research, and specialized primate research; develop research 
capacity in minority institutions; and enhance the science 
education of precollege students and the general public.
    IDeA grants.--The Committee has provided $20,000,000 for 
the Institutional Development Award [IDeA] Program authorized 
by section 402(g) of the Public Health Service Act. This is 
$10,000,000 over both fiscal year 1999 and the budget request. 
The program is intended to broaden the geographic distribution 
of NIH funding of biomedical research by enhancing the 
competitiveness of biomedical and behavioral research 
institutions which historically have had low rates of success 
in obtaining funding. The Committee intends that the increase 
will be used in eligible States to co-fund high quality 
applications for shared instrumentation and RO-1 proposals to 
those who would otherwise not receive support under the normal 
peer-review cycle. The Committee believes that the existing 
Shannon Awards Program can serve as the model for deciding 
which grants should be selected by NCRR for funding under the 
expanded IdeA Program.
    Proton therapy.--The Committee is impressed with the 
promise of proton therapy using sophisticated nuclear particle 
accelerators to reach cancer tumors without collateral damage 
to surrounding tissue. The Committee urges priority 
consideration for a facility construction proposal from a 
university-based health science center with significant and 
long term success with clinical research in radiation oncology 
techniques.
    Animal research facilities for minority health profession 
schools.--The Committee has carefully reviewed documentation 
identifying the need for the upgrade of animal research 
facilities at minority health professions schools. The 
Committee encourages the NCRR to begin an aggressive effort to 
work with the minority health professions schools to provide 
grants to upgrade their animal facilities in an effort to 
assist them in complying with Federal laws and regulations, and 
to seek and receive accreditation by the appropriate scientific 
accreditation organization. The Committee encourages the 
Director to consider waiving the matching requirement for 
qualified applications from minority health professions 
schools. The Committee has provided funding for the NIH 
Minority Health Initiative in the Office of the Director and 
encourages the Office of Research on Minority Health to 
continue to contribute to this important research 
infrastructure building program.
    Plant-based medicines.--The Committee supports the need to 
accelerate the commercialization of plant-based medicinal 
products and encourages the Institute to develop and begin to 
implement an action strategy to achieve this goal in a cost-
effective and timely manner.
    Human islet transplantation.--The Committee supports 
consideration of the designation of the former NIH/Perrine 
Campus-based animal research facility in South Florida as a 
Clinical Diabetes Islet Transplantation Research Center. The 
Committee also encourages consideration of the request to 
develop the facility on a collaborative basis, working with 
NIDDK to facilitate a partnership with the Naval Medical 
Research Center and the Walter Reed Army Medical Center that 
will benefit research entities nationally and respond to the 
critical need for islet transplantation research and 
technology.
    Primate Centers.--The Committee is pleased with the 
addition of an eighth Regional Primate Research Center during 
fiscal year 1999. The new center will complement existing 
centers by providing outstanding expertise in primate genetics 
and chronic disease research, and by strengthening the current 
program's capabilities in infectious disease research. The 
Committee is aware that initial funding to the new center was 
well below the NIH peer review system recommended funding 
level. The Committee encourages the NCRR to increase support 
for the center.
    Diabetes.--The Committee urges the Center to review and 
implement the recommendations of the Diabetes Research Working 
Group report. The Committee understands that there is a 
shortage of human islets for basic and clinical research and 
recommends that the NCRR fund regional resource centers to 
focus specifically on supplying human islet cells for 
researchers. The Committee understands that plans for a set of 
such centers is in the initial stages and would like to see 
NCRR play a major role in the funding and oversight of such 
centers to ensure that human islet cells are purified and 
shipped to researchers around the country for experimentation. 
The Committee urges the Center to give its fullest 
consideration to funding a project that would establish such a 
resource. Also, the Committee urges NCRR, through the general 
clinical research centers program, to support research projects 
focused on transplantation of insulin-producing cells.
    Gene Therapy.--The Committee has learned of the tremendous 
commitment that the Center has made to supporting a gene 
therapy monitoring center. CF provides an excellent model for 
the evaluation of novel approaches to gene therapy in the 
management of genetically-based diseases. Thus, CF research is 
a high priority for the Committee in defining approaches for 
the effective treatment and cure of genetically-based diseases. 
The unique contribution of the Center to this important disease 
is critically important to effectively and efficiently 
translate research progress from the laboratory to the clinical 
area in genetic diseases and the Center is commended for its 
support to realize this objective.
    Science Education Policy Awards.--The Committee urges the 
Institute to increase public understanding of health and 
medical sciences at institutions around the country. The 
Committee urges the Director to support efforts to modify and 
expand the Science Education Partnership Awards program to more 
closely follow the National Science Foundation's Informal 
Science Education program.
    Research resource centers.--The Committee urges the NCRR to 
support research resource centers for the development and 
optimization of functional MRI technology that can be applied 
to the largest possible general population of patients in the 
field of neuroscience, including those difficult to manage such 
as children and obese patients. The Committee recognizes the 
diversity in technology in the MRI technology field and 
encourages the NCRR to support a research resource center in 
functional MRI technology development that reflects the current 
state of clinical practice using a magnet strength in common 
clinical use.
    The Committee also urges NCRR to support research resource 
centers for the development and refinement of positron emission 
tomography (PET) as a unique imaging technology to diagnose and 
stage diseases of the brain, including Alzheimer's disease.
    As funding for medical research is doubled over the next 
five years, the already serious shortfall in the modernization 
of the nation's aging research facilities and labs will 
continue to worsen unless action is taken. Future increases for 
NIH must be matched with increased funding for the repair, 
renovation and construction of research facilities, as well as 
grants for the purchase of shared-use, state-of-the-art 
laboratory equipment costing over $100,000. Examples of shared 
instrumentation could include PET scans, MRIs, and diagnostic 
imaging devices. For that reason, the Committee has included 
$60,000,000 for the repair, renovation and construction of 
research facilities and the purchase of shared-use state-of-
the-art laboratory equipment.

   National Center for Complementary and Alternative Medicine [CCAM]

Appropriations, 1999....................................     $50,000,000
Budget estimate, 2000...................................      50,168,000
Committee recommendation................................      56,214,000

    The Committee has included $56,214,000 for the National 
Center for Complementary and Alternative Medicine, an increase 
of $6,046,000 above the budget request and $6,214,000 over the 
fiscal year 1999 appropriation.
    Mission.--The Office of Alternative Medicine was elevated 
to Center status with the intent of assuring that complementary 
and alternative therapies be rigorously reviewed to provide 
consumers reliable information. The Center was given greater 
authority and independence--including the initiation of 
research projects and development of its own peer review panels 
with appropriate expertise.
    New Director.--The Committee strongly supports the work of 
the Office and is very concerned that after 9 months, a 
permanent director has yet to be named.
    New centers.--The Committee expects that funding for 
existing and new Centers supported by the Office will be 
expanded significantly. The Committee directs NCCAM to 
undertake field investigations and a program for the collection 
and evaluation of outcome data on promising alternative 
therapies, including new clinical trials of herbal and other 
CAM therapies. The Committee also expects the center to 
continue and expand its work with CDC on field investigations 
and with AHCPR on literature reviews.
    National Center for Complementary and Alternative Medicine 
Policy.--The Committee continues to believe that Federal policy 
in a number of areas is failing to keep up with the increased 
use of complementary and alternative therapies. Last year it 
provided funding to support the establishment and operation 
(including the hiring of an executive director and staff) of a 
National Center for Complementary and Alternative Medicine 
Policy to study and make recommendations to the Congress on 
appropriate policies regarding consumer information, training, 
insurance coverage, licensing and other pressing issues in this 
area. This Commission is not intended to review the work of or 
set the priorities for NCCAM. Rather, NCCAM is expected simply 
to provide administrative support to the Commission.
    Consumer information centers.--The Committee notes that 
alternative medicine is becoming increasingly popular among 
American consumers. With this increased popularity comes the 
need to ensure objective research so that consumers can make 
informed decisions about using natural products as curative and 
preventive measures. Therefore, the Committee encourages the 
Director to establish not less than two competitively-selected 
centers that would conduct research and disseminate information 
to consumers on natural products.
    Herbal therapies.--The Committee encourages NIH, through 
the National Center for Complementary and Alternative Medicine 
(NCCAM), the Office of Dietary Supplements and other Centers 
and Institutes of the NIH, to provide increased funding support 
for studies on herbal therapies. Increasing numbers of 
Americans are using herbal products, and sound and rigorous 
research will help determine the interactive effects of herbal 
remedies with prescription drugs. The Committee encourages the 
NIH to include pharmacologists in study sections considering 
research proposals to study herbal therapies.
    Training of Physicians in Integrative Medicine.--The 
Committee urges the National Center for Complementary and 
Alternative Medicine (NCCAM) to give priority to the funding of 
post-graduate training of physicians in integrative medicine. 
In particular, the Committee encourages study of strategies for 
integrating complementary and alternative medicine into the 
traditional premedical, predoctoral, postdoctoral medical 
education curricula. The Committee encourages NCCAM to give 
consideration to funding programs at academic institutions 
which offer post-graduate fellowships for physicians in 
integrative medicine, continuing education in integrative 
medicine for other health professionals, and distance-learning 
models in complementary and alternative medicine for doctors 
and other health professionals throughout the country.
    Center grants.--There is a tremendous consumer need for 
evidence-based research in complementary and alternative 
medicine. The Committee is concerned about the lack of 
continuity of leadership at the Center. The Committee 
encourages NCCAM to fund developmental research and 
administrative core capabilities of pre-existing NIH funded 
NCCAM centers which have demonstrated ongoing leadership as 
evidenced by peer-reviewed research.

 JOHN E. FOGARTY INTERNATIONAL CENTER FOR ADVANCED STUDY IN THE HEALTH 
                                SCIENCES

Appropriations, 1999....................................     $35,415,000
Budget estimate, 2000...................................      36,274,000
Committee recommendation................................      43,723,000

    The Committee recommends an appropriation of $43,723,000 
for the Fogarty International Center [FIC]. This is $7,449,000 
more than the budget request and $8,308,000 more than the 
fiscal year 1999 appropriation. The comparable amounts for the 
budget estimate include funds to be transferred from the Office 
of AIDS Research.
    Mission.--The primary function of the FIC is to improve the 
health of the people of the United States and other Nations 
through international cooperation in the biomedical sciences. 
In support of this mission, the FIC pursues the following four 
goals: mobilize international research efforts against global 
health threats; advance science through international 
cooperation; develop human resources to meet global research 
challenges; and provide leadership in international science 
policy and research strategies.
    Global tuberculosis threat.--The Committee commends the FIC 
for its cooperation and collaboration with the International 
Union Against Tuberculosis and Lung Disease, the American Lung 
Association and the American Thoracic Society in developing a 
program to train TB health professionals. The Committee also 
finds positive the joint U.S. AID and FIC collaboration in 
implementing this effort and encourages the Center to expand 
the effort this fiscal year.
    Global health status.--The Committee commends the Center 
for its leadership in fostering international research 
cooperation, in particular with developing nations, to address 
and reverse the deepening disparities in global health status. 
FIC's international training and research capacity-building 
programs are a key element of NIH's overall strategy for the 
prevention, treatment, and control of diseases, thereby 
protecting the health of all Americans. The Committee 
encourages the FIC to continue to strengthen its programs to 
address global priorities such as HIV/AIDS; emerging and 
reemerging infectious diseases; population and health; maternal 
and child health; environment and occupational health; and 
biodiversity.
    New global health challenges.--The Committee is aware of 
the three new interdisciplinary initiatives in bioethics, 
health and economic development, and ecology of infectious 
diseases planned by the FIC. The new programs will address a 
number of important issues related to: research and research 
ethics to improve our understanding of local value systems in 
interpreting and implementing ethical precepts in 
internationally-based research; the correlation between the 
health status of people and increases in economic productivity; 
and the assessment of habitat-level changes in biodiversity 
that may affect disease prevalence in humans. The Committee is 
supportive of efforts by FIC to develop its new programs 
jointly with other NIH entities and government agencies, and to 
enhance its efforts in building partnerships with international 
organizations, including the World Health Organization, the 
World Bank, and others.
    Medical informatics.--Because of the importance of access 
to and training in the latest state-of-the-art information 
technology, in last year's report, the Committee encouraged the 
FIC to expand the international training program in medical 
informatics in sub-Saharan Africa and to other regions of the 
world. The Committee is pleased the FIC was able to provide 
additional support for expansion of the program.
    Training.--The FIC has established a new program for U.S. 
post-doctoral scientists who are committed to a career in 
international health research and would benefit from an 
additional period of mentored research as part of a strong, 
established collaboration between a U.S. sponsor and leading 
scientists at a developing country center of scientific 
excellence. The Committee recognizes the importance of 
attracting new research talent to pursue research relevant to 
global health problems and is supportive of the FIC's efforts 
to provide international training opportunities for U.S. 
postdoctoral scientists.
    International research surveillance.--The Committee 
recognizes the growing importance of international research 
surveillance programs with respect to infectious diseases such 
as tuberculosis (TB). The Committee is pleased by the Center's 
research collaboration with international organizations and 
governments on multi-drug resistant TB and encourages the 
Center to continue these important studies.

                      NATIONAL LIBRARY OF MEDICINE

Appropriations, 1999....................................    $181,309,000
Budget estimate, 2000...................................     185,654,000
Committee recommendation................................     210,183,000

    The Committee recommends an appropriation of $210,183,000 
for the National Library of Medicine [NLM]. This is $24,529,000 
more than the budget request and $28,874,000 more than the 1999 
appropriation. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The National Library of Medicine is the Federal 
institution that for more than 150 years has collected, 
organized, preserved, and disseminated the world's output of 
biomedical literature in all forms. As a result of this 
activity NLM is the world's largest library of the health 
sciences, its holdings numbering more than 5 million items. The 
NLM has pioneered innovative methods to disseminate 
bibliographic information. Basic to the mission of the NLM is a 
wide-ranging research program to improve how medical 
information is communicated. This responsibility is aided by a 
grants program and by specialized services in toxicology, 
environmental health, and biotechnology.
    Outreach.--The Committee continues to note the success of 
NLM's MEDLINE database and its new MEDLINE Plus initiative. The 
Committee encourages NLM to continue its outreach activities 
aimed at educating health care professionals and the general 
public about the Library's products and services, in 
coordination with medical librarians and other health 
information specialists.
    Access for senior citizens.--The Committee notes that 
senior citizens would benefit greatly from expanded access to 
NLM's databases and encourages the NLM to take steps to improve 
seniors' access to this information.
    Home medical consultations.--The Committee urges the 
Institute to begin a demonstration to expand the use of 
telemedicine to in-home physician-patient consultations. This 
innovative approach could include testing of the placement of 
video, health monitoring and screening equipment in the home 
for consultation with patients requiring frequent monitoring 
and health professional consultations.
    Visible Human Project.--The Committee supports NLM's 
Visible Human project and urges the Institute to expand the 
Phase II effort to complete production of the fully segmented 
anatomical data. The Committee encourages the Institute to use 
funds to complete segmentation, classification and labeling 
which will increase Internet access to the full data set, and 
also to support development of tools so that research users of 
the anatomical data sets can create clinically useful 
applications.
    The Committee remains impressed with the efforts the 
National Library of Medicine has made to establish health 
components in the Nation's Next Generation Internet (NGI) 
Initiative and, in particular, the support for telemedicine 
sites in rural and underserved communities. The Committee 
believes that existing sites should, where appropriate, expand 
their efforts to homecare experiments.
    With the burgeoning programs of the National Center for 
Biotechnology Information and the growing limits of available 
storage space for the world's greatest medical collection, the 
Committee is pleased that the NIH is beginning to address the 
important space problem. The Committee urges NLM to conduct a 
feasibility study for building a structure for such storage 
needs.

                         OFFICE OF THE DIRECTOR

Appropriations, 1999....................................    $256,462,000
Budget estimate, 2000...................................     262,709,000
Committee recommendation................................     299,504,000

    The Committee recommends an appropriation of $299,504,000 
for the Office of the Director [OD]. This is $36,795,000 more 
than the budget request and $43,042,000 more than the fiscal 
year 1999 appropriation. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The Office of the Director provides leadership 
and direction to the NIH research community, and coordinates 
and directs initiatives which crosscut the NIH. The Office of 
the Director is responsible for the development and management 
of intramural and extramural research and research training 
policy, the review of program quality and effectiveness, the 
coordination of selected NIH-wide program activities, and the 
administration of centralized support activities essential to 
operation of the NIH.
    Training.--The Committee remains concerned that NIH 
rejected recommendations of the National Academy of Sciences 
for research training in nursing, oral health, health sciences, 
research and behavioral science. NAS recommended that stipends 
be increased, and the number of awards for these disciplines be 
increased. Though NIH implemented the stipend increase, the 
Committee requests NIH to reconsider and develop a plan for 
complying with the NAS recommendation regarding the number of 
training awards made available. The Committee encourages NIH to 
develop a plan for assisting national institutes to establish 
training programs for young behavioral science investigators 
similar to the B/START (Behavioral Science Track Awards for 
Rapid Transition) programs at NIMH, NIDA, and NIAAA.
    The Committee directs the Director of NIH to make a written 
request to the chairman of the Committee prior to reprogramming 
of $1,000,000, between programs, projects, activities, 
institutes, divisions and centers. The Committee desires to 
have the requests for reprogramming actions which involve less 
than the above-mentioned amounts if such actions would have the 
effect of changing funding requirements in future years, if 
programs or projects specifically cited in the Committee's 
reports are affected or if the action can be considered to be 
the initiation of a new program.
    Behavioral Science.--There is a growing public awareness of 
the behavioral and underpinnings of disease. Heart disease, 
lung cancer, liver disease, AIDS, suicide, developmental 
disabilities, and many neurological and cognitive disorders can 
be attributed directly or indirectly to unhealthy behavior. Yet 
NIH has never fully incorproated behavioral research as part of 
its core public health mission. The Committee urges the NIH to 
provide a detailed description of NIH's ongoing work in the 
behavioral sciences, including a breakdown by Institute, and 
funds within each Institute of research and training activities 
included in NIH's behavioral and social science portfolio.
    The Committee is encouraged by the number of opportunities 
for nursing research that could make a important improvements 
in health outcomes. The Committee notes the opportunities 
available for nursing research to improve: diabetes self 
management; symptom management of asthma in children and 
adults; reduce morbidity of individuals with chronic illnesses; 
sleep; acute care of children with post-traumatic brain injury; 
end of life care; and increase collaboration with clinical 
trials.
    Office of Rare Disease Research.--The diagnosis and 
treatment of nearly 6,000 rate diseases remains a persistent 
problem for approximately 25 million patients, their families 
and caregivers. The Committee commends the Office for its 
support of over 150 scientific workshops and symposia to 
stimulate research interest and opportunities related to rate 
disorders and for forging creative collaborations, both inside 
and outside of government, to advance the field. The continued 
involvement with the rare diseases community and the rate 
disease patient support organizations has enabled many of these 
organizations to assist in stimulating rate diseases research 
at the NIH and elsewhere. The Committee encourages the Office 
to consider establishing a public advisory panel to provide 
recommendations and solicit public advice on rate disease 
activities of the ORD and the NIH. The Committee urges the 
Office to continue the expansion of efforts to facilitate the 
diagnosis and extend the research and treatment of these 
inherited and acquired disorders. The Office also is encouraged 
to with the Food and Drug Administration to provide adequate 
access to gene therapeutics for treatment of rate inherited 
disorders in order to facilitate the research and review of 
gene therapeutics as investigational produces receiving NIH 
support.
    Behavioral and social sciences research.--The Committee is 
concerned with the progress made by NIH and the Office of 
Behavioral and Social Sciences Research in increasing the 
behavioral and social sciences research portfolio. While some 
progress has been made, the Committee notes that over two-
thirds of morbidity and mortality have behavioral origins. The 
Committee encourages additional growth in the area to help 
improve the health outcomes of Americans. Additionally, the 
Committee notes the very uneven progress of the various 
institutes to fund behavioral and social sciences research, 
which range from 6 percent for the National Institute for 
Nursing Research to 0 percent by the National Institute of 
General Medical Sciences. The Committee urges those institutes 
with negligible behavioral and social sciences research 
portfolios to further examine appropriate expansions. 
Additionally, the Committee urges the Office of Behavioral and 
Social Sciences Research to stress the need for all 
institutions to fund behavioral and social sciences research to 
improve adherence to medical regimes, exercise and weight 
reduction programs.
    The Committee continues to be concerned that NIH has not 
implemented the National Academy of Science recommendation 
regarding enhanced behavioral research training.
    The Committee commends the OBSSR for its quick and thorough 
solicitation of applications for the $10,000,000 added in 
fiscal year 1999 for program projects and investigator-
initiated research to augment NIH's investigation of mind-body 
connections and health. The Committee looks forward to 
discussing at next year's hearings the number and range of 
applications received in response to this request for 
applications. The Committee also commends OBSSR for its 
leadership on the NIH-wide priority of reducing health 
disparities and examining the interactions of the mind and body 
in determining health. The Committee urges NIH to provide 
additional funding for OBSSR to continue and expand efforts to 
promote interdisciplinary research and training in areas where 
psychological, environmental, and biological conditions 
intersect to determine health status.
    General clinical research centers.--The Committee remains 
concerned that the GCRC budget has decreased over the past 
three decades. The Committee urges the NCRR to increase funding 
for GCRS's and to use these additional funds to increase and 
enhance the training of clinical investigators, to implement 
the newly established guidelines for informatics, to establish 
supplemental clinical research funds at each center through 
which the GCRC's can provide seed funding for pilot studies; to 
support GCRC efforts to enhance patient access to clinical 
research through off-site activities, community outreach 
initiatives and patient travel support. The Committee also 
urges the NCRR to continue and accelerate progress towards 
fully funding centers at the Advisory Council approved levels.
    The Committee recognizes that the NIH Director has moved 
forward with initial efforts to address the training and career 
development of clinical investigators during fiscal year 1999. 
The Committee continues to be concerned that physician-
scientists are still leaving biomedical research careers and 
that more needs to be done to encourage a new generation of 
clinical investigators. The NIH is encouraged to increase the 
number of mentored patient-oriented research career development 
awards, mid-career investigator patient-oriented research 
awards, and to increase support for the clinical research 
curriculum awards.
    Training and career development.--The Committee recognizes 
that the NIH Director has moved forward with initial efforts to 
address the training and career development of clinical 
investigators during fiscal year 1999, however, the Committee 
feels that more needs to be done to stem the tide of physician-
scientists leaving biomedical research careers and to encourage 
a new generation of clinical investigators. The Committee urges 
NIH to increase the number of Mentored Patient-Oriented 
Research Career Development Awards, Mid-Career Investigator 
Patient-Oriented Research Awards, and to increase support for 
the Clinical Research Curriculum Award in fiscal year 2000. In 
addition, the Committee requests the Director to review the 
decision to disband the NIH Director's Advisory Panel on 
Clinical Research.
    Spinal cord research.--The Committee recognizes that 
biomedical research is on the verge of revolutionary advances 
in the area of spinal cord regeneration and the Committee 
encourages NIH to increase its investments in this area. The 
Committee recommends NIH, in conjunction with the appropriate 
Institutes, conduct a consensus conference to evaluate the 
current status of spinal cord regeneration research and 
promising directions in this area so as to identify a critical 
path for breakthrough research and opportunities for public-
private partnerships. The Committee will expect a report back 
on the conclusions of the meeting and the plans to move forward 
in this priority area.
    Hepatitis C.--The Committee is concerned that NIH has not 
followed through with a sustained commitment of increased 
funding consistent with the Hepatitis C (HCV) Consensus 
Development Conference recommendations to meet the significant 
public health challenge of this virus. The Committee requests 
that the Institute be prepared to report at next year's hearing 
on the progress in meeting the Conference's recommendations, 
indicating which research recommendations are being addressed, 
which are being funded by the fiscal year 2000 request, and 
which will be funded in subsequent years. The Committee 
requests the report by January 4, 2000.
    The Committee is pleased that NCI, NAID, NIDA, NIAAA and 
the Office of the Director participated in the trans-institute 
RFA for Hepatitis C, and urges additional research consistent 
with the recommendations made by the Hepatitis C Consensus 
Development Conference.
    Grant opportunities.--The Committee has been impressed with 
the efforts of the NIH to apply the technology of the Internet 
and specifically its weekly electronic mail service announcing 
grant opportunities. The Committee encourages the Department 
and those components that make funds available through grants 
and cooperative agreements to supplement the publication in the 
Federal Register with a weekly listserv to all interested 
parties that links back to the full document. In addition, the 
Department should announce such availability in the Federal 
Register and at each of the Department's component home pages. 
The Committee expects that this will improve the flow to all 
potential applicants concurrently in urban as well in isolated 
communities, such as Hawaii, Alaska, the western Pacific and 
rural communities that must now rely on the Federal Register.
    Medical isotopes.--A Federal advisory committee projects 
that demand for medical isotopes can be expected to increase 
between 8 and 17 percent per year over the next 20 years. 
Because the use of medical isotopes holds the promise for new 
treatment for many diseases, with the potential for reduced 
health care costs, less debilitating side effects, and/or 
higher quality of life, the Committee encourages the NIH to 
expand its current awarding of research grants using medical 
isotopes. Furthermore, the Committee encourages the NIH to work 
with the Department of Energy to expand the availability, 
reliability and variety of domestically produced isotopes for 
treating disease.
    Chronic fatigue and immune dysfunction syndrome.--The 
Committee is aware of the many difficulties victims of CFIDS 
(Chronic Fatigue Immuno Deficiency Syndrome) face in their 
everyday lives. Last year's increases in funding for research 
at the National Institutes of Health and CDC were important 
steps toward finding better treatments and a cure.
    Liver and biliary disease strategic plan.--In March 1998, 
the NIH submitted the liver and biliary diseases strategic plan 
to the Committee, outlining the most significant opportunities 
to prevent, treat, and cure liver disease. The Committee 
requests that the Director be prepared to give a progress 
report at next year's hearings on the Strategic Plan, 
highlighting the advances made since March 1998 and the most 
significant remaining research opportunities. The Committee 
requests the report by January 4, 2000.
    Class B dealers.--The Committee recognizes inherent 
difficulties in enforcing the regulations and standards of the 
Animal Welfare Act with respect to USDA-licensed Class B 
dealers who supply dogs or cats for research purposes. The 
Committee commends NIH's prohibition on the use of dogs or cats 
obtained from Class B dealers in intramural research. The 
Committee encourages NIH to examine the policy with regard to 
the use of dogs and cats obtained from Class B dealers in 
extramural facilities.
    Drug discovery proposals.--The Committee is concerned that 
while drug discovery proposals are submitted for review and 
funding, no study section at NIH has the broad expertise or 
special focus to give such proposals adequate review. The 
Committee is therefore pleased that the Office of the Director 
has established a panel to review the adequacy of the study 
section structure at NIH and requests that the issue of 
adequate review for drug discovery proposals be addressed as a 
part of the review process now underway.
    Minority health initiative.--The Committee is pleased that 
the Minority Health Initiative (MHI) has an interest in 
supporting the improvement of animal research facilities at 
minority health professions schools.
    Health status of disadvantaged populations.--The Committee 
encourages the Director to provide adequate funding for the 
continuation and growth of a variety of competitive programs at 
NIH that emphasize improving the health status of disadvantaged 
populations, including racial and ethnic minorities. The 
Committee has placed a special emphasis on the MARC, MBRS, 
RCMI, and ORMH programs, and expects these programs to continue 
to be supported at a level at least consistent with that of the 
overall increase for NIH.
    Cancer in ethnic minorities and the medically 
underserved.--The Committee continues to be concerned about the 
disproportionately high incidence and/or mortality rates of 
many cancers in ethnic minority, rural poor and other medically 
underserved populations. Equitable application of current 
knowledge about cancer prevention, early detection, and 
treatment as well as continued advances in research can reduce 
cancer incidence significantly and cancer mortality by 50 
percent among these populations. The Committee has conducted 
hearings regarding a study released in January 1999 by the 
Institute of Medicine, ``The Unequal Burden of Cancer: An 
Assessment of NIH Research and Programs for Ethnic Minorities 
and the Medically Underserved.'' This study confirms 
disproportionately high cancer levels in these minority, rural 
poor and other medically underserved populations and recommends 
both more targeted research funding and better coordinated data 
collection. The Committee requests that the Institutes, 
Centers, and Offices with cancer-directed research develop a 5-
year strategic plan to implement IOM recommendations; build in 
benchmarks, program evaluation, and accountability procedures; 
and address IOM identified priorities such as research 
training, cancer surveillance, and database enhancements.
    The Committee further urges the Institutes, Centers, and 
Offices with cancer-directed research agendas to increase 
funding for population and behavioral research; recruiting and 
training efforts to attract more candidates from ethnic 
minority and medically underserved populations in all areas of 
cancer research; community-based research, and dissemination of 
research results.
    The Committee also encourages increases for cancer data 
collection and management, including the funding for 
Surveillance, Epidemiology and End Results (SEER) to track 
cancer incidence, conduct more longitudinal studies of cancer 
outcomes, and achieve greater coordination with the Centers for 
Disease Control and Prevention's National Program of Cancer 
Registries, and other public and private sector cancer data 
collection programs.
    Diabetes.--The Committee believes that finding a cure for 
diabetes and its complications--a devastating disease affecting 
16 million Americans--should be a top priority as NIH makes 
funding allocations. The Committee is pleased that NIH has 
focused more attention over the past few years on diabetes 
research and has provided sufficient resources in the bill for 
all NIH institutes with an interest in diabetes to expand 
substantially their research in this area. The Committee has 
reviewed the recently released Diabetes Research Working Group 
report and urges the NIH to implement the recommendations. The 
Committee held a hearing this year focusing on the needs of 
children with diabetes and recommends that NIH place a high 
priority on research that is focused on a cure for diabetes and 
its complications, in particular, research on Type 1, or 
juvenile diabetes which is the most severe form of the disease. 
Given the tremendous research opportunities in the field, the 
Committee urges the Office of the Director to play the lead 
role by ensuring that a trans-NIH approach to diabetes research 
be developed at NIH and to review and implement where 
appropriate, the recommendations outlined in the DRWG report. 
Further, the Committee requests that NIH submit a report to the 
Committee before the fiscal year 2001 congressional hearings 
summarizing progress in fiscal year 2000 regarding the status 
of implementation of the DRWG recommendations, including 
initiatives that specifically impact Type 1 diabetes.
    Basic, behavioral and clinical research for children.--The 
Committee also continues to encourage the NIH to strengthen its 
portfolio of basic, behavioral, and clinical research for 
children overall, so that children can participate fully in 
this period of growth in funding and scientific opportunity in 
biomedical research. As part of that effort, the Committee 
requests that the NIH Director provide to the Committee, by May 
2000, an update from fiscal year 1997 to the present on the 
amount of funding devoted to pediatric research, including 
extramural research. Funding should be identified by Institute, 
and funding provided from the Pediatric Research Initiative 
should be identified separately and not otherwise included in 
any Institute's level of pediatric research support.
    Children's participation in clinical trials.--The Committee 
continues to be pleased by the efforts of NIH in its 
implementation of policies to increase the participation of 
children in clinical trials. The Committee looks forward to 
NIH's assessment of the effectiveness of this policy as its 
implementation evolves.
    Occupational safety.--The Committee recognizes the 
productive partnership between NIH and the National Institute 
for Occupational Safety and Health [NIOSH] on implementing the 
National Occupational Research Agenda [NORA]. The Committee 
notes that NIOSH has made significant strides in increasing 
extramural funds in NORA priority research areas using the NIH 
model of peer review. The Committee continues to encourage NIH 
to expand its work with NIOSH to co-sponsor and fund extramural 
research and applauds the leadership in this activity shown by 
the National Institute of Arthritis and Musculoskeletal and 
Skin Diseases; the National Heart, Lung, and Blood Institute; 
the National Cancer Institute; the National Institute of 
Environmental Health Sciences; the National Institute on Aging; 
and the National Institute on Deafness and Other Communication 
Disorders.
    Women and minorities in clinical trials.--Phase III 
clinical trials require broad participation to ensure that the 
results are broadly applicable. The NIH Institutes and Centers 
have emphasized the importance of the inclusion of women and 
minorities in such trials. However, there are still hurdles to 
overcome in terms of both outreach and recruitment of patients 
into trials. The NIH should notify the Committee by January 1, 
2000, of its plan to involve more women and minorities in Phase 
III clinical trials. The plan should include any impediments 
that they and their extramural and /or intramural investigators 
encounter to recruitment and retention of women and minorities 
in clinical trials. Understanding that different trials may 
have legitimately different scientific and recruitment goals, 
the plan should place the overall results in the context of 
this variability.
    Parkinson's Disease.--The Committee has provided increased 
funds for a Morris K. Udall Parkinson's Initiative to support 
research leading to the prevention, treatment, and cure of 
Parkinson's disease. With funding for the Morris K. Udall 
Parkinson's Research Initiative, the total funding for 
Parkinson's-focused research for fiscal year 2000 will be at 
least equal to the level of Parkinson's-focused research 
authorized by the Morris K. Udall Parkinson's Disease Research 
Act of 1997. The Committee understands Parkinson's-focused 
research to be that in which the principal focus of the 
research is the cause, pathogenesis, and/or potential therapies 
or treatment for Parkinson's disease. The Committee directs the 
Director to report within 120 days on plans and progress on 
implementing the Udall Research Initiative.
    Human tissue supply.--The Committee continues to be very 
interested in matching the increased needs of researchers who 
rely upon human tissues and organs, a very valuable and 
effective alternative research resource, to study human 
diseases and to search for cures. The Committee's continued 
interest is supported by a recent review by a panel of experts 
that concluded there is a rapidly expanding and unmet demand 
for the use of human tissue in research, and that the rapid 
pace of advancements in biomedical research make the use of 
human tissue samples for research increasingly feasible and 
attractive. The Committee is aware that the leader in this 
field, the National Disease Research Interchange [NDRI], 
dedicated to providing the research community with this 
valuable and effective alternative research resource, has 
supplied thousands of human tissues and organs, and thereby 
contributed to a number of recent significant research 
advances. The Committee, being greatly encouraged by NDRI's 
role in these research advances, encourages the Director to 
work with the other Institute Directors identified in this 
Report to implement a multi-institute initiative to expand 
support for NDRI to match the expanding and unmet demand for 
the use of human tissue in research, and to be submit a written 
progress report to the Committee no later than February 1, 2000 
outlining its plan and action steps taken to accomplish this 
goal.
    Office of Dietary Supplements.--The Committee continues to 
strongly support the important work of this Office. Use of 
dietary supplements has increased significantly among Americans 
who want to improve their health and prevent disease. There is 
a great need for additional research to better inform consumers 
of the health benefits of supplements. The President's 
Commission on Dietary Supplements recently recommended that ODS 
be funded at its fully authorized level to meet this need. The 
Committee encourages the Institute to comply with this 
recommendation.
    Botanical research centers.--The Committee is pleased that 
the Office has begun a botanical research centers initiative 
with major research institutions across the nation and has 
included funds to expand the number of centers to be supported. 
The Committee encourages such centers to include collaboration 
between agricultural research institutions and biomedical 
research institutions.
    Pediatric AIDS Clinical Trials Group (PACTG).--The 
Committee recognizes the important national and international 
research accomplishments of the PACTG, including reduction of 
perinatal HIV transmission. The Committee urges NIH to support 
PACTG inclusion in overall future NIH, HIV research agendas and 
the conduct of protocols for children, youth and women 
domestically and internationally. The Committee urges NIH to 
seek input from the Ryan White CARE Act Title IV projects in 
the development of protocols in order to maximize patient 
participation.
    Biomedical Imaging Research.--The Committee recognizes the 
importance of continued advancement of new imaging science and 
the transfer of imaging technologies from research projects to 
the public health sector. Developments from computed tomography 
and magnetic resonance imaging to single photon emission 
tomography have enabled physicians to visualize the body in 
ways that would have been considered miraculous less than a 
year ago. To further support continued advancements, the 
Committee urges the Director to assess the efficacy of 
establishing an Institute to improve communication, management, 
priority setting and accountability in this area.
    The Committee encourages the Director to conduct a research 
program in collaboration with other Federal medical research 
facilities on the effectiveness of EBCT in the early detection 
of heart disease. The Committee also encourages the Director to 
conduct studies on gender and racial differences in heart 
disease pathology using EBCT to monitor the course of illness 
and to determine the effectiveness of preventive interventions. 
The Committee further encourages the Director to study virtual 
colonoscopy, a technique using helical CAT scans and computer 
graphics to create a 3 dimensional picture of the colon, and 
compare its effectiveness to traditional colonoscopy in 
detecting polps and colon cancer.
    Bioengineering/Bioimaging.--The Committee is aware that 
recent advances in basic research, genetics, diagnosis, and 
health care have all been closely linked to the development of 
new technologies, yielding innovative biologics, materials, 
processes, implants, devices and informatics. The Office of 
Bioengineering/Bioimaging, reporting to the Director, NIH, 
would assume responsibility and direction of the Bioengineering 
Consortium, as a tool for coordination of activities across the 
NIH and with other Federal agencies. The Committee further 
directs that an advisory groups be established to formalize 
communication with the external community and to provide advice 
on issues related to the support of bioengineering and 
bioimaging research at the NIH.
    NIH/DOE Medical Technology Partnerships.--The committee 
urges the Director to establish a pilot program to ensure the 
National Institutes of Health may benefit from technologies 
developed within the Department of Energy weapons programs in 
terms of their potential to enhance health sciences and improve 
medical care. The Committee urges that the program be directed 
at ensuring that technologies developed within the nuclear 
weapons program, as well as other programs, of the Department 
of Energy are carefully evaluated for their impact on the 
health sciences, with the goal of achieving clinical 
applications and improved national health care. The Committee 
further urges the Director to establish an interagency 
committee to carry out this initiative with a matching amount 
of funds from the Department of Energy. Such funds would be 
available only for priorities established by the National 
Institutes of Health and activities that support the national 
security missions of the DOE. In developing an agreement for 
this program, the Committee urges that the Joint Conventional 
Munitions Memorandum of Understanding between the Departments 
of Energy and Defense be reviewed as a model for a Department 
of Energy-National Institutes of Health partnership.
    The Committee is concerned about the growing epidemic of 
obesity and its impact on health care and quality of life of 
all Americans. Therefore the Committee encourages NIH to 
vigorously increase efforts research to the area of obesity.
    Neuroscience.--Neuroscience studies the brain, the most 
complex human organ, comprising about 100 billion nerve cells 
consisting of thousands of distinct cell types. Communication 
between these cells occurs across junctions called synapses, 
and is accomplished by more than one hundred different 
chemicals called neurotransmitters. Although the mature brain 
weighs only about 3 pounds, more than half of the human genes 
are concerned with it directly. Since the abnormal function of 
the brain underlies so many of mankind's most devastating 
disorders, such as mental illness, Parkinson's Disease, 
Alzheimer's Disease, and many others, neuroscience is of 
central importance to making progress toward eliminating these 
diseases. The Committee is concerned that as facilities age on 
the NIH campus, these facilities will be unable to support 
essential brain research. The Committee therefore urges NIH to 
provide the resources necessary to adequately support this very 
complex and important work.

                        BUILDINGS AND FACILITIES

Appropriations, 1999....................................    $197,456,000
Budget estimate, 2000...................................     108,376,000
Committee recommendation................................     100,732,000

    The Committee recommends an appropriation of $100,732,000 
for buildings and facilities [B&F;]. The amount recommended is 
$7,644,000 less than the budget request and $96,724,000 less 
than the fiscal year 1999 appropriation.
    Mission.--The buildings and facilities appropriation 
provides for the NIH construction programs including design, 
construction, and repair and improvement of the clinical and 
laboratory buildings and supporting facilities necessary to the 
mission of the NIH. This program maintains physical plants at 
Bethesda, Poolesville, Baltimore, and Frederick, MD; Research 
Triangle Park, NC; Hamilton, MT; Perrine, FL; New Iberia, LA; 
and Sabana Seca, PR.

                        OFFICE OF AIDS RESEARCH

Appropriations, 1999....................................................
Budget estimate, 2000...................................  $1,833,826,000
Committee recommendation................................................

    The Committee recommendation does not include a direct 
appropriation for the Office of AIDS Research [OAR] as proposed 
in the budget request. Instead, funding for AIDS research is 
included within the appropriation for each Institute, Center, 
and Division of the NIH. The recommendation also includes a 
general provision which directs that the funding for AIDS 
research, as determined by the Director of the National 
Institutes of Health and the OAR, be allocated directly to the 
OAR for distribution to the Institutes consistent with the AIDS 
research plan. The recommendation also includes a general 
provision permitting the Director of the NIH and the OAR to 
shift up to 3 percent of AIDS research funding between 
Institutes and Centers throughout the year if needs change or 
unanticipated opportunities arise. These modifications to the 
budget recommendation are consistent with the manner in which 
funding for AIDS research was provided in fiscal year 1999. The 
Committee requests that the Director report on the fiscal year 
2000 allocation plans for AIDS research within 60 days of 
enactment and provide notification to the Committee in the 
event the Directors exercise the 3 percent transfer authority.
    The NIH Office of AIDS Research [OAR] coordinates the 
scientific, budgetary, legislative, and policy elements of the 
NIH AIDS research program. Congress provided new authorities to 
the OAR to fulfill these responsibilities in the NIH 
Revitalization Act Amendments of 1993. The law mandates the OAR 
to develop an annual comprehensive plan and budget for all NIH 
AIDS research and to prepare a Presidential bypass budget.
    The Committee was pleased with efforts made by OAR in 
fiscal year 1999 to provide additional to address AIDS in 
minority communities, to spearhead projects to bring research 
information to minority communities and to increase the number 
of minority investigators conducting AIDS research. The 
Committee also commends OAR for working in partnership with the 
National Minority AIDS Council, in abolishing a Minority 
Working Group, and for adding a section to the annual NIH Plan 
for HIV-Related Research targeting minority communities.

       Substance Abuse and Mental Health Services Administration

Appropriations, 1999....................................  $2,487,313,000
Budget estimate, 2000...................................   2,726,505,000
Committee recommendation................................   2,750,700,000

    The Committee recommends $2,750,700,000 for the Substance 
Abuse and Mental Health Services Administration [SAMHSA] for 
fiscal year 2000, $263,387,000 more than the fiscal year 1999 
level and $24,195,000 more than the administration request. 
This amount includes $100,000,000 advance funded in fiscal year 
2000. SAMHSA is responsible for supporting mental health, 
alcohol and other drug abuse prevention and treatment services 
throughout the country, primarily through categorical grants 
and block grants to States. The Committee has provided funding 
for the Knowledge, Development, and Application Program to each 
of three authorities: mental health, substance abuse treatment, 
and substance abuse prevention. Separate funding is provided 
for the Children's Mental Health Program, the PATH formula 
grant, the Protection and Advocacy Formula Grant Program, and 
for the two block grant programs.
    The Committee agrees with the President's request to 
establish new targeted capacity expansion line items in the 
areas of substance abuse prevention and treatment. These 
programs are intended to ensure that individuals with substance 
abuse problems can access services employing the best practices 
proven to be effective. Targeted capacity programs are designed 
to provide a rapid and strategic response to newly emerging 
substance abuse trends demonstrated by epidemiological data; to 
address serious and persistent gaps in local service capacity; 
and to address prevention and treatment issues particular to 
certain populations or geographic areas. The Committee intends 
that these programs work in a coordinated fashion with the 
block grants to the States to meet the highest priority service 
needs within the States.
    The Committee remains concerned by the disproportionate 
presence of substance abuse in rural and native communities, 
particularly for American Indian, Alaska Native and native 
Hawaiians communities. The Committee reiterates its belief that 
funds for prevention and treatment programs should be targeted 
to those persons and communities most in need of service. 
Therefore, the Committee has provided sufficient funds to fund 
projects to increase knowledge about effective ways to deliver 
services to rural and native communities. Within the funds 
reserved for rural programs, the Committee intends that 
$8,000,000 be reserved for CSAP grants, and $12,000,000 be 
reserved for CSAT grants.
    The Committee is impressed with evidence that integrated 
mental health and substance abuse treatment is effective for 
meeting the needs of individuals who suffer from mental illness 
and also have an addictive disorder. Sequential and parallel 
treatment of these disorders generally fails to result in 
recovery for this population, which is in great need of 
improved services. There is significant evidence that without 
effective treatment, these individuals have a higher risk of 
homelessness and tendency for violent behavior. States may use 
funds from both the mental health and the substance abuse block 
grants to treat individuals with co-occurring disorders. The 
Committee believes that the Department can provide technical 
assistance to States that plan to provide this type of 
integrated treatment.
    Last year, the Fetal Alcohol Syndrome Prevention and 
Services Act was enacted, authorizing a competitive grant 
program to develop urgently needed prevention and education 
strategies to reduce the number of children affected by Fetal 
Alcohol Syndrome [FAS]. These grants are also to be used to 
develop treatment strategies to assist parents and families as 
they cope with the impacts of FAS. The Committee urges the 
Department to fund grants in CSAP and CSAT to address FAS and 
its effects. The Committee further believes that these funds 
should be targeted to areas that demonstrate significant need 
and have a high incidence or risk of alcohol-related birth 
defects. Special consideration should be given to native 
American applicants, with recognition of the value of non-
traditional or culturally-based treatment methods and 
reservation-based substance abuse treatment services. The 
Committee is aware of a regional approach by South Dakota, 
North Dakota, Minnesota, and Montana to prevent and treat FAS, 
and believes that additional funding for this program will help 
lower the incidence of FAS, especially in native American 
communities. The Committee is concerned about the serious, 
lifelong conditions that are caused by prenatal exposure to 
alcohol. For instance, FAS is the leading cause of mental 
retardation in the western world, and is associated with 
serious behavioral problems including criminal behavior, 
unemployment, psychiatric problems, school failure, and the 
inability to live independently.

                   CENTER FOR MENTAL HEALTH SERVICES

Appropriations, 1999....................................    $513,569,000
Budget estimate, 2000...................................     588,737,000
Committee recommendation................................     581,932,000

    The Committee recommends $581,932,000 for mental health 
services, an increase of $68,363,000 over last year's level. 
Included in this amount is funding for mental health knowledge, 
development, and application demonstrations, the mental health 
performance partnership block grant to the States, children's 
mental health, programs to assist homeless persons with mental 
illnesses, and protection and advocacy services for individuals 
with mental illnesses. The Committee has doubled funding for 
mental health counselors for school-age children, as part of an 
effort to reduce school violence. The Committee intends that 
$80,000,000 be used for counseling services for school-age 
youth.

Mental health knowledge, development, and application

    The Committee recommends $137,932,000 for the mental 
health, knowledge, development, and application program [KDA], 
$40,000,000 more than the fiscal year 1999 amount and 
$39,968,000 more than the administration's request. The 
following programs are included in the mental health center 
KDA: Community Support Program [CSP]; homeless and AIDS 
demonstrations; and training and AIDS training programs.
    The Committee has included additional funds to continue and 
expand mental health services for schoolchildren that are at 
risk of exhibiting violent behavior. Last year, after the 
tragic shootings at a number of schools across the nation, the 
Congress provided funds to begin to address the problem of 
youth violence. Among other things, the Committee believes that 
mental health counseling for troubled youth can help prevent 
violent acts, and is therefore providing additional funds to 
help schools in that cause. It is again expected that SAMHSA 
will collaborate with the Department of Education to continue a 
coordinated approach.
    The Committee is pleased with the successful collaboration 
between the Center for Mental Health Services and the Bureau of 
Health Professions in HRSA to fund interdisciplinary health 
professions training projects, including training of behavioral 
and mental health professionals, for practice in managed care/
primary care settings and urges that this joint effort be 
continued. The Committee encourages both agencies to develop 
technical assistance for use in health professions training 
programs for the purpose of enhancing primary care 
interdisciplinary models of practice. These efforts should be 
focused upon rural native populations that are at-risk for the 
problems most encountered by these health professionals.
    The Committee recognizes the importance of the 
Comprehensive Community Mental Health Services for Children and 
Their Families Program in improving the lives of individuals 
with serious emotional disorders. Expanding these services and 
incorporating prevention and early intervention would increase 
the number of people served. The Committee supports extending 
the Knowledge Development and Application Program to all 50 
states, territories, and tribal communities. The Committee 
encourages the development of partnerships with local 
communities to further expand this program.
    The Committee understands that the California School of 
Professional Psychology plans to establish teleconferencing 
facilities at each of its four campuses and distance learning 
facilities at two campuses. These facilities will be used to 
provide service to the California Department of Developmental 
Services, and the California Department of Corrections, which 
is under a court order to provide inmates with reasonable 
access to mental health services.
    The Committee is aware of the Circle of Nations Behavioral 
Health Center in providing therapy to Native American school 
children with co-occurring disorders. The Center uses a multi-
disciplinary approach to address psychological and substance 
abuse problems and to help return these children to a normal 
school environment.
    The Committee commends the work of the National Mental 
Health Self-Help Clearinghouse in providing information and 
resources to individuals suffering from mental illnesses and 
their families. The Committee notes that continued and 
increased funding of this resource center will allow these 
services to be provided uninterrupted.
    The Committee recently heard testimony about the tragic 
results of addictive and pathological gambling. Gambling has 
destroyed the lives of many American families. A recent report 
by the National Gambling Impact Study Commission found that 
15.4 million Americans are either pathological or problem 
gamblers. Problem gambling burdens not only the addicted 
individual and his or her family, but society as well. Costs 
incurred can include unemployment benefits caused by the loss 
of a job, physical and mental health problems, domestic 
violence, and child abuse and neglect. The Committee urges CMHS 
to conduct demonstration projects to determine effective 
strategies and best practices for preventing and treating 
addictive gambling.
    The Committee applauds the work of the Farm Resource Center 
in providing outreach and counseling services to displaced coal 
miners, farm workers, and their families. The Committee 
recognizes that continued funding of this Center will allow 
more individuals and families to cope with the emotional trauma 
of losing their jobs and help them pursue other productive 
careers.
    The Committee recognizes the extraordinary obstacles facing 
individuals with mental illness and co-occurring psychiatric 
disorders towards achieving economic self-sufficiency. The 
Committee is aware of the Community Advocacy Training Services 
in providing training and technical assistance to persons with 
such disorders. The Committee believes that the Department 
should consider funding demonstrations that endeavor to help 
individuals with mental illnesses lead rewarding and productive 
lives.

Clinical and AIDS training

    The Committee is aware of the need for more trained health 
providers, including allied health professionals and social 
workers, to work with people suffering from HIV/AIDS. To the 
extent that funds are available, the Committee encourages 
SAMHSA to continue funding existing grants and contracts 
approved by SAMHSA under the current AIDS Training Program.
    The Clinical Training Program trains mental health 
personnel to deliver services to designated underserved 
populations in exchange for a repayment through service to 
underserved or priority populations, including severely 
mentally ill adults, children, and adolescents with serious 
emotional disorders, and the elderly. The AIDS Training Program 
provides training for mental health providers to address the 
neuropsychiatric aspects of HIV spectrum infection.
    The Committee recognizes the crucial role that the Minority 
Fellowship Program plays in training mental health 
professionals in providing mental health services for 
individuals who often fail to seek services.

AIDS demonstrations

    This program provides 4 year grants to public and nonprofit 
private organizations to provide innovative mental health 
services to individuals who are experiencing severe 
psychological distress and other psychological sequelae as a 
result of infection with HIV. One coordinating center is 
supported to independently evaluate the quality and 
effectiveness of these services. The Committee commends the --
Center for Mental Health Services for its commitment in 
disseminating knowledge gained from these demonstration 
projects. The Committee urges the center to maintain its 
support for projects that provide direct mental health services 
while at the same time using the findings from previous 
projects to develop new knowledge in this area. The Committee 
again commends CMHS for its leadership in working cooperatively 
in demonstrating the efficacy of delivering mental health 
services to individuals affected by and living with HIV/AIDS. 
The Committee encourages the Secretary to maintain these 
agencies' support for this program.

Mental health block grant

    The Committee recommends $310,000,000 for the mental health 
block grant, $21,277,000 more than the fiscal year 1999 amount 
and $48,816,000 less than the President's request. States use 
these funds to support the development and implementation of 
innovative community-based services and maintain continuity of 
community programs. Funds are allocated to States by formula.

Children's mental health

    The Committee recommends $78,000,000 for the Children's 
Mental Health Program, $26,000 above the fiscal year 1999 level 
and the same as the administration's request. This program 
provides grants and technical assistance to support community-
based services for children and adolescents with serious 
emotional, behavioral or mental disorders. States must provide 
matching funds, and services must involve the educational, 
juvenile justice, and health systems.

Projects for assistance in transition from homelessness [PATH]

    The Committee recommends $31,000,000 for the PATH Program, 
$5,009,000 more than the fiscal year 1999 amount and the same 
as the administration's request.
    PATH is a critical program which provides outreach, mental 
health, and case management services and other assistance to 
persons who are homeless and have serious mental illnesses. The 
PATH Program makes a significant difference in the lives of 
homeless persons with mental illnesses. PATH services eliminate 
the revolving door of episodic inpatient and outpatient 
hospital care. Multidisciplinary teams address client needs 
within a continuum of services, providing needed stabilization 
so that mental illnesses and co-occurring substance abuse and 
medical issues can be addressed. Assistance is provided to 
enhance access to housing, rehabilitation and training, and 
other needed supports, assisting homeless people in returning 
to secure and stable lives.

Protection and advocacy

    The Committee recommends $25,000,000 for protection and 
advocacy, $2,051,000 more than the fiscal year 1999 amount and 
$2,043,000 more than the administration's request. This program 
helps ensure that the rights of mentally ill individuals are 
protected while they are patients in treatment facilities and 
for 90 days following their discharge. Funds are allocated to 
States according to a formula based on population and relative 
per capita income.
    The Committee has learned that patients with mental 
illnesses have died or received life-threatening injuries in 
treatment facilities because of improper restraints and 
seclusion. The Committee has provided additional resources for 
protection and advocacy so that these deaths can be 
investigated and future incidences can be prevented.

                  CENTER FOR SUBSTANCE ABUSE TREATMENT

Appropriations, 1999....................................  $1,756,302,000
Budget estimate, 2000...................................   1,941,868,000
Committee recommendation................................   1,941,868,000

    The Committee recommends $1,941,868,000 for substance abuse 
treatment programs, an increase of $185,000,000 over last 
year's funding, and the same as the budget request. This amount 
funds substance abuse treatment knowledge, development, and 
application demonstrations, targeted capacity expansion, and 
the substance abuse block grant to the States.

Substance abuse treatment knowledge, development, and application and 
        targeted capacity expansion

    The Committee recommends $226,868,000 for the substance 
abuse treatment knowledge, development, and application program 
[KDA] and the targeted capacity expansion program [TCE]. This 
amount is the same as the administration's request and 
$55,058,000 above the comparable fiscal year 1999 amount.
    Alcohol-related deaths among Native American youth is one 
of the leading causes of death. In addition, these youths tend 
to reside in rural areas where drug treatment services are 
seriously inadequate or completely unavailable. The Committee 
is aware that the Gallup-McKinley County Youth Coalition is 
providing substance abuse treatment to this population and 
could develop collaborative community-based services for post-
discharge programs.
    The Committee reiterates its concern about the 
disproportionate impact of substance abuse in rural and native 
communities, and has included $12,000,000 for native and rural 
CSAT programs. The Committee again raises concern about the 
severe shortage of substance abuse treatment services in the 
State of Alaska for Native Alaskans, the pressing need to 
continue support of Alaska programs, and the need to develop 
knowledge about effective techniques for treating substance 
abuse in native populations. The Committee, therefore, expects 
that the increase provided will be reasonably allocated between 
existing programs and initiating new programs, especially in 
Alaska.
    The Committee recognizes the success of the Fairbanks 
Native Association's LifeGivers residential treatment program 
in helping pregnant women with substance abuse problems, and 
their children. The Committee notes that additional funding for 
this important activity will allow more women to conquer their 
substance abuse problems.
    The Committee understands that the Southcentral Foundation 
in Anchorage is providing substance abuse treatment programs 
for Native American adolescents and recognizes that funding 
from the Department would help more young people become drug 
and alcohol free.
    The Committee is aware of the 5-point State of Alaska plan 
of action to prevent fetal alcohol syndrome and other alcohol-
related birth defects and to improve the State's system of care 
for those individuals and their families already affected by 
prenatal exposure to alcohol. Alaska has one of the highest 
rates of Fetal Alcohol Syndrome in the nation. Lifetime cost 
for one person diagnosed with FAS is $1,400,000. This 5-year 
demonstration program will provide Alaska with a clear 
understanding of the prevalence of FAS, data on the effects of 
the State's prevention efforts, and clear direction on how to 
improve prevention and treatment services.
    The Committee is aware of the serious problem of drug use 
among the Nation's youth, noting that perhaps only 20 percent 
of youths who require drug treatment actually receive it. The 
Committee supports the funding of grants for national drug 
prevention and treatment for youths, as well as training for 
providers who work with this population.
    The Committee understands that methamphetamine abuse 
continues to be a major problem in many areas of the country, 
in particular, the South and the Midwest. The State of Iowa is 
experiencing a particularly high incidence of methamphetamine 
abuse. The Committee believes that additional funds could 
expand the number of prevention and treatment demonstration 
projects in Iowa and other parts of the Midwest. School-based 
prevention demonstration projects would teach the dangers of 
methamphetamine abuse and addiction, using methods that are 
effective and evidence-based and include initiatives that give 
students the responsibility to create their own anti-drug abuse 
education programs for their schools. Treatment demonstrations 
would carry out planning, establishing, or administering 
evidence-based methamphetamine treatment programs that are 
designed to assist individuals to quit their use of 
methamphetamine and remain drug-free.
    The Committee again recognizes the work of the model 
initiative in San Francisco for its comprehensive and 
community-based treatment on demand and substance abuse 
prevention.
    The Committee is aware of the Southern Indian Health 
Council's efforts to address the unmet health care needs of the 
Indian people living in Southern California. Today SIHC 
operates two health clinics and one substance abuse program. 
These facilities treat youth with substance abuse and primary 
or secondary psychiatric diagnoses.
    The Committee is aware of the work of the Center Point 
Program in Marin County, CA, which provides comprehensive, 
affordable substance abuse and related services to high-risk 
families and individuals.
    The Committee understands the tragic results of drug abuse 
among pregnant women. Babies of cocaine- or heroin-addicted 
mothers are addicted themselves and face increased risk of 
severe health problems or early death. The Committee has 
provided funding for new and existing residential treatment 
facilities for pregnant and post-partum women and continues to 
be supportive of efforts to prevent and treat mothers with 
substance abuse problems.
    The Committee understands the serious problem of inhalant 
abuse in Alaska, especially among children and teenagers. With 
approximately 1 in 4 Alaska children having used inhalants, it 
is clearly a critical and widespread problem. The Committee is 
aware that the Yukon-Kuskokwim Health Corporation is 
establishing a facility in Bethel, Alaska to treat individuals 
with inhalant addiction. With funding from the Department, this 
center will be able to help rid Alaska of the problem of 
inhalant abuse. This center could serve as a model for similar 
treatment centers in other parts of the nation.
    The Committee remains concerned that substance abuse among 
the nation's homeless population remains a serious problem that 
receives limited attention. Existing addiction services are not 
adequately reaching the homeless population and are not 
adequately addressing their unique needs and life 
circumstances. Of the funds provided, the Committee encourages 
the Department to support the development and expansion of 
addiction services targeted to the homeless.
    The Committee recommends that the Department prepare and 
submit a report which details actions the Department will take 
to ensure that States, political subdivisions of States, tribes 
and tribal organizations, and public and private nonprofit 
entities receiving substance abuse block grant funds will use a 
portion of such funds for developing and expanding addiction 
services targeted to the homeless.
    The Committee understands that Pennsylvania's Department of 
Health is developing a research-based educational and training 
institute to provide health professionals with the most up-to-
date technical assistance in treating persons with substance 
abuse problems. The Committee believes that additional Federal 
resources can supplement current private and state funding so 
that more individuals can overcome their substance abuse 
problems. These types of activities can serve as a model for 
other facilities; therefore, the Committee encourages that best 
practices in treatment approaches be shared among providers.
    The Committee recognizes the high rate of drug and alcohol 
dependency among the Native American communities in 
northwestern Nebraska. The Committee believes that funding from 
the Department would allow the Nebraska Panhandle Partnership 
for Health and Human Services to create a culturally-sensitive, 
community-based substance abuse treatment and after-care pilot 
program for Native Americans. The Committee also believes that, 
because of their large concentrations of Native Americans, 
Sheridan and Dawes Counties and their surrounding communities 
would be well-suited for these services.
    The National Household Survey on Drug Abuse (NHSDA) is a 
basic survey providing information on the prevalence and 
incidence of substance abuse and the number of persons who have 
received treatment. This survey is being expanded to provide 
information that will assist State and local agencies with 
responsibility for providing substance abuse treatment and 
prevention services. Last year, NHSDA was expanded to include a 
more comprehensive set of data on tobacco product use, 
including information on user brands. The Committee is pleased 
with the progress made by SAMHSA in gathering data to identify 
emerging substance abuse problems, including tobacco, and 
expanding the survey size. This will enable state-by-state 
comparisons and the tracking of trends within a State. The 
Committee also recognizes the work SAMHSA has done to apply the 
newest technologies to data gathering.
    The Committee is concerned about the devastating effects of 
heroin use on individuals and their families. For decades, 
methadone has been the primary method of treating heroin 
addiction. The Committee has heard reports that expanding the 
availability of methadone would help additional heroin addicts 
receive treatment. The Committee is aware of a proposed rule to 
revise the conditions for the use of narcotic drugs in 
maintenance and detoxification treatment of opioid addiction. 
Comprehensive monitoring of the implementation of this 
regulation in conjunction with a study by the Secretary 
evaluating the possibility and effects of expanding the use of 
methadone would be valuable to the Committee.
    The Committee understands that Mexican black tar heroin 
abuse has become a major problem in many areas of the country, 
in particular, Southwestern border states and major 
metropolitan areas in the West. The State of New Mexico has 
experienced an extremely high incidence of Mexican black tar 
heroin abuse in Rio Arriba and Santa Fe counties. The Committee 
believes that funding for a demonstration project in Rio Arriba 
and Santa Fe counties would yield valuable information 
concerning how to treat this deadly addiction. The Committee 
believes that a demonstration project to determine ways to 
prevent this addiction would also yield valuable benefits.

Substance abuse block grant

    The Committee recommends $1,715,000,000 for the substance 
abuse block grant of which $100,000,000 shall become available 
on October 1, 2000, $30,508,000 more than the comparable fiscal 
year 1999 level and the same as the administration's request.
    The substance abuse block grant provides funds to States to 
support alcohol and drug abuse prevention, treatment, and 
rehabilitation services. Funds are allocated to the States 
according to formula. State plans must be submitted and 
approved annually.

                 CENTER FOR SUBSTANCE ABUSE PREVENTION

Appropriations, 1999....................................    $163,944,000
Budget estimate, 2000...................................     138,000,000
Committee recommendation................................     168,000,000

    The Committee recommends $168,000,000 for programs to 
prevent substance abuse, an increase of $4,056,000 over last 
year's level and $30,000,000 more than the budget request. This 
amount funds substance abuse prevention knowledge, development, 
and application demonstrations, targeted capacity expansion, 
and grants for youths at risk of substance abuse.

Substance abuse prevention, knowledge, development, and application and 
        targeted capacity expansion

    The Committee has provided $161,000,000 for the substance 
abuse prevention, knowledge, development, and application 
program [KDA] and the targeted capacity expansion program 
[TCE], $4,053,000 more than the fiscal year 1999 amount and 
$30,000,000 more than the administration's request.
    The Committee has included $7,000,000 for the purpose of 
making grants to public and nonprofit private entities for 
projects to demonstrate effective models for the prevention, 
treatment, and rehabilitation of drug abuse and alcohol abuse 
among high risk youth, as authorized by section 517 of the 
Public Health Service Act as amended. The Committee is highly 
concerned about the extent of substance abuse among high risk 
youth. This population is vulnerable to initiating criminal 
activity against people and property, especially following the 
acute and chronic use of illicit substances and the abuse of 
alcohol. These grants are intended to strengthen local 
capabilities in confronting the complex interrelationships 
between substance and alcohol abuse and other activities that 
may predispose young individuals toward criminal, self-
destructive, or antisocial behavior.
    The Committee expects that States receiving funding under 
the State Incentive Grant Program will give priority in the use 
of the 20 percent prevention set-aside in the block grant to: 
(1) working with community coalitions to develop communitywide 
strategic plans and needs assessments; and (2) filling program 
and service gaps identified by these community plans.
    The Committee reiterates its concern about the 
disproportionate impact of substance abuse in rural and native 
communities, and has included $8,000,000 for CSAP programs 
which serve rural communities. The Committee intends this 
increase to be reasonably allocated between expanding existing 
programs and initiating new programs, especially in Alaska.
    The Committee believes that prevention programs need to 
start when children are young, and need to continue to help 
children make successful transitions. The Committee has 
included sufficient funds for evaluations of established 
school-based early prevention and transition programs and 
continues to be supportive of the efforts of the Corporate 
Alliance for Drug Education [CADE] which has been operating a 
program providing education and prevention services to 120,000 
elementary school-aged children in Philadelphia.
    Within the funds available, the Committee urges CSAP to 
continue the national effort to provide alcohol and substance 
abuse prevention and education to children of native Americans 
with alcoholism.
    The Committee understands that there is an urgent problem 
of drug and alcohol abuse across the Nation. The National 
Family Policy Assessment Center, located on the campus of 
Oregon State University, is working to implement proven 
prevention initiatives for children, youth, and families.
    The Committee is aware that the University of Mississippi 
Medical Center plans to establish the Southeastern Center for 
Addictive Disorders to treat addictions of youth and 
underserved populations in the Southeast region of the United 
States. The Center would generate knowledge about the causation 
and prevention of addiction that can be used by health 
professionals across the Southeast.
    The Committee recognizes the efforts of the Alaska Council 
on Prevention of Alcohol and Drug Abuse, the Yukon-Kuskokwim 
Health Corporation's Regional Substance Abuse Services Program, 
and the Phillips Ayagnirvik Treatment Center to prevent 
inhalant abuse among high-risk youth. The goal of this program 
is to prevent inhalant use by developing rural-focused media 
messages and materials to educate youth about the consequences 
of this dangerous substance.
    Drug and alcohol related birth defects are a significant 
problem throughout the Nation. The Committee understands that 
in Montana the problem is particularly acute in rural areas and 
on Native American reservations. Montana State University in 
Billings plans to develop and maintain a web page with relevant 
information in order to prevent drug and alcohol related birth 
defects.
    The Committee recognizes the efforts of the City of 
Providence's Southeast Asian youth and Family Development 
(SEAYFD) project in addressing the rising drug and alcohol 
abuse, and the alarming gang activity among the Southeast Asian 
community. SEAYFD has significantly improved the lives of 
participating youths, demonstrated in fewer school suspensions, 
higher grade point averages, and increased school attendance.

                           PROGRAM MANAGEMENT

    The Committee recommends $58,900,000 for program management 
activities of the agency, $1,000,000 more than the President's 
request and $5,402,000 more than the 1999 level.
    The program management activity includes resources for 
coordinating, directing, and managing the agency's programs. 
Program management funds support salaries, benefits, space, 
supplies, equipment, travel, and departmental overhead required 
to plan, supervise, and administer the programs.

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

Appropriations, 1999....................................    $201,635,000
Budget estimate, 2000...................................     214,905,000
Committee recommendation................................     214,905,000

    The Committee provides an estimated $214,905,000 for 
retirement pay and medical benefits for commissioned officers 
of the U.S. Public Health Service. This is the same as the 
administration request and is $13,270,000 over the estimated 
payments for fiscal year 1999.
    This account provides for: retirement payments to U.S. 
Public Health Service officers who are retired for age, 
disability, or length of service; payments to survivors of 
deceased officers; medical care to active duty and retired 
members and dependents and beneficiaries; and for payments to 
the Social Security Administration for military service 
credits.

               Agency for Health Care Policy and Research

Appropriations, 1999....................................    $172,818,000
Budget estimate, 2000...................................     206,255,000
Committee recommendation................................     211,255,000

    The Committee recommends $19,504,000 in Federal funds for 
the Agency for Health Care Policy and Research [AHCPR]. In 
addition, the Committee provides transfers of $191,751,000 from 
funds available under section 241 of the Public Health Service 
Act. Total funding provided for the Agency is $211,255,000, 
which is $38,437,000 over the fiscal year 1999 funding and 
$5,000,000 above the administration's request.
    The Agency for Health Care Policy and Research was 
established in 1990 to promote improvements in clinical 
practice and patient outcomes, promote improvements in the 
financing, organization, and delivery of health care services, 
and increase access to quality care. AHCPR is the Federal 
agency charged to produce and disseminate scientific and 
policy-relevant information about the cost, quality, access, 
and medical effectiveness of health care. AHCPR provides 
policymakers, health care professionals, and the public with 
the information necessary to improve cost effectiveness and 
appropriateness of health care and to reduce the costs of 
health care.
    Biosecurity analysis and research.--The Committee urges the 
agency to use $5,000,000 above the administration request to 
initiate a new activity concerning biosecurity and associated 
bioterrorism threats. The Committee urges the agency to support 
and conduct research to investigate and evaluate rapid response 
systems and the most effective clinical interventions to treat 
patients who have been exposed to chemical and biological 
agents. This research would provide information about the most 
effective means to organize health care systems to respond to 
the health needs of populations exposed to these agents. Such 
research should investigate and report on the state of 
readiness for emergency rooms, medical personnel and public 
health infrastructures. The Committee encourages the agency to 
establish partnerships with health care organizations, schools 
of public health and medicine, professional societies, and 
policy research organizations to translate findings from this 
research into practice.
    The Committee is aware of the efforts of the BioMed 
Security Institute, a collaboration between the University of 
Pittsburgh and Carnegie Mellon University in Pittsburgh, 
Pennsylvania, to address the national need for greater 
preparedness for biological terrorist attack. The Committee 
recognizes the urgency of independent research and analysis 
into enhanced preparedness, coordination and response to 
biological terrorism. The Committee commends the Institute for 
uniquely combining the latest in information technology and 
biomedical research to address this critical national need.
    The Committee is aware of the efforts by the St. Louis 
University School of Public Health to conduct analysis in 
biosecurity and urge the agency to review its proposal for 
merit.
    The Committee is aware of recent studies that may indicate 
the disparity by gender in the aggressiveness of the treatment 
of heart disease for men and women. The Committee encourages 
the agency to make suggestions on needed changes in policy and 
research priorities to address any such inequities. Sufficient 
funds are available to conduct this activity.
    The Committee is aware of the Dental Health Services Report 
submitted by the Agency and is concerned that only three 
extramural dental projects were supported in 1998. Given the 
cost to society and given the findings of the Early Childhood 
Caries Conference that dental caries is of epidemic proportions 
in many low socioeconomic preschool children in the U.S., the 
Committee requests that AHCPR expand its investment in dental 
health services research and the training of dental health 
services researchers.
    The agency is urged to enhance its investment in health 
services research devoted to improving the quality and outcomes 
of children's health care, including support for research, 
research centers and training.
    The Committee encourages the agency to assist the National 
Breast and Cervical Cancer early detection program in 
determining the extent of medical treatment obtained by 
individuals screened and then determined to have breast and/or 
cervical cancer.
    The Committee urges AHCPR to conduct a study of the per-
patient cost of treatments for temporomandibular joint (TMJ) 
patients and to conduct an analysis of the efficacy of these 
treatments.
    The Committee notes that the AHCPR has begun to rebuild the 
investigator-initiated research program and the career 
development program. The Committee encourages the AHCPR to 
continue this expansion and specifically target some of these 
initiatives to physician-scientists who provide a unique 
perspective on research regarding the quality and cost-
effectiveness of medical care. In addition, the Committee urges 
greater efficiency in the Agency's contract research portfolio 
and the use of resulting savings for the investigator-initiated 
research program and the career development program in fiscal 
year 2000.

                  Health Costs, Quality, and Outcomes

    The Committee provides $172,914,000 for research on health 
costs, quality and outcomes [HCQO]. Of the amount provided, 
$155,751,000 is derived from section 241, 1-percent evaluation 
set-aside funds and $17,163,000 is derived from Federal funds. 
HCQO research activity is focused upon improving clinical 
practice, improving the health care system's capacity to 
deliver quality care, and tracking progress toward health goals 
through monitoring and evaluation.
    Rural managed care program.--The Committee encourages the 
agency to support an additional rural managed care 
demonstration grant to build upon the achievements of the past 
five years and for further network development.
    Centers for Education and Research in Therapeutics.--The 
Committee notes that the introduction of highly effective drugs 
to prevent or treat a wide array of diseases and disorders has 
engendered growing concern about the extent to which drugs and 
devices are used inappropriately. It has been brought to the 
Committee's attention that adverse drug reactions comprise the 
fourth leading cause of death in the United States among 
hospitalized patients. To address this problem, Congress 
established the Centers for Education and Research in 
Therapeutics, which will research and educate the public on the 
use of approved drugs, the prevention of adverse drug 
reactions, and the appropriate use and dosage of specific drugs 
in special populations such as women, children, minorities, and 
the elderly. The Committee encourages the agency to accelerate 
its commitment to these centers.
    Children's health.--The Committee is supportive of the 
Agency's efforts to establish a children's health services 
agenda. The Committee continues to encourage AHCPR to work with 
schools of nursing to identify the high risk areas requiring 
research to provide better direction in caring for this 
vulnerable group and to continue work with the Emergency 
Medical Services for Children Program at the Health Resources 
Services Administration to evaluate the potential impact of 
managed care on children's access to emergency medical care.
    The uninsured.--The Committee is aware of a proposal by the 
Access to Health Project to study barriers to accessing health 
care among the uninsured in the St. Louis region by undertaking 
primary research, data collection and analysis.
    Women's health.--The Committee commends the agency for its 
ongoing work to improve the standards of care in women's 
health. The Committee is aware that a significant number of 
gynecologic exams yield inconclusive results that often require 
expensive re-testing. Last year, the Committee encouraged the 
agency to conduct outcomes research that would incorporate 
ultrasound technology as a standard of care for women's health 
services. The Committee understands that the agency is further 
examining such research efforts and looks forward to receiving 
updates on the progress being made to date.
    Vision health.--The Committee is aware of the work of 
vision rehabilitation professionals who help to restore the 
safe functional ability of patients with visual impairments by 
teaching a wide range of daily independent livings skills. The 
Committee encourages the agency to conduct research on 
potential models of care.

            health insurance and expenditures panel surveys

    The Committee provides $36,000,000 for health insurance and 
expenditures panel surveys [MEPS], which is the same as the 
administration request and $8,200,000 above the fiscal year 
1999 level. The entire amount provided is derived from 1 
percent evaluation set-aside funds. Within this category of 
activity, the Administration proposes to include activities 
previously designated as research on health insurance and 
expenditure surveys. MEPS is intended to obtain timely national 
estimates of health care use and expenditures, private and 
public health insurance coverage, and the availability, costs 
and scope of private health insurance benefits. It also 
develops cost and savings estimates of proposed changes in 
policy and identifies impact of policy changes on payers, 
providers, and patients.

Program support

    The Committee recommends $2,341,000 for program support. 
This amount is the same as the administration request and is 
$1,795,000 lower than the fiscal year 1999 level. This activity 
supports the overall management of the Agency.

                  Health Care Financing Administration


                     GRANTS TO STATES FOR MEDICAID

Appropriations, 1999.................................... $74,720,544,000
Budget estimate, 2000...................................  86,087,393,000
Committee recommendation................................  86,087,393,000

    The Committee recommends $86,087,393,000 for grants to 
States for Medicaid. This amount is $11,366,849,000 more than 
the fiscal year 1999 appropriation and the same as the 
administration's request. This amount excludes $28,733,605,000 
in fiscal year 1999 advance appropriations for fiscal year 
2000. In addition, $30,589,003,000 is provided for the first 
quarter of fiscal year 2001, as requested by the 
administration.
    The Medicaid Program provides medical care for eligible 
low-income individuals and families. It is administered by each 
of the 50 States, the District of Columbia, Puerto Rico, and 
the territories. Federal funds for medical assistance are made 
available to the States according to a formula which determines 
the appropriate Federal matching rate for State program costs. 
This matching rate, which may range from 50 to 90 percent, is 
based upon the State's average per capita income relative to 
the national average.
    In order to provide the most effective services to abused 
and neglected children in our child welfare system, it is 
important to ensure providers have the flexibility they need. 
Currently Medicaid Rehabilitative Treatment Services are 
combined with state and local resources to create a package of 
treatment, safety, and permanency services for these children 
and their families. However, administering these separate 
programs is extremely complex, and bogs down service providers 
with inflexible rules and multiple paperwork and documentation 
requirements. The State of Iowa has submitted a proposal to 
HCFA to restructure services in order to increase flexibility, 
ease administrative burdens and encourage innovation in service 
selection and delivery. The Iowa proposal would utilize 
existing Medicaid resources and does not request additional 
appropriations. The Committee encourages HCFA, pending 
agreement on a final plan, to consider approving the Iowa 
proposal as a two-year project to demonstrate the efficacy for 
this service approach.
    The Committee continues to be concerned about the 
widespread problem of state Medicaid programs' noncompliance 
with requirements to conduct blood lead screening for children 
served by the program. In light of the General Accounting 
Office's February 1998 finding that there is widespread 
noncompliance with Medicaid's lead screening requirements, the 
Committee again strongly urges the Department to submit the 
report it requested last year by January 1, 2000. The report 
should cover the policy, program, oversight, enforcement, and 
education steps HCFA is taking to dramatically increase blood 
lead screening of children served by Medicaid.

                  PAYMENTS TO HEALTH CARE TRUST FUNDS

Appropriations, 1999.................................... $62,823,000,000
Budget estimate, 2000...................................  69,289,100,000
Committee recommendation................................  69,289,100,000

    The Committee recommends $69,289,100,000 for Federal 
payments to the Medicare trust funds. This amount is the same 
as the administration's request and is an increase of 
$6,466,100,000 from the fiscal year 1999 appropriation.
    This entitlement account includes the general fund subsidy 
to the supplementary medical insurance trust fund (Medicare 
part B), plus other reimbursements to the hospital insurance 
trust fund (Medicare part A), for benefits and related 
administrative costs which have not been financed by payroll 
taxes or premium contributions.
    The Committee has provided $68,690,000,000 for the Federal 
payment to the supplementary medical insurance trust fund. This 
payment provides matching funds for premiums paid by Medicare 
part B enrollees. This amount is the same as the administration 
request, and is $6,811,000,000 more than the fiscal year 1999 
amount.
    The recommendation also includes $349,000,000 for hospital 
insurance for the uninsured. This amount is the same as the 
administration's request and is $206,000,000 less than the 1999 
amount.
    The Committee also recommends $121,000,000 for the Federal 
uninsured benefit payment. This payment reimburses the hospital 
insurance trust fund for the cost of benefits provided to 
Federal annuitants who are eligible for Medicare. This amount 
is the same as the administration's request and is $24,000,000 
more than the fiscal year 1999 appropriation.
    The Committee recommendation includes $129,100,000 to be 
transferred to the hospital insurance trust fund as the general 
fund share of HCFA's program management administrative 
expenses. This amount is the same as the administration's 
request and is $162,900,000 less than the fiscal year 1999 
level.

                           PROGRAM MANAGEMENT

Appropriations, 1999....................................  $2,142,835,000
Budget estimate, 2000...................................   2,016,127,000
Committee recommendation................................   1,991,321,000

    The Committee recommends $1,991,321,000 for HCFA program 
management. This is $24,806,000 less than the budget request 
and $151,514,000 less than the fiscal year 1999 enacted level.

Research, demonstrations, and evaluation

    The Committee recommends $65,000,000 for research, 
demonstration, and evaluation activities. This amount is 
$10,000,000 more than the budget request and $15,000,000 more 
than the amount provided in fiscal year 1999.
    HCFA research and demonstration activities facilitate 
informed, rational Medicare and Medicaid policy choices and 
decisionmaking. These studies and evaluations include projects 
to measure the impact of Medicare and Medicaid policy analysis 
and decisionmaking, to measure the impact of Medicare and 
Medicaid on health care costs, to measure patient outcomes in a 
variety of treatment settings, and to develop alternative 
strategies for reimbursement, coverage, and program management.
    The recommended funding level for the research and 
demonstration program will provide for continuation of current 
activities including telemedicine demonstration projects, which 
should remain a high priority. Priority areas for HCFA research 
include access to high-quality health care, health service 
delivery systems, and provider payment systems.
    The Committee has included funds to continue at current 
levels the Nursing Home Transition Initiative, to help states 
carry out demonstration projects of developing community-based 
attendant care services that ensure maximum control by 
consumers to select and control their attendant care services. 
The Committee also has included funds to support a study, 
utilizing existing data, to determine the impact of expanded 
personal assistance services on the utilization and cost of 
institutional services, and the utilization and supply of 
unpaid informal support services.
    The Committee is aware that the Health Care Financing 
Administration has a Nursing Home Initiative (NHI) underway 
with the goal of achieving improvements in the quality of care 
in federally certified nursing homes. The Committee notes the 
agency's demonstrated commitment to this initiative with 
approval. The Committee is interested in the measurable 
outcomes of the agency's NHI with respect to quality of care. 
The Committee requests that the Secretary report no later than 
July 15, 2000 to this Committee and appropriate committees of 
Congress in regard to improvements in quality of care for 
nursing homes.
    The Committee encourages HCFA to review the need for the 
following activities: Conduct a nationwide survey and define 
appropriate physician and non-physician clinical resources that 
are necessary to provide safe outpatient cancer therapy; 
determine the practice expenses associated with the utilization 
of those resources; report to Congress with recommendations 
regarding the development and inclusion of work units in the 
practice expense formula and the development and adoption of 
standards to assure the provision of safe outpatient cancer 
therapy.
    The Committee is aware that Medicare currently covers drugs 
and biologics that are administered in a hospital or physician 
office but not those that are self-administered by the patient 
at home for the treatment of the same disease, which may be 
more cost effective.
    The Committee urges the Secretary of Health and Human 
Services to review the policy regarding Medicare coverage of 
self-injected biologics as alternatives to therapies that are 
currently covered under Medicare for the treatment of 
rheumatoid arthritis. The Secretary is encouraged to consider 
the costs of administration when assessing the efficacy, safety 
and cost of the covered therapy as compared to the self-
administered biolgic.
    The Committee recognizes that Children's Hospice 
International has designed an appropriate model of 
comprehensive community-based hospice care for children with 
life threatening conditions and their families by changing the 
eligibility requirements to better meet the needs of this 
underserved population. The model is complete, and states are 
ready to develop demonstration model programs with a relatively 
small federal investment.
    The Committee is aware of research conducted at the 
University of Missouri-Kansas City (UMKC) that is aimed at 
developing and testing behavioral interventions that address 
inappropriate behaviors of older nursing home residents with 
moderate to severe dementia. The Committee believes this type 
of research is critical to improving the quality of care 
provided to the elderly living in nursing homes across the 
country. Additional demonstration funding would support a 
research project at UMKC's School of Nursing to test behavioral 
interventions that could alleviate the inappropriate behaviors 
of nursing home residents with moderate to severe dementia.
    The Committee is aware that an estimated 4,800,000 
Americans suffer from heart failure and that heart failure is 
the leading cause of hospitalization among all Medicare 
patients. The total estimated cost of heart failure patient 
hospitalizations is $6,600,000,000 a year. The Committee has 
included funding to allow HCFA to conduct a demonstration of an 
innovative integrated technology and nursing services program 
to provide accurate daily in-home monitoring of patient symptom 
changes so that physicians can intervene to reduce 
hospitalizations among high-risk patients with congestive heart 
failure. The Committee is aware that the University of 
Pennsylvania Medical Center, the University of Louisville 
Sciences Center, and St. Vincent's Hospital in Montana are 
leading facilities for the treatment of congestive heart 
failure, and are uniquely qualified to coordinate this project.
    The Committee is aware that Littleton Regional Hospital in 
New Hampshire was forced to divert scarce resources from other 
worthy community health programs to meet its responsibilities, 
when HCFA failed to fulfill its obligations to complete the 
funding cycle under the Rural Health Care Transition Grant 
Program. A grant to this hospital would help support a trauma 
service program.
    The Committee encourages HCFA to include the concept of 
nurse-run clinics and the utilization of advanced practice 
nurses as primary care providers in its research and 
demonstration activities. As Medicare and Medicaid move into 
the managed care arena, it is important that the most effective 
health care delivery systems be identified and utilized. Health 
promotion and prevention initiatives which are integral 
functions of nursing will play a significant role in the future 
of health care of our aging population. The Committee requests 
a report on the status of nurse-run clinics and advanced 
practice nurses in their demonstration projects by March 1, 
2000.
    The Committee remains concerned about the extraordinary 
adverse health status of Native Hawaiians and encourages HCFA 
to initiate a special demonstration project at the Waimanalo 
health center exploring the use of preventive and indigenous 
health care expertise. The Committee further recommends that 
Papa Ola Lokahi, the Native Hawaiian health care oranization 
recognized in the Native Hawaiian Health Care Act, actively 
participate in this demonstration project.
    The Committee is concerned about the extraordinary adverse 
health status and the limited access to health services of 
Alaska Natives and others living in Southwestern Alaska, the 
poorest section of Alaska, and encourages HCFA to initiate a 
demonstration project in Southwestern Alaska with the State of 
Alaska and the Yukon-Kuskokwim Health Corporation to provide 
comprehensive managed health services to indigent residents of 
that area.
    The Committee recognizes that there is a tremendous 
disparity in funding to Indian tribal governments when 
comparing per capita expenditures available to Indian health 
beneficiaries versus other non-Indian Federal Agency health 
beneficiaries. The Committee acknowledges that equivalent 
funding in these areas would decrease the progression of 
preventable diseases, significantly reduce prolonged medical 
treatment, and promote an altogether healthier Indian 
community, which in turn could actually reduce Indian need for 
health care. Given the demonstrated capability of the Rocky Boy 
Tribe in Montana, in administering its own health care 
services, the Committee recognizes the importance of the Rocky 
Boy Tribe's health Disparity Project.
    The Committee is aware of two ISO certification projects, 
one to include two small rural hospitals, the other to include 
a nationally renowned medical research, teaching and 
biotechnology institution. It is anticipated that quantifiable 
data will be produced to demonstrate the advantages of 
implementing ISO for rural and small clinical applications and 
environmental management standards in health-care related 
biotechnology applications.
    The Committee is concerned about high percentage of people 
living along the U.S.-Mexico border who have neither health 
insurance nor, in many cases, access to a primary health care 
provider. Therefore, the Committee urges that an innovative 
public health and health care delivery research project be 
conducted by the University of Arizona, the University of Texas 
at Houston and the University of Texas at San Antonio along the 
U.S.-Mexico border.
    The Committee understands that there can be a great degree 
of variability in skilled nursing certification and compliance 
surveys both among states and within a single state. An 
Informal Dispute Resolution (IDR) process can serve as the 
venue for the provider to air a disagreement with the 
surveyor's findings. The Committee is aware that the IDR 
process is not always objective, and understands that often 
personnel in the same office conducting the survey are 
responsible for reviewing the disputes. Because of these 
concerns, the Committee urges HCFA to use its research and 
demonstration authority to conduct pilot studies in several 
states utilizing an independent body to perform the IDR 
process.
    The Committee is aware of efforts at Georgetown University 
Medical Center to improve medical care of Medicare eligible 
patients by designing a computer system to track actual costs 
of treatment for under-served Medicare patients in the 
Washington metropolitan area and comparing these costs with the 
DRG-established program costs. This demonstration would provide 
the Medicare system with a model for closer tracking of health 
care costs needed to improve coverage, and ultimately, improve 
medical care.
    To assist health care facilities in maximizing their use of 
existing capital equipment and minimizing lost or stolen 
assets, the Committee is aware of a project that would use 
radio-frequency identification technology to maximize use of 
existing equipment, provide an instant inventory, and improve 
patients to services within health care facilities.
    The Committee reiterates its recommendation, contained in 
last year's report, for a pilot program for optical memory 
cards to be used for the recording and keeping of medical 
records.
    The Committee is aware that the Oregon Health Sciences 
University proposes to undertake a Health Aging Demonstration 
Project to provide coordinated, individualized management and 
treatment of patients in a health coaching system prior to the 
onset of problems associated with aging. Federal support for 
this project would allow for a unique system of care 
coordination and case management in the elderly population, 
which will yield demonstrated cost savings to the federal 
Medicare program.
    In the coming years, the elderly will provide the greatest 
challenge to our ability to provide health care at reasonable 
cost and with human dignity. At present, the elderly often die 
or remain sick because of their institutional environment. In 
order to encourage adoption of concepts such as ``Aging in 
Place'' and the ``Eden Alternative'', by nonprofit health 
institutions it is proposed that seed money or grants be 
considered for institutions who initiate such programs.
    The Committee is aware of efforts by the Health and 
Hospital Corporation of Marion County in Indianapolis, Indiana 
to provide coordinated continuous care, including mental health 
care, to low income elderly beneficiaries who are dually 
eligible for health care services under the Medicare and 
Medicaid programs. Federal research and demonstration funding 
would make possible an integrated senior care demonstration 
project at multiple settings including hospital, nursing home 
and outpatient ambulatory sites. This would include home care 
services for the purpose of evaluating methods, such as 
management, interdisciplinary team evaluations and other 
methods of coordination of care that improves the continuity 
and quality of care provided to low income, dually eligible 
elderly beneficiaries. The demonstration project would also 
evaluate methods that optimize the functional status and 
independence of target individuals, integrate mental health 
services with physical health services, and reduce long-term 
combined expenditures under the Medicare and Medicaid programs.
    The Committee is aware that the Medicare Demonstration 
program in the nation's capital is authorized in the Balanced 
Budget Act of 1997. The objective of the Demonstration, as 
specified in the legislation, is to improve the quality of care 
for the sickest, neediest Medicare patients in the national 
capital region at no increase costs to Medicare. Federal 
funding would ensure the success of the demonstration by 
covering the three components of the demonstration project: 
case management services, flexible benefits and information 
infrastructure.
    The Committee remains concerned that Medicare policies are 
not flexible enough to provide for third party reimbursement of 
patient care in high quality cancer clinical trails. The 
Committee was pleased that the Administration addressed this 
important issue in its budget request and encourages HCFA to 
work with the National Institutes of Health and National Cancer 
Institute to develop a plan for reimbursing NIH sponsored 
cancer clinical trials.
    The Committee is pleased with HCFA's proposal to provide 
demonstration grants to states to test innovative asthma 
disease management techniques for children enrolled in 
Medicaid. The Committee encourages HCFA to consider providing 
this program with the necessary funding to carry out this 
initiative.
    A recent General Accounting Office report estimated that 
more than 400,000 children eligible for federal health care 
programs have undetected harmful levels of lead in their blood, 
despite federal laws requiring that they be screened for lead 
poisoning. The Committee understands that HCFA recently revised 
its Medicaid screening and reimbursement policy for childhood 
lead poisoning testing. The Committee urges HCFA to monitor the 
impact of these policy changes and to take every appropriate 
step to ensure that screening rates among children enrolled in 
Medicaid are substantially increased. Moreover, the Committee 
encourages HCFA to consider the development of new screening 
technologies that have the potential to significantly increase 
screening rates when evaluating its reimbursement policy.
    The Committee is aware of the need for a demonstration 
project to determine the applicability of managed care 
principles in the long-term care setting. Federal funding would 
permit a Medicaid demonstration project showing that the 
concept of least restrictive setting can be implemented on a 
trial basis. Outcomes should be measured by such factors as 
life span and length of time patients are not in a nursing home 
or acute care settings. Appropriate sites for this 
demonstration would be rural and urban areas of Ohio, New York, 
Pennsylvania, and Florida.
    The Committee is aware that a recent study by Johns Hopkins 
University indicates that some HIV patients were receiving sub-
standard medical care. The Committee is pleased with the 
success of the treatment demonstration being conducted at the 
AIDS Healthcare Foundation in Los Angeles, and urges the 
Administration to expand the demonstration of residential 
treatment facilities.

Medicare contractors

    The Committee recommends $1,244,000,000 for Medicare 
contractors, which is $30,303,000 less than the 
administration's request and $21,081,000 less than the 
comparable fiscal year 1999 appropriation. This recommendation 
does not include user fees proposed by the administration, to 
charge Medicare providers for processing paper claims and 
duplicate or unprocessable claims and for initial and continued 
enrollment in the Medicare Program. The Committee 
recommendation includes a reduction to reflect its 
understanding that HCFA has changed its approach for processing 
managed care encounter data, resulting in an estimated savings 
of $30,000,000. In addition, $630,000,000 is available for the 
Medicare Integrity Program within the mandatory budget as part 
of the recently enacted health insurance reform legislation.
    Medicare contractors, who are usually insurance companies, 
are responsible for reimbursing Medicare beneficiaries and 
providers in a timely fashion and a fiscally responsible 
manner. These contractors also provide information, guidance, 
and technical support to both providers and beneficiaries.
    The Committee agrees that contracts with States for health 
advisory services programs for Medicare beneficiaries is an 
allowable activity under the Medicare contractor beneficiary 
services budget, and recommends maintaining funding for this 
activity in fiscal year 2000. These contracts would provide 
assistance, counseling, and information activities relating to 
Medicare matters as well as Medicare supplemental policies, 
long-term care insurance, and other health insurance benefit 
information.
    The Committee understands that there are continued 
disparities in reimbursing Medicare covered chiropractic health 
care services that are not applied to other health care 
providers under current law. The Committee urges the Secretary 
of Health and Human Services to review and amend, where 
necessary, its regulations, rules and limits on chiropractic 
health care services under Medicare, and to report to the 
Committee regarding efforts to correct these disparities.

State survey and certification

    Survey and certification activities ensure that 
institutions and agencies providing care to Medicare and 
Medicaid beneficiaries meet Federal health, safety, and program 
standards. Onsite surveys are conducted by State survey 
agencies, with a pool of Federal surveyors performing random 
monitoring surveys.
    The Committee recommends $204,347,000 for Medicare State 
survey and certification activities, an increase of $29,347,000 
over the 1999 level.

Federal administration

    The Committee recommends $477,974,000 for Federal 
administrative costs. This is $4,503,000 less then the 
administration's request. Excluding year 2000 computer 
conversion funds provided in 1999, the recommendation is 
$22,216,000 more then the 1999 level.
    The Committee remains extremely concerned with the amount 
of money lost every year to fraud, waste, and abuse in the 
Medicare program. The Committee has held many hearings and 
taken other corrective actions over a 10-year period to expose 
and reduce these losses. The Balanced Budget Act contains a 
number of important reforms derived from Committee hearings. 
The Committee urges HCFA to promptly utilize these new 
authorities for competitive bidding and improved beneficiary 
information so that savings to Medicare will accrue as quickly 
as possible. Because the Veterans Administration has 
successfully operated competitive bidding programs for medical 
supplies for years, the Committee urges HCFA to contract with 
the VA to carry out a competitive bidding demonstration.
    There is strong evidence, through reports by the General 
Accounting Office, the Department and others that Medicare is 
significantly overpaying for many medical supplies. Therefore, 
the Committee strongly urges prompt use of the Secretary's 
enhanced inherent reasonableness authority on a national basis.
    The Committee has raised its concerns about HCFA and its 
contractors' plans for assuring year 2000 compliance. Without 
appropriate corrective action, Medicare payments could be 
significantly delayed and could result in significant loss of 
confidence among beneficiaries and a reduction of providers 
willing to accept Medicare patients. The Committee is pleased 
with the increased attention the Administrator has placed on 
solving this problem and expects to be briefed on progress to 
compliance. The Committee encourages the Administrator to 
devote sufficient personnel resources to this effort.
    The Committee is pleased with the collaboration of HCFA and 
HRSA in implementing the Children's Health Insurance Program. 
The Committee urges continuing this partnership to assist 
states in developing community-based comprehensive systems of 
quality care so that every child and particularly adolescents, 
may have available appropriate health and mental health 
services. The Committee urges expanded partnership of Medicaid 
and Maternal and Child Health programs at both the federal and 
state level, particularly concerning outreach and systems 
development issues, to assure effective, efficacious and 
efficient use of federal funds.
    The Committee requests that HCFA submit a report prior to 
the fiscal year 2001 appropriations hearings providing an 
estimate of the number of children enrolled in the CHIP, an 
analysis of the obstacles to enrollment, including issues 
related to immigration status, and provide recommendations for 
increasing enrollment of children, as well as recommendations 
for Congress, HHS, and states to better coordinate CHIP with 
other programs serving children.
    The Committee urges HCFA to consider recognizing all health 
professions in allocations for Graduate Medical Education.
    The Committee is pleased that HCFA has recently agreed to 
begin covering pancreas transplantation for Medicare 
beneficiaries.
    The Committee affirms that Congress enacted the Indian 
Health Care Improvement Act with the intention of improving 
access to health care for Native Americans, including access to 
Medicaid-funded services. Congress intended to cover 100 
percent of amounts that states expend for medical assistance 
received through an Indian Health Service facility, including 
contractual and referral arrangements made through IHS. 
Moreover, medical assistance includes the full array of 
services for which a state Medicaid program can claim federal 
matching funds. therefore, the committee urges HCFA to 
reconsider its interpretation of the Indian Health Care 
Improvement Act.
    The Committee understands that Medicare payments for 
pessaries fall below the cost physicians and other women's 
health providers must incur to furnish these prosthetic devices 
to Medicare beneficiaries. Pessaries offer an important 
treatment option for elderly women suffering from uterine 
prolapse. HCFA is urged to review the Medicare payment for 
pessaries in order to insure that its reimbursement policy is 
sufficient to insure access to these devices.
    The Committee understands that health care is moving 
towards an emphasis on primary care and health promotion and 
increasing the role for advanced practice nurses. The Committee 
also understands that Medicare GME provides $200,000,000 for 
nursing. The Committee requests a report by March 1, 2000 on 
how the Medicare Nursing GME needs to be changed to meet 
today's requirements. This report should also include 
recommendations for a demonstration project regarding Medicare 
Nursing GME.
    The Committee is aware of HCFA's decision to reduce funding 
for child neurology residency training programs and urges HCFA 
to continue funding the entire five years required to complete 
the residency requirement.
    There is strong evidence, through reports by the General 
Accounting Office, the Department and others that Medicare is 
significantly overpaying for many medical supplies. Therefore, 
the Committee strongly urges prompt use of the Secretary's 
enhanced inherent reasonableness authority on a national basis.
    The Committee is aware that HCFA recently completed tests 
of commercial off-the-shelf computer software designed to 
reduce Medicare mispayments and found that significant savings 
could be achieved by employing edits from the tested software. 
The Committee urges HCFA to promptly incorporate these edits 
and to test other commercial software for other edits that 
could be used to further increase savings while maintaining 
current Medicare regulations.
    The Committee is pleased that HCFA has moved ahead to 
establish program integrity contracts. These contractors have 
significant potential to reduce losses to the Medicare program. 
The Committee encourages HCFA to fully utilize these 
contractors and to explore the use of companies to recover 
mispayments that have significant experience providing this 
service to major commercial insurers and major employers.
    The Committee is encouraged by HCFA's efforts to strike a 
balance between regulatory flexibility and evidence-based 
requirements linked to anesthesiology outcomes. The Committee 
believes that it is important to move forward on the issue of 
whether or not to defer to states the right to impose 
supervisory or related requirements on the services provided by 
certified registered nurse anesthetists, and urges the 
Secretary of Health and Human Services to finalize regulations 
establishing Medicare conditions of participation for hospitals 
and ambulatory surgical centers relating to anesthesia services 
under Title XVIII of the Social Security Act.
    The Committee encourages the Secretary to encourage 
applications and to select grantees from private, not-for-
profit health systems, particularly those that demonstrate the 
ability to generate private matching funds to create model 
public-private partnerships that enhance integrated systems of 
health care for the working poor.
    The Committee is concerned about the effects of proposed 
outpatient prospective payment system Medicare rules on 
reimbursement for stereotactic radiosurgery and other 
specialized radiation procedures. The Committee urges the 
Health Care Financing Administration, working with patient 
groups and the industry to maintain consistency and inpatient 
reimbursement system. An important element of such consistency 
would include separating stereotactic radiosurgery coding by 
industry segment, and by cost resources and clinical outcomes. 
Due to concerns about jeopardizing patient lives and quality of 
care, HCFA is urged to carefully study before implementing any 
proposed changes to the current practice that stereotactic 
radiosurgery treatment remain exclusively in the hospital based 
inpatient and outpatient system.
    The Committee is encouraged that HCFA is reviewing its 
reimbursement rate for hospitals for the cost of copying 
medical records requested by peer review organizations in their 
audits of Medicare claims and urges HCFA to update that 
reimbursement rate.
    The Committee is pleased that HCFA is working with the 
Social Security Administration and the appropriate State 
agencies in identifying potential Medicare buy-in eligibles. 
The Committee encourages HCFA and the Social Security 
Administration to expand these efforts by placing a specific 
emphasis on identifying and helping states enroll widowed 
spouses who may have recently become eligible due to the 
recalculation of their Social Security benefits upon their 
spouses' death. The Committee urges HCFA to consider a 
demonstration project to provide grants to support new 
enrollment promotion projects among this vulnerable position.
    The Committee is pleased with the progress made to date 
concerning the translation of HCFA materials into Chinese in 
key communities, and encourages the agency to expand this 
effort to include additional Asian and Pacific languages and to 
initiate other outreach efforts. The Committee further urges 
the agency to continue its collaboration with national aging 
organizations with proven experience in serving minority 
elders.
    The Committee urges HCFA to review the requirement of law 
that the Secretary pay hospitals under Medicare an additional 
amount for their costlier, sicker patients. The Committee 
understands that these outlier payments are to be between 5 and 
6 percent of total projected DRG payments. It has been brought 
to the Committee's attention that HCFA has underpaid outliers 
for several years, and to avoid correcting these underpayments, 
is seeking to change the existing payment methodology to avoid 
retroactive adjustments.
    The Committee is extremely concerned over HCFA's failure to 
articulate clear guidelines and to set expeditious timetables 
for consideration of new technologies, procedures and products 
for Medicare coverage. Two particularly troubling examples are 
HCFA's lengthy delays and failure to articulate clear standards 
regarding Medicare coverage of positron emission tomography 
(PET) and lung volume reduction surgery (LVRS). The effect of 
these delays in instituting Medicare coverage is to deny the 
benefits of these technologies and products to Medicare 
patients. The Committee is also concerned that HCFA appears to 
be requiring new technologies to repeat clinical trials and 
testing already successfully completed by the new products in 
the process of gaining FDA approval or in NIH clinical trials 
and which serve as signals to private insurers to cover new 
technologies. The recent creation of a 120-person advisory 
committee to review new technologies is also of some concern to 
the Committee, and the Committee notes that it will be 
observing the new advisory committee to review its costs and to 
see whether its use further delays Medicare coverage of new 
products. Because of the possible duplication of efforts among 
HHS agencies and related unnecessary costs to the Medicare 
program and the Department, the Committee expects that the 
Secretary will take a leadership role in resolving this matter 
expeditiously.
    The Committee strongly urges the Secretary to appoint a 
three-person Medicare-Technology Consumer Advisory Committee. 
The Committee should be appointed from among knowledgeable 
patient advocates and members of the medical community with 
expert knowledge of new technologies and cost-benefit analysis. 
The new Committee should study the current HCFA process for 
determining new coverages and should report at least every six 
months to the Secretary, this Committee and to the general 
public on its findings and recommendations. The Committee will 
also expect to hear from the Secretary during the fiscal year 
2001 hearing, recommendations on streamlining HCFA's approval 
process for Medicare coverage of new technologies and products.

Medicare choice

    The Committee has included bill language giving HCFA the 
authority to collect $95,000,000 in user fees for the costs of 
beneficiary enrollment and dissemination of information for the 
managed care activities now permitted under the Medicare 
Program.
    The Committee recognizes that the enrollment and 
information activities required are new ground for HCFA. The 
Committee also recognizes the value of any data and reporting 
on this and other programs which are designed to improve the 
quality of care and contain costs for Medicare beneficiaries. 
Therefore, the Committee believes HCFA should provide a 
quarterly report to Congress detailing the substance and 
implementation of information being provided to beneficiaries 
and an accounting of its expenditures under section 1857(e)(2) 
as soon as they become available.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

Appropriations, 1999....................................  $3,122,800,000
Budget estimate, 2000...................................   3,216,800,000
Committee recommendation................................   3,291,000,000

    The Committee recommends that $3,291,000,000 be made 
available in fiscal year 2000 for payments to States for child 
support enforcement and family support programs, $74,200,000 
more than the administration request. These payments support 
the States' efforts to promote the self-sufficiency and 
economic security of low-income families. The Committee does 
not agree with the President's recommendation to change the 
match rate for paternity testing or to repeal the provision in 
statute that holds the States harmless from receiving less than 
the fiscal year 1995 State share of collections.
    The Committee recommendation also provides $650,000,000 in 
advance funding for the first quarter of fiscal year 2001 for 
the child support enforcement program. These funds support 
efforts to locate noncustodial parents, determine paternity 
when necessary, and establish and enforce orders of support.
    The Committee recognizes that, because of continued 
uncertainty regarding the actual native populations within each 
State, the funding amounts provided to tribal governments for 
administering TANF may be inadequate.

               low-income home energy assistance program

Appropriations, 1999....................................  $1,100,000,000
Budget estimate, 2000...................................   1,100,000,000
Committee recommendation................................   1,100,000,000

    The Committee recommendation includes a $1,100,000,000 
advance appropriation for fiscal year 2001, the same as the 
budget request. The advance appropriation, as authorized by 
law, gives States greater opportunity for effective program 
planning, including sound allocation of resources among the 
various components of the program.
    LIHEAP grants are awarded to the States, territories, and 
Indian tribes to assist low-income households in meeting the 
costs of home energy. States receive great flexibility in how 
they provide assistance, including direct payments to 
individuals and vendors and direct provision of fuel. LIHEAP 
grants are distributed by a formula defined by statute, based 
in part on each State's share of home energy expenditures by 
low-income households nationwide.
    The Committee recommendation includes an emergency 
allocation of up to $300,000,000 to be made available, only 
upon submission of a formal request designating the need for 
the funds as an emergency, as defined by the Balanced Budget 
and Emergency Deficit Control Act. This is the same level as 
the emergency allocation available in fiscal year 1999.
    The Committee intends that up to $27,500,000 of the amounts 
appropriated for LIHEAP for fiscal year 2000 be used for the 
leveraging incentive fund, which will provide a percentage 
match to States for private or non-Federal public resources 
allocated to low-income energy benefits. Of the fiscal year 
2001 advance appropriation, up to $27,500,000 is recommended 
for the leveraging fund.
    The Committee believes that it would be beneficial for the 
Department to expand its existing clearinghouse contract to 
undertake a national program of information collection and 
dissemination regarding the effects of energy restructuring and 
deregulation on low-income communities and their families.

                     refugee and entrant assistance

Appropriations, 1999....................................    $514,868,000
Budget estimate, 2000...................................     430,500,000
Committee recommendation................................     430,500,000

    The Committee recommends $430,500,000 for refugee and 
entrant assistance, $84,368,000 less than the fiscal year 1999 
level and the same as the budget request. In addition, in the 
fiscal year 1999 supplemental appropriations bill, the 
Committee provided $100,000,000 in emergency appropriations to 
assist in the resettlement of Kosovo refugees.
    Based on an estimated refugee admission ceiling of 116,000, 
this appropriation, together with bill language allowing prior-
year funds to be available for 2000 costs, will enable States 
to continue to provide at least 8 months of cash and medical 
assistance to needy refugees.
    The Refugee Assistance Program is designed to assist States 
in their efforts to assimilate refugees into American society 
as quickly and effectively as possible. The program funds 
State-administered cash and medical assistance, the voluntary 
agency matching grant program, employment services, targeted 
assistance, and preventive health.
    In order to carry out the program, the Committee recommends 
$220,698,000 for transitional and medical assistance, including 
State administration and the voluntary agency program; 
$147,990,000 for social services; $4,835,000 for preventive 
health; and $49,477,000 for targeted assistance.
    The Committee provides $19,000,000 to serve communities 
affected by the Cuban and Haitian entrants and refugees, the 
same as the amount contained in last year's appropriation. The 
Committee also includes $14,000,000 to address the needs of 
refugees and communities affected by recent changes in Federal 
assistance programs, and $16,000,000 to assist communities with 
large concentrations of refugees whose cultural differences 
make assimilation difficult. These funds are included in the 
social services line item.
    The Committee is aware of the Mundelein College at Loyola 
University-Chicago's efforts to provide educational and 
counseling outreach to Chicago's immigrant and refugee 
communities. This program helps facilitate immigrant and 
refugee populations adapt to the American culture, and obtain 
all of the educational and career information needed to help 
them become economically self-sufficient.
    The Committee requests a report by March 1, 2000 on the 
extent to which Hawaii is receiving refugees and immigrants for 
which the federal government is primarily responsible. This 
report should address the country of origin and numbers of 
individuals, and their impact on health care and social 
services.
    The Committee is aware of the valuable work the Voluntary 
Agency Assistance Program is doing to resettle immigrants, 
especially Russian Jews, in the United States. The Committee 
urges $39,000,000 will be used to support grants for the 
Voluntary Agency Grant Program.
    Section 412(a)(7) of title IV of the Immigration and 
Nationality Act authorizes the use of funds appropriated under 
this account to be used to carry out monitoring, evaluation, 
and data collection activities to determine the effectiveness 
of funded programs and to monitor the performance of States and 
other grantees.
    The Committee recommends $7,500,000 to treat and assist 
victims of torture. These funds may also be used to provide 
training to healthcare providers to enable them to treat the 
physical and psychological effects of torture. The Committee 
believes that the Department should use the funds provided for 
torture victims relief in a way that can provide the greatest 
impact. One way to do this is to consider funding organizations 
specifically established to address the rehabilitation and 
social services needs of these victims.

                 child care and development block grant

Appropriations, 1999....................................  $1,182,672,000
Budget estimate, 2000...................................   1,182,672,000
Committee recommendation................................   1,182,672,000

    The Committee recommends an appropriation of $1,182,672,000 
for the advance for the child care and development block grant 
for fiscal year 2001. This is the same as the fiscal year 1999 
level and the administration request.
    These funds provide grants to States to provide low-income 
families with financial assistance for child care; for 
improving the quality and availability of child care; and for 
establishing or expanding child development programs. The funds 
are used to both expand the services provided to individuals 
who need child care in order to work or attend job training or 
education and allow States to continue funding the activities 
previously provided under the consolidated programs.
    The bill provides that $19,120,000 of the amount 
appropriated shall be for the purposes of supporting resource 
and referral programs and before and afterschool services. This 
represents the Federal commitment to the activities previously 
funded under the dependent care block grant. The Committee 
further expects that these funds will not supplant current 
funding dedicated to resource and referral and school age 
activities provided by the child care and development block 
grant. The Committee strongly encourages States to address the 
matters of before and afterschool care and the establishment of 
resource and referral programs with the funds provided in this 
program. The Committee recommendation includes $50,000,000 for 
an infant care quality initiative, the same amount provided in 
fiscal year 1999.
    The Committee understands that the National Association of 
Child Care Resource and Referral Agencies is currently 
operating Child Care Aware, the national toll-free information 
hotline, which links families to local child care services and 
programs. The Committee recognizes that funding from the 
Department would allow the Association to continue to provide 
this critical assistance to parents returning to the workforce.

                      social services block grant

Appropriations, 1999....................................  $1,909,000,000
Budget estimate, 2000...................................   2,380,000,000
Committee recommendation................................   1,050,000,000

    The Committee recommends an appropriation of $1,050,000,000 
for the social services block grant. The recommendation is 
$1,330,000,000 below the budget request and $859,000,000 below 
the 1999 enacted level. The Committee has reduced funding for 
the block grant because of extremely tight budget constraints. 
The Committee believes that the States can supplement the block 
grant amount with funds received through the recent settlements 
with tobacco companies.
    The Committee recognizes that some states have successfully 
pooled resources from the Social Services Block Grant [SSBG] to 
maximize the number of children served under the Child and 
Adult Care Food Program. The Committee believes that the 
Department could provide technical assistance and guidance to 
other states so that they may use SSBG resources to serve more 
children in the CACFP.

                children and families services programs

Appropriations, 1999....................................  $6,054,238,000
Budget estimate, 2000...................................   6,587,953,000
Committee recommendation................................   6,682,635,000

    The Committee recommends an appropriation of $6,682,635,000 
for children and families services programs. This is 
$94,682,000 more than the administration request and 
$628,397,000 more than the fiscal year 1999 appropriation.
    This appropriation provides funding for programs for 
children, youth, and families, the developmentally disabled, 
and Native Americans, as well as Federal administrative costs.

Head Start

    Head Start provides comprehensive development services for 
low-income children and families, emphasizing cognitive and 
language development, socioemotional development, physical and 
mental health, and parent involvement to enable each child to 
develop and function at his or her highest potential. At least 
10 percent of enrollment opportunities in each State are made 
available to children with disabilities.
    The Committee recommends $5,267,000,000 for the Head Start 
Program, an increase of $608,483,000 above the 1999 level and 
the same as the budget request.
    The Committee recommendation includes funding for the 
expansion of the Head Start Program in an amount consistent 
with the bipartisan balanced budget agreement. The expansion 
funds shall be used in a manner which is responsive to the 
needs of each community, as identified in individual needs 
assessments. In addressing the needs of families returning to 
work under welfare reform, the Committee expects the Department 
to focus on full-day, full-year services to children and 
families in need who are presently enrolled in the program.
    Last year, the Congress reauthorized the Head Start 
program. Among other things, the legislation authorized the 
Department to conduct the Head Start National Impact Study to 
assess the success of the program. Because of the historical 
significance of this research and its importance to the future 
of Head Start, the Committee believes that the Department 
should commit the maximum amount of resources authorized for 
this effort.
    The Committee recognizes that Texas A&M; University-Corpus 
Christi's early childhood development center is serving the 
needs of low-income and Hispanic children. The Committee 
believes that a demonstration project, funded by the 
Department, would yield valuable information on children's 
intellectual, language, social, and physical development during 
the first three years of life.
    The Committee applauds the Department's inclusion of 
seasonal farmworker children within the Migrant Head Start 
program. However, the Committee continues to be concerned that 
funding for Migrant Head Start programs has not kept pace with 
other elements of Head Start and has kept children of 
farmworkers from gaining access to Head Start services. On 
average, 40 to 50 percent of eligible children receive Head 
Start services. By comparison, only about 10 percent of 
children of farmworkers who are eligible receive Migrant Head 
Start services.
    The Committee believes that additional funds are needed to 
assist children of farmworker families, and therefore 
recommends that assistance for migrant farmworker children be 
increased above the fiscal year 1999 level. The Committee notes 
that the Department provided only $500,000 in additional 
funding to serve seasonal farmworker children last year. The 
Committee believes that this is not an adequate amount to 
address this critical need.
    The Committee is aware of the Early Childhood Development 
Center in Louisville, Kentucky which provides intervention 
services for infants and preschool children. The Committee 
recognizes that additional funds would allow more children and 
infants to be served.
    The Committee understands the serious need for additional 
and expanded Head Start facilities in rural areas and among 
native American populations. The Committee believes that the 
Department could help serve these needy communities by 
providing minor construction funding for facilities in the 
Alaskan communities of Chevak, Napakiak, Haines, Marshall, 
Noorvik, Selawik, Pilot Station, Hooper Bay, and Dillingham.
    The Committee is increasingly concerned about reports that 
policies and regulations promulgated by the Head Start Bureau 
are neither interpreted nor administered consistently in 
regions around the country. While one of Head Start's most 
attractive factors is the program's responsiveness to local 
community needs and delivery systems, programs in various parts 
of the country should not receive conflicting administrative 
guidance from the Department.
    The Committee believes that the Secretary should ensure 
that adequate numbers of qualified regional office staff be 
assigned to handle the complexity of issues facing Head Start, 
consistent with the funds appropriated to the Department for 
the staffing and management of regional offices. One solution 
to this recurring problem could be the assignment of Head 
Start-specific staff in regional offices. As Head Start embarks 
upon a period of significant investment in quality improvement 
and professional development, the Committee urges the Secretary 
to place adequate staff and management systems in regional 
offices to provide regulatory support for the efforts being 
made in this critical area.

Runaway and homeless youth

    The Committee recommends $43,653,000 for this program, an 
increase of $14,000 above the fiscal year 1999 level and the 
same as the administration request. The Committee has also 
provided an additional $15,000,000 from the violent crime 
reduction program.
    This program addresses the crisis needs of runaway and 
homeless youth and their families through support to local and 
State governments and private agencies. The Runaway and 
Homeless Youth Act requires that 90 percent of the funds be 
allocated to States for the purpose of establishing and 
operating community-based runaway and homeless youth centers, 
on the basis of the State youth population under 18 years of 
age in proportion to the national total. The remaining 10 
percent funds networking and research and demonstration 
activities including the National Toll-Free Communications 
Center. Consolidated within this line item is the transitional 
living for homeless youth program, which awards grants to 
public and private nonprofit entities to address the shelter 
and service needs of homeless youth. Grants are used to develop 
or strengthen community-based programs which assist homeless 
youth in making a smooth transition to productive adulthood and 
social self-sufficiency; and to provide technical assistance to 
transitional living programs for the acquisition and 
maintenance of resources and services.
    The Committee is aware of the progress of the California 
Child, Youth, and Family Coalition in providing runaway and 
homeless youth with a safe place to sleep, food and clothing, 
counseling, educational opportunities, and job training.

Runaway youth--transitional living

    The Committee recommends $19,949,000 for the transitional 
living grant program, an increase of $5,005,000 over last 
year's level. This program provides grants to local public and 
private organizations to address shelter and service needs of 
homeless youth, ages 16-21. The program's goals are to have 
youth safe at home or in appropriate alternative settings and 
to help them develop into independent, contributing members of 
society.
    A homeless youth accepted into the program is eligible to 
receive shelter and services continuously for up to 540 days. 
The services include counseling; life skills training, such as 
money management and housekeeping; interpersonal skill 
building, such as decision-making and priority setting; 
educational advancement; job preparation attainment; and mental 
and physical health care.
    The Committee recognizes a significant unmet need among 
transitional living programs for youth after they leave 
residential care and applaud the successful work of the House 
of Mercy. The Committee believes that continuing this program 
will allow more young people to receive the support that they 
need.

Child abuse prevention programs

    The Committee has included $43,180,000 for child abuse and 
neglect prevention and treatment activities, including 
$21,026,000 for State grants and $22,154,000 for discretionary 
activities. This is $8,012,000 above the fiscal year 1999 level 
and $8,000,000 above the administration request. These programs 
seek to improve and increase activities at all levels of 
government which identify, prevent, and treat child abuse and 
neglect through State grants, technical assistance, research, 
demonstration, and service improvement.
    The Committee recognizes that the Child Abuse Prevention 
and Treatment Act (CAPTA) discretionary grants embody federal 
leadership in supporting innovative program development, 
research, training, technical assistance, and data collection 
to address national issues in child protection. The Committee 
also recognizes the importance of the CAPTA Community-Based 
Family Resource and Support Grants in supporting state efforts 
to strengthen families and communities. The Committee believes 
that some CAPTA funds could be designated to support programs 
that enhance the mental health of at-risk families.
    The Committee is concerned that at-risk families in rural 
areas with highly dispersed populations may not be receiving 
the services they need because offices providing these services 
are not co-located. The Committee recognizes that co-locating 
offices would lower administrative costs and reduce the number 
of stops individuals would have to make in order to receive 
services. The Committee believes that the Department of Health 
and Human Services could be the lead agency on a demonstration 
project and could work with other agencies to develop a one-
stop shopping center approach. Juneau, Alaska would be an ideal 
venue for such a demonstration project since it provides 
services to a significant number of families in a large rural 
area.
    The Committee understands that the Association of Retarded 
Citizens plans to assess and test independent living 
arrangements and study their impact on the ability of the 
mentally retarded to function beyond institutionalized care.
    The Committee is aware of studies that have shown an 
increased incidence of abuse and neglect in families with 
chronically ill and medically fragile members when no respite 
is available to family caregivers. The Committee is further 
aware of indications that there are substantial public savings 
involved, including avoidance or limitation of hospitalization, 
when respite care is available to such families. The Committee 
recognizes that the nationally-recognized Family Friends 
Project has been working with the Allegheny County, PA Respite 
Care Coalition to develop a respite care model. Such a 
demonstration could involve a variety of volunteer and for-
profit respite care agencies and would provide a point of 
access for families requiring respite care, and reduce the cost 
of care by introducing trained volunteers as caregivers.
    The Committee recognizes the innovative work of The 
Children's House on the campus of Hackensack University Medical 
Center in treating victims of child abuse. The program 
coordinates housing, police, and medical facilities in a 
single, nonthreatening environment. The Committee understands 
that if the facility were expanded, it could meet the needs of 
additional numbers of children.
    The Committee is aware of the Hale County School System's 
efforts to deliver hypertension services, child abuse 
prevention counseling, and abstinence and healthy lifestyle 
education to residents of Hale County, AL.
    The Committee recognizes the work of Parents Anonymous, the 
oldest and largest child abuse prevention organization. Through 
funding from the Child Abuse Prevention Act, Parents Anonymous 
works in community-based settings to help at-risk parents 
develop good coping skills. The Committee notes that continued 
funding of Parents Anonymous will strengthen families and their 
communities in the fight against child abuse.
    The Committee is also aware of the efforts of other parent 
self-help organizations that are working to prevent child 
abuse. The Committee recognizes that Child Abuse Prevention Act 
funds would allow these organizations to help more families in 
crisis.
    The Committee has supported Family Place in Louisville, 
Kentucky as a family-centered model for treating victims of 
child abuse. The Committee recognizes that the funding provided 
by the Department in fiscal year 1999 was not sufficient to 
fully support Family Place's protocols. Additional funding 
would allow the demonstration to be conducted in a scientific 
and statistically valid way so it can be determined if this 
program should be replicated nationally.
    The Committee applauds the success of the Healthy Families 
Home Visiting Program in Alaska for its success in preventing 
child abuse. The Committee has learned that Alaska has one of 
the highest rates of child abuse in the nation. The Healthy 
Families Home Visiting Program is supported by the State of 
Alaska, in cooperation with the Bristol Bay Native Association 
and the Rural Alaska Community Action program. The Committee 
believes that incidences of child abuse could be lowered 
dramatically if the Department were to provide additional funds 
to this program. The Committee believes that funding for the 
Better Beginnings project in Alaska would help further address 
the serious child abuse problem in the State.
    The Committee is aware of the efforts of the Texas A&M; 
University-Corpus Christi's early childhood development center 
in assisting low-income children. Recognizing that parents are 
the child's first teachers, the center will focus on ways to 
help parents interact positively with their children. The 
Committee recognizes the value of the center in reducing child 
abuse by teaching parents good coping skills. Strategies to 
reduce child abuse include parenting classes, family nights, 
and home visits.
    The Committee is aware that respite services can prevent 
more costly out-of-home placements by providing planned and 
emergency relief to primary caregivers of individuals with 
disabilities. Respite services can prevent child abuse by 
allowing parents the opportunity to receive periods of relief 
from the enormous burden of caring for their disabled children. 
A national resource center like ARCH has helped many families 
find the respite services they need. The Committee believes 
that continued funding of this resource center will allow more 
families to be served.
    The Committee supports the efforts of the National 
Association of Foster Care Reviewers (NAFCR) in providing 
independent reviews of child foster care cases. The Committee 
encourages the Department to provide technical assistance and 
resources for the dissemination of guidelines for the 
administration of state-based foster care review, especially in 
light of the Department's cooperative agreement with NAFCR.

Abandoned infants assistance

    The Committee concurs with the budget request in 
recommending an appropriation of $12,251,000 for abandoned 
infants assistance, an increase of $4,000 over the 1999 level. 
This program provides financial support to public and private 
entities to develop, implement, and operate demonstration 
projects that will prevent the abandonment of infants and young 
children. Grants provide additional services such as 
identifying and addressing the needs of abandoned infants, 
especially those who are drug exposed or HIV positive; 
providing respite care for families and care givers; and 
assisting abandoned infants and children to reside with their 
natural families or in foster care.

Child welfare

    The Committee recommends an appropriation of $291,989,000 
for child welfare services, the same as the administration 
request and $93,000 above the 1999 level. This program helps 
State public welfare agencies improve their child welfare 
services with the goal of keeping families together. State 
services include: preventive intervention, so that, if 
possible, children will not have to be removed from their 
homes; reunification so that children can return home and 
development of alternative placements like foster care or 
adoption if children cannot remain at home.
    For child welfare training, the Committee recommends 
$7,000,000, the same as the administration request. Under 
section 426, title IV-B discretionary grants are awarded to 
public and private nonprofit institutions of higher learning to 
develop and improve education/training programs and resources 
for child welfare service providers. These grants upgrade the 
skills and qualifications of child welfare workers.
    The Committee supports efforts by colleges and universities 
to enroll American Indian and/or Alaska Natives in masters 
degree programs in social work. The Committee recognizes the 
need to provide field practicum placements of masters degree 
candidates in Indian reservation and rural Indian community 
settings.

Adoption opportunities

    The Committee recommends $26,000,000 for adoption 
opportunities, an increase of $1,008,000 above the fiscal year 
1999 level and $1,363,000 below the administration request. 
This program eliminates barriers to adoption and helps find 
permanent homes for children who would benefit by adoption, 
particularly children with special needs. Since the Committee 
recommendation exceeds $5,000,000, grants for placement of 
minority children and postlegal adoption services, as well as 
grants for improving State efforts to increase placement of 
foster children legally free for adoption, should be made, as 
required by law.
    The Committee recognizes that, under the Adoption and Safe 
Families Act, States are required to use all available 
resources to find homes for children. The Committee is aware 
that the National Adoption Center operates a multi-state, 
technology-based adoption clearinghouse to facilitate placement 
of needy children with adoptive parents.
    The Committee understands that the Department plans to 
implement a national adoption photo listing service on the 
internet to help increase the number of adoptions. The 
Committee supports the idea that a national web site could 
include all youngsters available in public adoptions and will 
increase the likelihood that children will find loving, stable 
homes. The National Adoption Center has been at the forefront 
of developing and implementing technology-based resources to 
help facilitate adoptions and could be instrumental in creating 
a national adoption web site.

Adoption incentives

    The Committee recommends $20,000,000 for adoption 
incentives, the same as the budget request. These funds are 
used to pay States bonuses for increasing their number of 
adoptions. The purpose of this program is to double the number 
of children adopted or permanently placed out of public child 
welfare systems by the year 2002.

Battered women's shelters

    The Committee recommends $13,500,000 for battered women's 
shelters. This amount is in addition to the $88,800,000 
provided under the violent crime reduction programs, bringing 
the total Committee recommendation for battered women's 
shelters to $102,300,000, the same as the administration 
request.

Social services research

    The Committee recommends $36,991,000 for social services 
and income maintenance research, $10,991,000 above the 
administration request. These funds support cutting-edge 
research and evaluation projects in areas of critical national 
interest. Research includes determining services that are more 
cost-effective and alternative ways to increase the economic 
independence of American families.
    Temporary Assistance for Needy Families (TANF) affords 
States more flexibility in the design of programs aimed at 
promoting work over welfare. At the same time, TANF assigns 
greater responsibility for meeting complex information systems 
and federal reporting requirements. To assist in this effort, 
last year the Department called on the State information 
technology consortium to identify information systems issues 
confronting States and to determine best practices for 
resolving those issues. The Committee supports this effort and 
believes that States should work with the consortium to 
determine which best practices are appropriate for their 
particular needs. States could then work with the consortium to 
implement those best practices.
    The Committee remains interested in the University of 
Hawaii Center on the Family's use of Hawaii's ethnically 
diverse population to investigate family coping and resiliency 
in the face of economic distress and changes in social 
policies. The Committee is particularly interested in the role 
of family dynamics and its implications for containment of 
social program costs.
    The Committee continues to support a 5-year demonstration, 
authorized last year, to establish individual development 
accounts (IDAs). IDAs are savings accounts that encourage low-
income families and individuals to acquire productive assets. 
IDAs use private matching funds to promote economic self-
sufficiency by encouraging savings for investments in small 
businesses, homes, and education.

Community-based resource centers

    The Committee recommends $32,835,000 for community-based 
resource centers. This amount, the same as the administration 
request, funds a consolidation of the community-based family 
resource program and the temporary child care and crisis 
nurseries program. This program is intended to assist States in 
implementing and enhancing a statewide system of community-
based, family-centered, family resource programs, and child 
abuse and neglect prevention through innovative funding 
mechanisms and broad collaboration with educational, 
vocational, rehabilitation, health, mental health, employment 
and training, child welfare, and other social services within 
the State. The temporary child care and crisis nurseries serve 
thousands of families with children who have a disability or 
serious illness, and families that are under stress, including 
families affected by HIV/AIDS, homelessness, violence, family 
crisis, and drugs and alcohol.

Developmental disabilities

    The Committee recommends $125,732,000 for developmental 
disabilities programs, which is $6,500,000 higher than the 
request. The Administration on Developmental Disabilities 
supports community-based delivery of services which promote the 
rights of persons of all ages with developmental disabilities. 
Developmental disability is defined as severe, chronic 
disability attributed to mental or physical impairments 
manifested before age 22, which causes substantial limitations 
in major life activities.
    The Committee has recently learned that persons with 
developmental disabilities have died or received life-
threatening injuries because of improper restraints and 
seclusion. The Committee has provided additional resources to 
programs serving the developmentally disabled to help prevent 
the occurrence of any future incidences.

State councils

    For State councils, the Committee recommends $66,803,000. 
In 1987, the Developmental Disabilities Act changed the focus 
of State councils from services provision and demonstration to 
planning and services coordination directed to effecting 
systems change. Since that time, the States have been shifting 
away from their original role of services provision to their 
current mission to effect system change on behalf of persons 
with developmental disabilities.

Protection and advocacy grants

    For protection and advocacy grants, the Committee 
recommends $28,718,000. This formula grant program provides 
funds to States to establish protection and advocacy systems to 
protect the legal and human rights of persons with 
developmental disabilities who are receiving treatment, 
services, or rehabilitation within the State.

Projects of national significance

    The Committee recommends $11,250,000 for projects of 
national significance to assist persons with developmental 
disabilities. This program funds grants and contracts providing 
nationwide impact by developing new technologies and applying 
and demonstrating innovative methods to support the 
independence, productivity, and integration into the community 
of persons with developmental disabilities.
    The Committee recognizes the significant obstacles facing 
persons with developmental disabilities. There is a need for 
additional training for professionals who provide support to 
these individuals. Sertoma Center in Knoxville has a 
distinguished record of serving individuals with disabilities 
through a wide variety of programs and could develop a training 
regime for providers of services for the developmentally 
disabled.
    The Committee understands that the Developmental 
Disabilities Resource Center is a non-profit agency providing 
services to individuals with developmental disabilities who 
live in Front Range communities. The Center provides services 
and programs designed to enhance the quality of life for 
individuals with disabilities and help them learn strategies 
for self-sufficiency.
    The Committee recognizes the importance of the training of 
qualified direct service personnel to provide support to 
individuals with developmental disabilities. Currently, the 
training of direct service personnel is difficult due to the 
fact that half of the 400,000 personnel are part-time working 
nontraditional hours with an annual turnover of 50 percent. In 
order to provide the best quality of care possible to 
individuals with developmental disabilities, the Committee 
supports the development of a national multimedia interactive 
computer-assisted training curriculum for professionals who 
provide support for individuals with developmental 
disabilities.

University-affiliated programs

    For university-affiliated programs, the Committee 
recommends $18,961,000. This program provides operational and 
administrative support for a national network of university-
affiliated programs and satellite centers. Grants are made 
annually to university-affiliated programs and satellite 
centers for interdisciplinary training, exemplary services, 
technical assistance, and information dissemination activities.

State support system

    The Committee concurs with the budget request in 
eliminating line item funding for the state support system.

Native American programs

    The Committee concurs with the budget request in 
recommending $36,922,000 for Native American programs, 
$1,989,000 more than the 1999 level. The Administration for 
Native Americans [ANA] assists Indian tribes and native 
American organizations in planning and implementing long-term 
strategies for social and economic development through the 
funding of direct grants for individual projects, training and 
technical assistance, and research and demonstration programs.
    The Committee is concerned that Native American children 
may be placed in homes without foster care maintenance payments 
to support the cost of food, shelter, clothing, daily 
supervision, school supplies, or liability insurance for the 
child. For children adopted through tribal placements, there 
may be no administrative payments for expenses associated with 
adoption and training of professional staff or parents involved 
in the adoption. The Committee believes that the Department 
could conduct a demonstration in which it would provide funds 
to two Alaska Native Regional non-profit organizations so that 
these organizations could develop a State/Native American 
information system so that Native American children would have 
the same support as other American children. This demonstration 
would not affect the continuation of Tribal-State agreements. 
Cook Inlet Tribal Council, Inc. in Anchorage and Kawerak, Inc. 
in Nome would be well suited for such a demonstration.
    The Committee is aware of a proposal from the Hoonah Indian 
Corporation and the Alaska Native Brotherhood to establish a 
spirit camp to provide tradition-based counseling and 
rehabilitation services for Alaska Native men as an alternative 
to incarceration in certain selected cases. The Committee 
encourages ANA to give serious consideration to a proposal for 
planning funding for this project and notes that the State of 
Alaska Department of Corrections supports the project and will 
be working with the Native organizations to make the project 
self-sustaining once it is established.
    The Committee recognizes the efforts of the Inter-Tribal 
Bison Cooperative in rebuilding bison herds on Indian 
reservations. The Cooperative's efforts have not only restored 
a national treasure, but have brought significant economic 
benefits to participating tribes.

Community services

    The Committee recommends an appropriation of $555,065,000 
for the community services programs. This is $1,676,000 above 
the fiscal year 1999 level and $55,065,000 higher than the 
administration request.
    Within the funds provided, the Committee recommends 
$500,000,000 for the community services block grant [CSBG]. 
These funds are used to make formula grants to States and 
Indian tribes to provide a wide range of services and 
activities to alleviate causes of poverty in communities and to 
assist low-income individuals in becoming self-sufficient. The 
Committee recommendation recognizes the increased demand by the 
low-income population for services provided by CSBG-funded 
community action agencies.
    The Committee bill again contains a provision requiring 
that carryover CSBG funds remain with the local grantee. This 
is the same language that was contained in the fiscal year 1999 
appropriations bill.
    The Committee also expects fiscal year 2000 CSBG funding to 
be allocated to the States in a timely manner. In addition, the 
Committee again expects the Office of Community Services to 
inform the State CSBG grantees of any policy changes affecting 
carryover CSBG funds within a reasonable time after the 
beginning of the Federal fiscal year.
    Several discretionary programs are funded from this 
account. Funding for these programs is recommended at the 
following levels for fiscal year 2000: rural community 
facilities, $3,500,000; national youth sports, $15,000,000; 
community food and nutrition, $6,500,000; and community 
economic development, $30,065,000. Community economic 
development grants are made to private, nonprofit community 
development corporations, which in turn provide technical and 
financial assistance to business and economic development 
projects that target job and business opportunities for low 
income citizens. Of the total provided, the Committee has 
included $5,500,000 for the Job Creation Demonstration 
authorized under the Family Support Act to target community 
development activities to create jobs for people on public 
assistance. As in the past, the Committee expects that a 
priority for grants under this program go to experienced 
community development corporations. The Committee reiterates 
its expectation that national youth sports funds be awarded 
competitively.
    The Committee has provided funding for Rural Community 
Facilities Technical Assistance. Most of the drinking water and 
waste water systems in the country that are not in compliance 
with federal standards are in communities of 3,000 or fewer. 
Rural Community Assistance Programs [RCAPs] use these funds to 
assist a number of communities in gaining access to adequate 
community facilities, gaining financing for new or improved 
water and waste water systems and in complying with federal 
standards.
    The Committee is aware of the excellent work of the 
Community Loan Fund of Southwestern Pennsylvania, Inc. [CLF] in 
serving low-income communities through loans to nonprofit 
organizations and small to medium-sized businesses. CLF targets 
enterprises that are owned or controlled by women, minorities, 
the unemployed, or the underemployed. The Committee believes 
that additional funds from the Department will provide more 
opportunities to serve these disadvantaged groups in struggling 
neighborhoods.
    The Committee continues to support the Job Creation 
Demonstration program, authorized by the Family Support Act. 
Approximately 46 nonprofit organizations have been funded under 
this program since 1990, providing welfare recipients and low 
income individuals an estimated 4,000 new jobs and allowing 
them to start 2,000 new micro-businesses. The Committee 
recognizes that continued and additional funding of the Job 
Creation Demonstration program would provide opportunities for 
more low-income individuals.

Program administration

    The Committee recommends $150,568,000 for program 
administration, $6,114,000 above the fiscal year 1999 
appropriation and the same as the administration request.

Crime reduction programs

    The Committee recommends $105,000,000 for violent crime 
reduction programs, the same as the fiscal year 1999 
appropriation. The Committee notes that an additional 
$51,000,000 for crime bill activities is provided under the 
Centers for Disease Control and Prevention.
    For the runaway youth prevention program, the Committee 
recommends $15,000,000, which is the same as the fiscal year 
1999 appropriation and the administration request. This is a 
discretionary grant program open to private nonprofit agencies 
for the provision of services to runaway, homeless, and street 
youth. Funds may be used for street-based outreach and 
education, including treatment, counseling, provision of 
information, and referrals for these youths, many of whom have 
been subjected to or are at risk of being subjected to sexual 
abuse.
    For the national domestic violence hotline, the Committee 
recommends $1,200,000, which is the same as the administration 
request. This is a cooperative agreement which funds the 
operation of a national, toll-free, 24-hours-a-day telephone 
hotline to provide information and assistance to victims of 
domestic violence.
    The Committee recommends $88,800,000 for the grants for 
battered women's shelters program, the same as the fiscal year 
1999 program level. This is a formula grant program to support 
community-based projects which operate shelters for victims of 
domestic violence. Emphasis is given to projects which provide 
counseling, advocacy, and self-help services to victims and 
their children. The Committee is providing an additional 
$13,500,000 in Children and Families Services Programs for 
battered women's shelters.

                   promoting safe and stable families

Appropriations, 1999....................................    $275,000,000
Budget estimate, 2000...................................     295,000,000
Committee recommendation................................     295,000,000

    The Committee recommends $295,000,000 for fiscal year 2000, 
the same as the amount requested by the administration and 
$20,000,000 above the fiscal year 1999 level. These funds will 
support: (1) community-based family support services to assist 
families before a crisis arises; and (2) innovative child 
welfare services such as family preservation, family 
reunification, and other services for families in crisis. These 
funds include resources to help with the operation of shelters 
for abused and neglected children, giving them a safe haven, 
and providing a centralized location for counseling.

       payments to states for foster care and adoption assistance

Appropriations, 1999....................................  $4,921,500,000
Budget estimate, 2000...................................   5,667,300,000
Committee recommendation................................   5,667,300,000

    The Committee recommends $5,667,300,000 for this account, 
which is the same as the budget request and $745,800,000 more 
than the 1999 comparable level. Also included is the 
administration's request of $1,538,000,000 for an advance 
appropriation for the first quarter of fiscal year 2001 as 
requested by the administration. The Foster Care Program 
provides Federal reimbursement to States for: maintenance 
payments to families and institutions caring for eligible 
foster children, matched at the Federal medical assistance 
percentage [FMAP] rate for each State; and administration and 
training costs to pay for the efficient administration of the 
Foster Care Program, and for training of foster care workers 
and parents.
    The Adoption Assistance Program provides funds to States 
for maintenance costs, and the nonrecurring costs of adoption, 
for children with special needs. The goal of this program is to 
facilitate the placement of hard-to-place children in permanent 
adoptive homes, and thus prevent long, inappropriate stays in 
foster care. As in the Foster Care Program, State 
administrative and training costs are reimbursed under this 
program.

                        Administration on Aging

Appropriations, 1999....................................    $882,339,000
Budget estimate, 2000...................................   1,048,055,000
Committee recommendation................................     928,055,000

    The Committee recommends an appropriation of $928,055,000 
for aging programs, $45,716,000 above the 1999 appropriation 
and $120,000,000 below the administration request.

Supportive services and senior centers

    The Committee recommends an appropriation of $310,082,000 
for supportive services and senior centers, the same amount as 
requested by the administration and $9,890,000 more than the 
amount appropriated in fiscal year 1999. The increased funding 
will allow in-house services for frail older individuals to 
continue at last year's level. This State formula grant program 
funds a wide range of social services for the elderly, 
including multipurpose senior centers and ombudsman activities. 
State agencies on aging award funds to designated area agencies 
on aging who in turn make awards to local services providers. 
All individuals age 60 and over are eligible for services, 
although, by law, priority is given to serving those who are in 
the greatest economic and social need, with particular 
attention to low-income minority older individuals. Under the 
basic law, States have the option to transfer up to 20 percent 
of funds appropriated between the senior centers program and 
the nutrition programs which allows the State to determine 
where the resources are most needed.

Ombudsman/elder abuse

    The Committee recommends $8,449,000 for the ombudsman 
services program and $4,732,000 for the prevention of elder 
abuse program. The amount recommended for the ombudsman 
services program is $1,000,000 more than the fiscal year 1999 
level. The amount recommended for the elder abuse prevention 
program is the same as the fiscal year 1999 level. Both 
programs provide formula grants to States to prevent the abuse, 
neglect, and exploitation of older individuals. The ombudsman 
program focuses on the needs of residents of nursing homes and 
board and care facilities, while elder abuse prevention targets 
its message to the elderly community at large.
    The Committee supports continued and additional funding for 
the long-term care ombudsman resource center and its training 
and clearinghouse functions, which provide information, 
technical assistance, programmatic, and other support for State 
and regional long-term care ombudsmen.

Preventive health services

    The Committee recommends $16,123,000 for preventive health 
services, the same amount as the budget request and the amount 
appropriated in fiscal year 1999. Funds appropriated for this 
activity are part of the comprehensive and coordinated service 
systems targeted to those elderly most in need. Preventive 
health services include nutritional counseling and education, 
exercise programs, health screening and assessments, and 
prevention of depression.

Congregate and home-delivered nutrition services

    For congregate nutrition services, the Committee recommends 
an appropriation of $374,412,000, the same amount as the budget 
request and $154,000 more than the amount appropriated in 
fiscal year 1999. For home-delivered meals, the Committee 
recommends $147,000,000, the same as the amount recommended by 
the administration and $35,000,000 more than the amount 
appropriated in fiscal year 1999. These programs address the 
nutritional need of older individuals. Projects funded must 
make home-delivered and congregate meals available at least 
once a day, 5 days a week, and each meal must meet one-third of 
the minimum daily dietary requirements. While States receive 
separate allotments of funds for congregate and home-delivered 
nutrition services and support services, they are permitted to 
transfer up to 30 percent of funds between these programs.
    The Committee has included a provision carried in last 
year's bill which requires the Assistant Secretary to provide 
the maximum flexibility to applicants who seek to take into 
account subsistence, local customs, and other characteristics 
that are appropriate to the unique cultural, regional, and 
geographic needs. The provision clarifies that applicants who 
serve American Indian, native Hawaiian, and Alaska Native 
recipients in highly rural and geographically isolated areas 
are permitted to continue to tailor nutrition services that are 
appropriate to the circumstances associated with the served 
population.

In-home services for frail older individuals

    The Committee agrees with the President's request to 
include in-home services for frail older individuals in the 
supportive services and centers program. The Committee has 
provided additional funds in that program to allow these in-
home services to continue.

Aging grants to Indian tribes and native Hawaiian organizations

    The Committee recommends $18,457,000 for grants to Indian 
tribes, the same amount as the budget request and the amount 
appropriated in fiscal year 1999. Under this program awards are 
made to tribal and Alaskan Native organizations and to public 
or nonprofit private organizations serving native Hawaiians 
which represent at least 50 percent Indians or Alaskan Natives 
60 years of age or older to provide a broad range of services 
and assure that nutrition services and information and 
assistance services are available.

State and local innovations/projects of national significance

    The Committee recommends $26,000,000 for aging research, 
training, and discretionary programs, $8,000,000 more than the 
fiscal year 1999 enacted level and the budget request. These 
funds support activities designed to expand public 
understanding of aging and the aging process, test innovative 
ideas and programs to serve older individuals, and provide 
technical assistance to agencies who administer the Older 
Americans Act. The Committee has included funding for a 
national program of statewide senior legal services hotlines 
and related elder rights projects.
    Three years ago, the Committee provided funds to launch a 
``Senior Waste Patrol'' pilot project to test the best ways of 
using the skills of retired nurses, doctors, accountants and 
other professionals to train seniors and to serve as expert 
resources to detect and stop Medicare fraud, waste and abuse. 
These pilots have proven quite successful in activating seniors 
in the effort to protect Medicare from unnecessary losses. The 
project has now been expanded to 36 states. The Committee has 
provided $10,000,000 to expand this project nationwide and to 
expand efforts in states currently receiving grants. The 
Committee expects that these funds will be used to make grants 
and that administrative costs will be minimized.
    The Committee recognizes the efforts of the National Asian 
Pacific Center on Aging to develop, strengthen, and expand 
linkages of a rapidly growing Asian Pacific aging community 
with local, State, and national community service providers and 
organizations.
    The Committee recommendation includes sufficient funds for 
the pension information and counseling demonstration program, 
authorized under title IV of the Older Americans Act, to 
continue the existing demonstration projects, technical 
assistance and training projects. Pension counseling projects 
provide information, advice, and assistance to workers and 
retirees about pension plans, benefits, and pursuing claims 
when pension problems arise.
    The Committee recognizes the efforts of the City of 
Norwalk's Adult Day Care Services to individuals afflicted with 
Alzheimer's Disease and other dementia. The Adult Day Care 
Program allows families to rest 8 hours per week from the 
strains of care-giving.
    The Committee commends the Family Friends Project for its 
work in training senior volunteers to provide respite to 
families whose members have chronic illnesses, disabilities, 
and related problems. The Committee is aware that the program 
provides obvious benefits to families receiving the assistance, 
as well as savings of public dollars by allowing families to 
continue to provide in-home care.
    The Committee is aware of the Anchorage Senior Center's 
success in providing services to elderly Alaskans. The Center 
provides fitness facilities, educational opportunities, and 
leisure activities to seniors that would not otherwise have 
access to these services. With additional funds, the Center 
would be able to make the lives of more seniors active and 
productive.
    The Committee is aware that counties in southern Illinois 
have twice the national percentage of individuals aged 65 and 
over who suffer from chronic diseases. The Committee recognizes 
that the Aging and Outreach Institute at Southern Illinois 
University in Carbondale could address these problems with 
post-graduate training for healthcare workers; support, 
training, and information to family members; and guidance for 
facilities that care for the elderly.
    The Committee understands that the newly-established Texas 
Tech University Center for Aging is a state-of-the-art teaching 
nursing home and geriatric outpatient clinic that is providing 
comprehensive care to patients, training, and education to care 
providers, and research on health and aging issues. With 
additional funds, the Center will be able to provide services 
for more patients and training for more students specializing 
in geriatric care.
    The Committee continues to support the efforts of the 
Northwest Area Center for Studies on Aging, which is currently 
using existing telemedicine and video conferencing technology 
to improve the health status of aging Americans residing in 
underserved rural areas and is educating physicians and health 
care professionals in those areas.
    The Committee is aware that Montana State University-
Billings proposes to develop a telemedicine program in 
collaboration with the area's medical facilities. The focus of 
the project would be on serving nursing homes and assistive 
care facilities.
    The Committee understands that West Virginia University's 
Rural Aging Project is working to plan and implement the Year 
2000 International Conference on Rural Aging. The Committee is 
supportive of efforts to understand and address the many issues 
facing individuals as they age.
    The Committee applauds the work of the Senior Outreach 
Center at the Sinai Family Health Centers in Chicago. The 
program, which features physician-led health screening visits 
to seniors in low-income housing facilities, could provide 
services to additional seniors if adequate funding were 
provided.
    The Committee is aware of the efforts of the National 
Resource Centers on Native American Aging, located at the 
University of North Dakota and the University of Colorado, in 
providing aging-related research, training, and technical 
assistance to American Indians, Alaskan Natives, and Native 
Hawaiians.
    The rapidly escalating cost of nursing home services is one 
of the greatest challenges facing rural communities in the 
Northeast. The Committee is aware of a proposal by Elderly 
Services, Inc. in Middlebury, Vermont, that would serve as a 
national model for the provision of cost-effective, adult 
daycare and healthcare services for Alzheimer's patients in 
rural settings.
    The Committee continues to have a strong interest in 
efforts to promote seniors' access to health information and 
senior services through the World Wide Web. In this regard, the 
Committee recognizes the continued efforts of the Setting 
Priorities for Retirement Years Foundation [SPRY], and looks 
forward to the results of such outreach efforts.
    The Committee supports the efforts of the agency in 
implementing the Government Performance and Results Act and 
believes that the agency should continue work in this area.
    The Committee supports the continuation of the elder care 
locator program, a toll-free telephone service for older 
Americans and their caregivers. The Committee notes that the 
National Association of Area Agencies on Aging is currently 
providing this service.

Alzheimer's Disease Demonstration Grants to States

    As a result of the aging of the Baby Boom generation, the 
number of individuals affected by Alzheimer's Disease will 
double in the next twenty years. These demonstration grants 
generate models for addressing the social supports needed by 
individuals with Alzheimer's Disease and their families. The 
Committee recommends a funding level of $5,970,000, the same as 
the fiscal year 1999 level and the Administration's request.

National Family Caregiver Support

    The Committee does not recommend funding for the National 
Family Caregiver Support Program because this program requires 
new authorizing legislation.

Health Disparities Interventions

    The Committee has included an increase of $25,003,000 over 
the fiscal year 1999 level for a health disparities 
demonstration within the Centers for Disease Control and 
Prevention [CDC]. These funds will support prevention 
activities to eliminate health disparities among racial and 
ethnic minorities. The Committee expects that CDC will use a 
portion of these funds to partner with the Administration on 
Aging to provide culturally appropriate prevention activities 
aimed at minority elders.

Program administration

    The Committee recommends $16,830,000 to support Federal 
staff that administer the programs in the Administration on 
Aging, the same amount as the budget request and $1,435,000 
above the 1999 level. These funds provide administrative and 
management support for programs administered by the Department.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 1999....................................    $261,761,000
Budget estimate, 2000...................................     217,412,000
Committee recommendation................................     199,720,000

    The Committee recommends $199,720,000 for general 
departmental management [GDM]. This is $17,692,000 below the 
administration request and $62,041,000 below the fiscal year 
1999 level, which included new funding from an emergency fund. 
Within this amount, the Committee includes the transfer of 
$6,517,000 from Medicare trust funds, which is the same as the 
administration request and the fiscal year 1999 level.
    This appropriation supports those activities that are 
associated with the Secretary's role as policy officer and 
general manager of the Department. It supports certain health 
activities performed by the Office of Public Health and 
Science, including the Office of the Surgeon General. GDM funds 
also support the Department's centralized services carried out 
by several Office of the Secretary staff divisions, including 
personnel management, administrative and management services, 
information resources management, intergovernmental relations, 
legal services, planning and evaluation, finance and 
accounting, and external affairs.
    The Office of the Surgeon General, in addition to its other 
responsibilities, provides leadership and management oversight 
for the PHS Commissioned Corps, including the involvement of 
the Corps in departmental emergency preparedness and response 
activities.
    The Committee is aware of the unique capabilities of the 
Commissioned Corps of the U.S. Public Health Service and its 
inactive reserve. It has been brought to the Committee's 
attention that the ability of the Corps and the reserve to 
respond to biosecurity incidents may be impeded by the Surgeon 
General's lack of direct authority over all PHS officers, which 
is a result from a diversity of officer assignments both within 
and outside the department. The Committee urges the Secretary 
to review this situation and act to ensure that, in the event 
of a biosecurity incident or other national emergency, the 
Surgeon General has the necessary authority to direct the 
response of all Commissioned Corps officers, regardless of the 
agency to which the officer is assigned.
    U.S.-Mexico Border Health Commission.--The Committee has 
provided $1,500,000 to support the activities of the United 
States-Mexico Border Health Commission as authorized by Public 
Law 103-400. The Commission is authorized to assess and resolve 
current and potential health problems that affect the general 
population of the United States-Mexico border area. The 
Committee urges the department and the commission to carefully 
consider locating its permanent offices of the secretariat in 
El Paso, Texas, in partnership with the consortium of 
universities and other entities supporting the creation of a 
border health institute in El Paso. The Committee further 
encourages the department and the commission to consider 
funding and otherwise promoting the Baylor College of 
Dentistry's health outreach initiative to study, diagnose, and 
treat craniofacial deformities along the border.
    The Committee has included $700,000 for the Human Services 
Transportation Technical Assistance Program, which is the same 
as last year's amount. As in previous years, this program is to 
be administered by a national membership organization with 
expertise in working with local transit organizations. The 
program provides technical assistance and training to 
organizations that provide transportation services to the 
elderly, people with physical and developmental disabilities, 
and the economically disadvantaged. With these funds, the 
Committee expects a continued emphasis on assisting communities 
with transportation issues related to welfare reform since in 
many rural communities the largest obstacle in gaining 
employment is transportation to work sites. The Committee 
further expects the technical assistance to be provided include 
developing strategies for cost-effective transportation under 
Medicaid. The Committee also notes that the technical 
assistance provided by the Community Transportation Association 
of America is vital to the success of this project. To improve 
coordination, the Committee will expect that the funds made 
available under this program be allocated to a national 
membership organization with a demonstrated record of 
achievement in this area.
    The Committee also expects this program to initiate a new 
activity. States are increasingly looking for new and 
innovative approaches to provide nonemergency transportation 
through the Medicaid Program. As more medical services are 
being provided through managed care, States are also looking at 
means to contain transportation costs. The Committee expects 
the Department to work with the Community Transportation 
Association of America to develop a program of assistance for 
local communities find efficient ways to provide medical 
transportation services. The Committee also notes that the 
technical assistance provided by the Community Transportation 
Association of America is vital to the success of this project.
    The Committee reiterates its support of the Chronic Fatigue 
Syndrome Coordinating Committee [DHHS CFSCC]. The Committee 
urges the DHHS CFSCC to coordinate CFIDS research across the 
Public Health Service by defining priorities and creating a 
yearly action plan and recommends that the chartered committee 
conduct oversight into DHHS and SSA programs, evaluate program 
performance, review budget allocations, and identify priorities 
in CFS research and education. The Committee supports the 
renewal of the CFSCC's charter beyond its scheduled expiration 
in 1998.
    The Committee urges the development of a national media 
campaign targeting, but not limited to, adolescent girls and 
women, to educate them about healthy eating behaviors, positive 
body image, and self-esteem. The Secretary should consult 
widely among those agencies of the Public Health Service that 
could contribute content to the effort. The program should also 
educate the public about the risks of restrictive dieting and 
the prevention of eating disorders. Such programs may include 
development of a toll-free number and information clearinghouse 
on eating disorders.
    The Committee is aware of the high number of accidental 
needle-stick injuries that occur primarily to health care 
workers. These injuries are major risk factors for the 
transmission of HIV, hepatitis B, and hepatitis C. The 
Committee urges the Centers for Disease Control and Prevention, 
the National Institute for Occupational Safety and Health, the 
Food and Drug Administration, and the Occupational Safety and 
Health Administration of the Department of Labor to make 
reduction of accidental needle sticks a priority by increasing 
cooperation among these agencies and taking all necessary 
actions to address this serious public health problem.
    The Committee encourages the National Heart, Lung, and 
Blood Institute to continue its efforts to persuade the 
National Committee for Quality Assurance to accredit health 
plans based on their ability to reach treatment goals 
established by the National Cholesterol Education Program in 
treating patients with hypercholesterolemia. Further, the 
Committee expects the Health Care Financing Administration to 
encourage health care plans that treat cholesterol patients 
enrolled in the Medicaid and Medicare programs to pursue 
vigorous management of the disease resulting in the attainment 
of the treatment goals established by the National Cholesterol 
Education Program.
    The Committee is supportive of efforts to coordinate a 
strategy to reduce the incidence of fetal alcohol syndrome 
[FAS] and fetal alcohol effects [FAE]. The Department is 
encouraged to identify resources among the agencies to initiate 
a national task force on FAS and FAE.
    The Committee remains concerned about the disproportionate 
environmental and human health burdens in low-income and 
minority communities, and about the insufficient resources 
being targeted to community health centers to conduct research 
and to develop effective intervention and prevention 
strategies. The Committee urges the Department to identify 
potential interagency resources and cooperation with community 
health centers. The Committee expects to be informed within 6 
months on what steps have been taken to address this 
recommendation.
    Commission on Background Screening for Long-Term Care 
Facilities.--The Committee is aware of increasing numbers of 
reports of people with abusive and criminal backgrounds finding 
work in direct patient care in Medicare and Medicaid long-term 
care facilities. Reports indicate that known abusers can travel 
between States and between facilities and continue to attack 
vulnerable patients. The Committee believes that a national 
system should be considered to screen potential employees at 
long-term care facilities to ensure that they do not have an 
abusive or criminal background and to ensure they do not work 
with patients.
    Microbicide Research.--The Committee is aware of the need 
for HIV and STD prevention technologies and of the scientific 
opportunity in the field of microbicides. Microbicide research 
and development holds high promise for new products and urges 
the Department to continue supporting microbicide research. The 
Committee encourages the Secretary and the Director of the NIH 
to develop an integrated, coordinated strategy directed toward 
microbicide research and development in which clear lines of 
responsibility are identified. All available resources should 
be identified to promote development in this area.
    The Committee is aware of the work of the Department's 
Advisory Committee on Blood Safety and Availability. Persons 
with primary immune deficiency disorders represent a 
significant population dependent upon blood products to 
maintain their health. As opportunities permit, the Committee 
continues to encourage the Department to appoint a 
representative who has expertise in primary immune deficiency 
diseases to the advisory committee.
    The Committee recommends the development of an innovative 
service delivery model and day health center facility to care 
for the elderly. The Committee recognizes the multi-
disciplinary management program operated by the Albert Einstein 
Healthcare Network in Philadelphia, PA.
    The Secretary is urged to develop a report to Congress on 
selected states' Children's Health Insurance Program. The 
report should include the following items furnished by the 
states (1) an estimate of the number of children enrolled; (2) 
an analysis of the obstacles to enrollment of eligible 
children, including obstacles related to a child's immigration 
status; and (3) recommendations for increasing enrollment of 
children in the programs, including recommendations for 
Congress, for HHS and for the states concerning coordination 
with other programs serving children.
    The Committee notes the constructive role played by the 
Office of the Secretary and its Office of Public Health and 
Science in the development and support of the Smoke-Free Kids & 
Soccer program. The program warrants continued support by the 
Department as it holds great promise in offering adolescent 
girls and their families ways to resist the pressure to smoke 
through sports participation. The Committee believes there may 
be additional ways to work collaboratively with the community 
to support other important public health objectives, such as 
nutrition and physical activity, while maintaining a commitment 
to reducing underage tobacco use. The Committee recommends that 
the Department convene an interagency panel including 
representation from CDC, NIH and private and nonprofit sectors 
to determine the most effective means for developing and 
evaluating such an activity.
    The Committee is aware of the efforts by the University of 
Vermont Cancer Center to enhance teaching, research, and 
clinical outreach through the acquisition of state-of-the-art 
instrumentation, and encourages the Department to consider 
means to assist the center.
    Promoting reading and literacy.--The Committee has received 
information supporting reading aloud to young children as a 
means of enhancing their language abilities and cognitive 
development. The Committee is aware that a program at Boston 
Medical Center called ``Reach Out and Read'' treats early 
literacy development as a medical issue similar to 
immunizations for young children, and seeks to integrate 
reading with physical examinations that children receive 
between six months and five years of age. This program has been 
replicated through pediatric health care providers at many 
sites with the goal of improving early literacy development for 
children of low-income parents. The Committee urges the 
Department to support early literacy programs that train 
pediatric health care providers, clinic staff, administrators 
and volunteers to engage low-income parents and their children 
in daily reading activities as part of each well-child 
examination. Health care providers can help parents select, 
order, and provide age-appropriate reading materials at each 
well-child examination, and encourage parents to read to their 
children as a means of strengthening the bond between parent 
and child.
    The Committee is aware of the proposal for an integrative 
medicine program which combines conventional medical science 
with promising alternative therapies. The Committee is further 
aware of the programs now being conducted at the Center for 
Integrative Medicine at Thomas Jefferson University Hospital in 
Philadelphia, Pennsylvania.
    The Committee is aware of a proposal by the American Red 
Cross to develop a technology demonstration program using new 
generation blood-testing equipment.
    It has been brought to the Committee's attention that new 
technologies can foster the creation of ``customized on line 
real time'' markets, which can help purchasers of goods and 
services realize substantial savings. Private companies who 
have utilized such technology have already seen large cost 
reductions in their procurement decisions. It is essential that 
the federal government determine whether customized on line 
real time markets can help realize procurement savings. The 
Committee encourages the Department to conduct demonstration 
procurements in the coming fiscal year utilizing this 
technology as a means of determining its feasibility as a 
federal procurement option.
    The Committee understands that the most critical years in 
brain development are from birth to age 3. The foundation for a 
child's future is formed during this crucial time. The 
Committee believes that each parent should have access to 
materials to help them promote their child's intellectual, 
social, and emotional development. The ``I am your child'' 
materials are an important tool, since they include parent 
training materials, as well as referral information on existing 
state and federal programs. These materials could be provided 
through a network of OB/GYNs, pediatricians, nurses, and other 
health care providers, in consultation with the American 
Academy of Pediatrics.
    Children's health.--The Committee is aware of efforts by 
the Public Health Policy Advisory Board to examine the leading 
causes and contributing risk factors of mortality and morbidity 
among children. The Committee urges the Surgeon General, in 
conjunction with other agencies and non-profit entities, to 
establish a process to select health priorities based on clear 
scientific data with direct relevance to emerging threats to 
children's health. Such a process could identify projects that 
examine underage drinking, unintentional injuries, homicides, 
suicides, morbidity, characteristics of family and community 
structure, violence, etc. The Committee urges the Surgeon 
General to build upon these initiatives in order to allow for 
broader dissemination of information critical to the health of 
our nation's children.
    Obesity.--The Committee is aware of the increasing economic 
costs to the nation resulting from obesity, which leads to 
health complications and loss of productivity. It has been 
estimated that more than half of all Americans adults are 
deemed overweight or obese. Obesity rates have doubled in 
children over the last decade and approximately one-half of 
obese school-age children go on to become obese adults. The 
Committee urges the Secretary to convene a summit on obesity 
policy to develop a national strategic plan to prevent obesity. 
The summit should assemble policy makers and leading 
researchers in obesity, nutrition, physical activity, and 
community-based health promotion. The Secretary should consult 
with and involve other relevant government agencies. The 
Committee also encourages the Surgeon General to to consider 
developing a report on obesity prevention.
    It has been brought to the Committee's attention that the 
Surgeon General is substantially overdue in filing a report 
specified by the Preventive Health Amendments of 1993 (Public 
Law 103-183), namely the Surgeon General's Report on Nutrition 
and Health which was to focus on dietary fat was due in 
February 1995. The Committee urges the Surgeon General to 
complete and publish that report as soon as possible.
    National Health Museum.--The Committee is aware of efforts 
to secure incentive funds to cover a share of the costs of 
program and site development for the National Health Museum in 
Washington, D.C. Such funds could be made available until 
expended and be contingent upon their being matched by non-
Federal, private sector contributions. The Department is urged 
to consider this proposal.

Adolescent family life

    The Committee has provided $19,700,000 for the Adolescent 
Family Life Program [AFL]. This is $10,500,000 more than the 
administration request and is $2,000,000 above the fiscal year 
1999 appropriation.
    AFL is the only Federal program focused directly on the 
issue of adolescent sexuality, pregnancy, and parenting. 
Through demonstration grants and contracts, AFL focuses on a 
comprehensive range of health, educational, and social services 
needed to improve the health of adolescents, including the 
complex issues of early adolescent sexuality, pregnancy, and 
parenting.
    Within the total provided, the Committee continues the 
prevention projects begun in fiscal year 1998, as well as new 
prevention projects. The Committee again expects the Department 
to fund new prevention projects which enable smaller 
communities to begin the organization and implementation of 
coalitions to implement abstinence-based education programs. 
The Committee again expects the Department, when announcing 
grant competitions, to provide a reasonable length of time for 
applicants to complete application packages, provide extensive 
technical assistance to applicants, with special assistance 
given to new applicants, and revise the terminology and 
instructions in grant applications to assure that the 
information being requested is as clear as possible.

Physical fitness and sports

    The Committee recommends $1,097,000 for the Federal staff 
which supports the President's Council on Physical Fitness and 
Sports. This is the same as the administration request and 
$92,000 more than the fiscal year 1999 appropriation.
    The President's Council on Physical Fitness and Sports 
serves as a catalyst for promoting increased physical activity/
fitness and sports participation for Americans of all ages and 
abilities, in accordance with Executive Order 12345, as 
amended. The programs sponsored by PCPFS are supported largely 
through private sector partnerships.

Minority health

    The Committee recommends $28,000,000 for the Office of 
Minority Health. This is $8,000,000 less than the fiscal year 
1999 appropriation and the same as the administration request.
    The Office of Minority Health [OMH] focuses on strategies 
designed to decrease the disparities and to improve the health 
status of racial and ethnic minority populations in the United 
States. OMH establishes goals, and coordinates all departmental 
activity related to improving health outcomes for disadvantaged 
and minority individuals. OMH supports several demonstration 
projects, including the Minority Community Health Coalition, 
the Bilingual/Bicultural Service, the Center for Linguistic and 
Cultural Competency in Health Care, and the Family and 
Community Violence Prevention Program.
    The Committee recognizes the need to encourage minority 
development of family practice physicians and encourages the 
Office to assist programs designed for the purpose of direct 
and indirect support of family practice residency programs 
which focus on training, recruitment, and retention of 
minorities, including American Indian and Alaska Natives, as 
family practice physicians.
    The Committee is supportive of the work of the Philadelphia 
Citywide project, initiated with OMH funding in fiscal year 
1999, and expects that it be continued at current levels.
    The Committee is pleased with the effort by the Children's 
Hospital of Philadelphia to confront the causes of asthma in 
underserved populations. The hospital now proposes a 
demonstration to expand the effort to involve direct 
intervention of environmental factors in the home among a 
number of households in west Philadelphia. Sufficient funds are 
available to initiate this project.
    The Committee is aware of the proposal by Southcoast Health 
System to serve minority and under-served populations in the 
New Bedford/Fall River area of Massachusetts.
    The Committee recognizes that there are few comprehensive 
care programs that support children with brain tumors and their 
families over the long term and none that serve a large 
economically disadvantaged population. The Committee is aware 
of the efforts by the NYU School of Medicine and the Stephen 
Hassenfeld Children's Center to establish a demonstration 
program which will serve as a model for providing comprehensive 
care to disadvantaged and minority children with brain tumors.
    The Committee is aware of the effort by New York 
University's children's center for cancer and blood disorders 
to develop a pediatric oncology program.
    The Committee encourages the expansion of the multi-
disciplinary team approach which has been proven effective in 
the management of sickle cell disease so that a broader patient 
base can be served, including children and adolescents. The 
Committee is aware that such a program is currently being 
conducted in Philadelphia by Thomas Jefferson University 
Hospital and the Albert Einstein Medical Center.
    The Committee continues to support implementation of campus 
and community violence prevention programs administered through 
the Office of Minority Health. The innovative campus and 
community prevention programs developed by the member colleges 
and universities of the Minority Males Consortium have 
demonstrated their impact and should be strengthened and 
expanded.
    The Committee is aware of the efforts by the CORE Center at 
Cook County Hospital in Chicago, Illinois to develop a model 
HIV/AIDS education and training center that incorporates modern 
technology.

Office on Women's Health

    The Committee recommends $15,495,000 for the Office on 
Women's Health. This is $2,027,000 less than the administration 
request and the same as the fiscal year 1999 appropriation.
    The PHS Office on Women's Health [OWH] develops, 
stimulates, and coordinates women's health research, health 
care services, and public and health professional education and 
training across HHS agencies. It advances important 
crosscutting initiatives and develops public-private 
partnerships, providing leadership and policy direction, and 
initiating and synthesizing program activities to redress the 
disparities in women's health.
    Moreover, in view of the disparities in women's health 
research, services, and education and training, the Committee 
believes that one mechanism through which these inequities can 
be resolved is through providing support through various 
mechanisms to academic, consumer, health care professional, and 
community groups in this important area. To that end, the 
Committee urges that the PHS OWH develop and support programs 
to support crosscutting research, services, innovative 
partnerships, and demonstrations that will advance women's 
health.
    Within the amount provided, the Committee has included 
sufficient funds to support continued implementation of the 
National Women's Health Information Center. This Center in 
partnership with the Department of Defense, provides a single 
access point to Federal information on women's health through a 
toll-free telephone number and the Internet, and links to over 
1,000 private sector resources as well. Consumers, researchers, 
health professionals, women's health advocates and the media 
will have access to the wide variety of information and 
resources on women's health that has been created by the 
various agencies of the Department of Health and Human 
Services, in partnership with the Department of Defense and all 
other agencies in the Federal Government.
    The National Centers of Excellence in Women's Health 
Program, established in fiscal year 1996 by the PHS OWH, 
through contracts to academic health centers around the Nation, 
is developing model health care services, multidisciplinary 
research, public and health care professional education on 
women's health, and fostering leadership opportunities for 
women's health care professionals. The Committee has provided 
funds to continue funding the existing centers established in 
1996 and to support additional new centers.
    The Committee has also included funds for women's health 
coordinators. Regional coordinators have been established in 
the 10 Public Health Service regions around the Nation and link 
together all of the resources available from the Department of 
Health and Human Services. The Committee has included funds to 
coordinate and stimulate women's health activities to work with 
women's groups and health care professionals at the regional, 
State, and local levels and to develop regional women's health 
activities in each of the 50 States.
    Osteoporosis.--Osteoporosis is today a major health problem 
that the World Health Organization has characterized as an 
epidemic with an estimated 28 million individuals who either 
have or are at risk for the disease. A task force convened by 
the Office of Public Health and Science on Women's Health, in 
conjunction with the National Osteoporosis Foundation has 
determined that a public education campaign is needed. In its 
first stage, the campaign targets girls and teenage women from 
the ages of 9 to 18, to help them develop positive health 
behaviors such as diet, exercise, adequate calcium intake, that 
would have a significant effect upon sustained bone strength. 
Within the amount recommended, the Committee has included 
$3,000,000 in funds to continue this campaign.

Office of Emergency Preparedness

    The Committee has provided $9,668,000, which is $15,332,000 
less than last year's level and the same as the President's 
amended request, for activities to counter the adverse health 
and medical consequences from major terrorist events. Within 
this amount, sufficient funds are provided for the Office of 
Emergency Preparedness to staff and administer this program, as 
well as the other OEP activities specified in the 
administration's request. The amount provided by the Committee 
is intended to continue the formation of new metropolitan 
medical strike teams in key uncovered urban areas of the 
country. The Committee has provided additional funding for 
bioterrorism within the public health and social services 
emergency fund.
    The Department has lead responsibility for health, medical, 
and health-related support under the Federal response plan to 
catastrophic disasters. On behalf of the Department, the Office 
of Emergency Preparedness assesses the potential health and 
medical consequences of a terrorist incident and to formulate 
necessary responses. The funds provided would support 
activities to build local, State, and Federal capacity to 
respond to terrorist acts with public health implications. Such 
activities would include assisting local emergency managers 
through the MMST system to build an enhanced capability to 
detect and identify biologic and chemical agents.
    Biosecurity.--The Committee continues to be supportive of 
efforts to strengthen the Nation's capabilities to confront 
threats to biosecurity including activities identified for 
anti-bioterrorism. In the previous fiscal year, the Committee 
established a special funding mechanism in the Public Health 
and Social Services Fund to enable key agencies of the Public 
Health Service to develop these capabilities and to establish a 
vaccine stockpile. There continues to be, however, a need to 
articulate a clear and coherent biosecurity strategy to the 
public and to Congress that is rooted in both national security 
needs and scientific opportunities. To this end, the Committee 
directs the department to develop and submit to the House and 
Senate Committees on Appropriations a long-term strategic plan, 
including five years of funding requirements for the national 
pharmaceutical stockpile that is based upon the results of a 
documented, national-level threat and risk assessment. The 
five-year strategic plan should begin with fiscal year 2000 and 
then be updated annually thereafter.
    The threat and risk assessment for the strategic plan 
should be conducted by a multi-disciplinary team of experts on 
intelligence, terrorism, chemical and biological agents, 
ordnance, law enforcement, public health and medical treatment, 
and other related areas of expertise. The team of experts 
should develop threat scenarios in consultation with the 
intelligence community and be based upon: written intelligence 
assessments of the most likely chemical and biological 
terrorist threats; relevant scientific information about 
identified threat agents; and the ease, difficulty, and 
propensity of potential state and non-state entities to 
successfully acquire, process, and deliver chemical and 
biological agents in order to cause mass casualties.
    Integral to the strategic plan, the department is expected 
to report the specific medical preparedness countermeasures 
that address the most likely chemical and biological terrorist 
threats according to established intelligence assessments and 
discuss how the countermeasures effectively mitigate the 
associated risks or enhance preparedness. Furthermore, the 
department should estimate the costs and estimated time needed 
to acquire and establish proposed countermeasures, including 
the acquisition of items currently available in the economy and 
items that require extensive research, development, and 
production. The plan should clearly identify the long-term 
costs and benefits of establishing and sustaining the 
production and inventory infrastructure for the national 
pharmaceutical stockpile and the management of its inventory, 
including stock replacement and rotation.

Health care access for the uninsured

    The administration has proposed $25,000,000 to establish a 
grant program for public and private entities to conduct system 
development and other activities aimed at improving the health 
of uninsured individuals and populations. The Committee has 
deferred on acting on this request, pending the enactment of 
authorizing legislation.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 1999....................................     $29,000,000
Budget estimate, 2000...................................      31,500,000
Committee recommendation................................      35,000,000

    The Committee recommends an appropriation of $35,000,000 
for the Office of Inspector General. This is $3,500,000 higher 
than the administration request and $609,000 higher than the 
fiscal year 1999 level. In addition to discretionary funds, the 
Health Insurance Portability and Accountability Act of 1996 
provides no less than $110,000,000 and no more than 
$120,000,000 in mandatory funds for the Office of the Inspector 
General in fiscal year 2000; the total funds provided to the 
Office by this bill and the authorizing bill would be between 
$155,000,000 and $145,000,000 in fiscal year 2000.
    The Office of Inspector General conducts audits, 
investigations, inspections, and evaluations of the operating 
divisions within the Department of Health and Human Services. 
The OIG functions with the goal of reducing the incidence of 
waste, abuse, and fraud. It also pursues examples of 
mismanagement toward the goal of promoting economy and 
efficiency throughout the Department.
    The Committee is concerned about the lack of OIG coverage 
in the Pittsburgh, Pennsylvania, region. The Committee 
understands that the office once had a presence in the city but 
with the growing number of cases originating in the region, the 
Committee has included an increase over the administration 
request to be made available for the re-establishment of an OIG 
presence, particularly professional staff, in the area.
    The Committee is aware that a number of private insurance 
companies, many of which act as Medicare administrators, 
utilize recovery specialists to recover overpayments they 
encounter in their private insurance business. The Office of 
the Inspector General has made a significant contribution by 
performing studies, particularly with respect to private sector 
practices which may have application in the public sector. The 
Committee urges the Office of the Inspector General, in 
cooperation with HCFA, to study the use of private recovery 
specialists with respect to Medicare overpayments and to inform 
the Committee on its findings.
    The Committee commends the Office of Inspector General for 
their continued work to reduce waste, fraud and abuse in 
Department programs. The third OIG CFO Medicare audit again 
revealed significant improvements in the Department's efforts 
to prevent mispayments. The Committee urges the OIG to do 
further analysis of the results of this audit so that it can 
provide the Committee with a specific set of recommendations 
for reform. The Committee expects to hold hearings on the 
fourth annual CFO report. Finally, the Committee seeks to 
assure that seniors calling into the toll-free telephone line 
to report Medicare fraud get a prompt and complete response. 
Therefore, the Committee urges the OIG to expand its staffing 
of their hotline.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 1999....................................     $20,652,000
Budget estimate, 2000...................................      22,159,000
Committee recommendation................................      22,159,000

    The Committee recommends $22,159,000 for the Office for 
Civil Rights. This is the same as the administration request 
and $1,507,000 more than the the fiscal year 1999 level.
    This recommendation includes the transfer of $3,314,000 
from the Medicare trust funds, which is the same as the 
administration request and the fiscal year 1999 level.
    The Office for Civil Rights is responsible for enforcing 
civil rights-related statutes in health care and human services 
programs. To enforce these statutes, OCR investigates 
complaints of discrimination, conducts program reviews to 
correct discriminatory practices, and implements programs to 
generate voluntary compliance among providers and constituency 
groups of health and human services.

                            POLICY RESEARCH

Appropriations, 1999....................................     $13,996,000
Budget estimate, 2000...................................      14,000,000
Committee recommendation................................      15,000,000

    The Committee recommends an appropriation of $15,000,000 
for policy research. This is $1,000,000 higher than the 
administration request and $1,004,000 more than the fiscal year 
1999 amount.
    Funds appropriated under this title provide resources for 
research programs that examine broad issues which cut across 
agency and subject lines, as well as new policy approaches 
outside the context of existing programs. This research can be 
categorized into three major areas: health policy, human 
services policy, and disability, aging and long-term care 
policy.
    The Committee is aware of the efforts by the East St. Louis 
Center to analyze problems faced by health service providers in 
administering multiple sources of funding and urge the 
department to give full and fair consideration to its proposal.
    The Committee recognizes the need for obtaining State level 
data regarding the impacts of welfare reform and is aware of 
the benefits of continuing the longitudinal study on the 
outcomes of welfare reform. The Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 directed the Census 
Bureau to conduct the survey of program dynamics [SPD] on the 
national level; however, there is no mechanism in place to 
provide State-based or multi-state information, particularly in 
less densely populated states and in states that administer 
welfare programs at the county level. Iowa State University has 
been working with the Census Bureau and the Department to 
develop an approach for state and county level surveys that are 
relevant for local welfare program design, implementation, and 
evaluation and can be integrated into the SPD. The Committee 
believes that it would be useful if the Department considered 
supporting a multi-state project to achieve the goal of 
creating an information base to support state-based policy 
development.

                 PUBLIC HEALTH AND SOCIAL SERVICES FUND

    The Committee recommendation includes an allocation of 
$475,000,000 within the public health and social services fund. 
This is $88,978,000 higher than the administration request and 
$251,578,000 above the fiscal year 1999 level.
    NIH challenge grants and partnerships.--To promote joint 
ventures between the National Institutes of Health and the 
biotechnology, pharmaceutical, and medical device industries, 
the Committee allocates $20,000,000. This is a new initiative. 
At a field site visit with executives of key biotechnology and 
pharmaceutical companies, the Committee received comments 
concerning the need for additional resources to develop 
promising technology and products while praising NIH for the 
depth and breadth of its scientific and medical expertise. The 
Committee also heard favorable comments regarding the 
establishment of a matching fund to catalyze cooperation and to 
accelerate research and development. Accordingly, the Committee 
has decided to establish this fund at NIH to be made available 
on a one-for-one matching basis to qualified organizations that 
are conducting R&D; activities in biomedical research or 
biotechnology with commercializable potential or conducting 
research in promising therapies, for example. Should all 
available funds be matched, $40,000,000 will be committed to 
catalyzing new technologies and therapies. The challenge grants 
should be structured to facilitate rapid implementation and 
should support projects that have a realizable goal of 
importance to public health that otherwise could not have been 
attained without matching funds. NIH is requested to provide an 
operational plan for the challenge grant program to the 
Committee within 90 days of enactment of the bill. The 
Committee notes that the National Endowment of the Humanities 
has a similar challenge grant program and its program may be a 
guiding model for NIH.
    The Committee is concerned about the global proliferation 
of antibiotic-resistant strains of viruses and bacteria. The 
power of microbes to evolve into more virulent and drug 
resistant forms often outstrip the ability of the 
pharmaceutical and biotechnology industries to develop 
effective treatments. For example, in 10 years, the proportion 
of hospital-acquired enterococci bacteria reported as resistant 
to vancomycin has risen from zero to over 20 percent, 
endangering the lives of tens of thousands of patients. The 
time, effort, and funding necessary to create a new antibiotic 
is substantial, and by the time a new drug comes to market, 
additional strains often have arisen to make the drug 
ineffective or to shorten the product's time of usefulness. It 
should be a major public health priority to assure a growing 
supply of safe and effective antibiotics and vaccines to keep 
up and outpace the rate of antimicrobial resistance.
    In establishing the NIH challenge grant fund, the Committee 
encourages the agency to work with the pharmaceutical and 
biotechnology sectors in accelerating the development of new 
antimicrobials, antivirals, and vaccines. Matching funds could 
be available to speed, for example: basic and translational 
research, global bio-prospecting for potentially 
pharmaceutically active compounds in plants, clinical trials, 
and other activities aimed at increasing the number of new 
treatments and shortening the time needed to bring a promising 
drug to market. Because new strains may arise from anywhere in 
the world, NIH should develop partnerships with both domestic 
and global firms, university consortia or other qualified 
entities. Priorities for this effort should be established and 
coordinated by the NIH Director, the Associate Director for 
International Research, and the Directors of the National 
Institute for Allergy and Infectious Diseases, Office for AIDS 
Research, Fogarty International Center and other relevant 
institutes and centers.
    The Committee is aware of the efforts of the University of 
Mississippi to work with HHS to identify candidate 
phytomedicines for clinical evaluation. Such a collaboration 
could encompass the use of biological, chemical, and botanical 
studies to assist in the development of the clinical evaluation 
of phytomedicines. Rural, urban, and Native American 
populations could be integrated into the clinical trials to 
reflect the natural diversity of the national population.
    Rebuilding public health infrastructure.--An essential 
element of the nation's public health infrastructure is the 
physical capacity to carry out laboratory and other research, 
house professionals in a safe and productive environment, and 
conduct other essential public health functions such as 
national disease and illness surveillance. Modern facilities 
also enable the recruitment and retention of key scientific 
personnel. The Committee has reviewed the status of certain 
buildings and facilities of the Centers for Disease Control and 
Prevention and is very concerned over the state of dilapidation 
of several sites. Certain assets such as frozen blood samples 
are housed in aging facilities with unstable roofing and 
piping, leaving them vulnerable to collapse or electrical 
malfunction. The Committee is encouraged to learn that the 
leadership of CDC is committed to restoring these facilities 
and establishing new modern facilities. The Committee has 
allocated $20,000,000 within this account that would be in 
addition to the amount already provided in the regular 
appropriations account for CDC's buildings and facilities. The 
Committee expects the agency to give accelerated priority to 
those critical functions with the highest need for modern 
facilities.
    Global health initiative.--The Committee has allocated 
$75,000,000 for activities that address critical global health 
issues. With accelerating disease burden in several regions of 
the world, it is imperative that the United States play an 
integral role in developing an international public health 
system. With the asset base of the U.S. Public Health Service 
and its agencies, the private sector and non-profit 
organizations, the United States is well positioned to 
establish a long-lasting framework toward global health 
stability in cooperation with international and national health 
authorities. Strengthening the capacity of other nations to 
confront both infectious and chronic diseases will enhance 
regional stability in key regions and protect the American 
public. While resources are limited and the areas of 
opportunity are many, the Committee has chosen to establish 
this initiative to catalyze bilateral and multilateral medical 
and scientific collaborations. The components of the initiative 
are as follows:
  --Global AIDS.--The Committee has allocated $50,000,000 to 
        combat the spread of HIV/AIDS in key regions of the 
        world where the prevalence and incidence rates are 
        extremely high, such as sub-saharan Africa, or in 
        countries with weak public health systems. This amount 
        is $15,000,000 higher than the administration's revised 
        budget request of $35,000,000 for activities at the 
        Centers for Disease Control and Prevention as part of 
        an overall budget request of $100,000,000 encompassing 
        other Federal agencies. The administration also 
        proposed to partially offset this new request with a 
        $35,000,000 reduction in the NIH buildings and 
        facilities account. The Committee has chosen not to 
        adopt this offset.
      While the administration request for HHS only includes 
        funding for CDC, the Committee has chosen to allocate 
        $15,000,000 to the National Institutes of Health and 
        $35,000,000 to CDC in order to incorporate 
        international biomedical research and training as well 
        as surveillance and tracking. With this broader base of 
        activity, the United States will be better able to 
        establish a comprehensive network of researchers and 
        epidemiologists who could track and analyze the spread 
        of HIV and who could help other nations with their 
        intervention strategies. Of the amount allocated to 
        NIH, it is expected that the NIH Associate Director for 
        International Research and the Office of AIDS Research, 
        in consultation with the National Institute of Allergy 
        and Infectious Diseases, the National Institute of 
        Child Health and Human Development, the Fogarty 
        International Center, and other relevant institutes, 
        will develop a strategy and determine funding 
        allocations. The NIH and CDC are also further 
        encouraged to involve the Maternal and Child Health 
        Bureau and the AIDS Education and Training Center 
        program of HRSA for their expertise in children's 
        health care delivery and health professional training.
  --Global malaria initiative.--The Committee has allocated 
        $15,000,000 to combat the spread of malaria worldwide. 
        According to the World Health Organization, the 
        worldwide prevalence of the disease is estimated to be 
        300 million to 500 million clinical cases each year. 
        More than 90 percent of all malaria cases are in sub-
        Saharan Africa and mortality due to malaria is 
        estimated to be over 1 million deaths each year. The 
        vast majority of deaths occur among young children in 
        Africa, especially in remote rural areas with poor 
        access to health services. Furthermore, drug resistant 
        strains may soon render current pharmaceutical 
        therapies worthless unless efforts are made to overcome 
        this resistance and to develop new generations of 
        therapies, including vaccination.
      Of the amount provided, $9,000,000 will be for activities 
        at CDC and $6,000,000 at NIH. With these funds, CDC is 
        tasked to conduct surveillance for resistance, evaluate 
        new drugs and insecticides, develop and use assays to 
        test the malaria parasite for drug resistance and 
        mosquitoes for insecticide resistance, and other 
        associated activities. The Committee is aware of the 
        promising work conducted by the University of 
        Mississippi Laboratory for Applied Drug Design and 
        Synthesis and the Tulane University Center for 
        Infectious Diseases.
      The Committee is also aware of the leadership provided by 
        the NIH Director in establishing the Multilateral 
        Initiative on Malaria with international partners. With 
        these funds, the NIH is tasked to accelerate and expand 
        the cluster of activities as part of the Multilateral 
        Initiative on Malaria and other activities as 
        identified by the NIH Director, in close consultation 
        with the Associate Director for International Research 
        and the Director of the National Institute of Allergy 
        and Infectious Diseases.
  --Global micronutrient malnutrition initiative.--The 
        Committee is concerned that an international public 
        health emergency exists in many regions of the world 
        because of acute and chronic illnesses arising from 
        preventable causes such as malnutrition. In particular, 
        there are certain crucial micronutrients with high 
        impact on a developing child or a pregnant woman. 
        Micronutrient malnutrition resulting from war or 
        poverty, for example, can permanently damage a 
        population's physical and mental development. Small 
        amounts of essential vitamins and minerals, when 
        delivered through dietary diversification, food 
        fortification, and supplementation can prevent or 
        reverse many illnesses. The Committee understands that 
        the World Bank has noted that no other technology 
        offers as large an opportunity to improve lives at such 
        low per-person cost and in such a short a period of 
        time. The Committee has allocated $5,000,000 for NIH 
        and $5,000,000 for CDC to establish international 
        research, prevention, and intervention strategies for 
        micronutrient malnutrition. The Associate Director for 
        International Research is expected to work with 
        relevant institutes to consider research and research 
        training needs and to assist in allocation of funds for 
        the NIH component. The Director of CDC is expected to 
        make a similar determination for the CDC component. The 
        Committee intends the agencies use these resources to 
        work toward the elimination of nutrition-dependent 
        diseases such as goiter, cretinism, iron and vitamin A 
        deficiencies. The agencies should also consider 
        applying resources in domestic pockets of 
        micronutrient-deficient areas such as the inner city or 
        certain minority populations.
    Biosecurity.--For activities relating to the protection of 
civilian populations against potential biological threats 
(``bioterrorism'') and to the building of the nation's public 
health infrastructure, the Committee allocates $175,000,000, 
which is $41,400,000 above last year's level and $11,022,000 
below the administration request. The administration requested 
separate funding in this account for the Centers for Disease 
Control and Prevention, Office of Emergency Preparedness, Food 
and Drug Administration and the authority to distribute funding 
to other HHS agencies. Funds were requested for biosecurity 
activities among these agencies including: deterrence, disease 
surveillance, medical and public health response preparation 
and planning, the national pharmaceutical stockpile, and 
research and development.
    The Committee expects that, within the amount provided to 
the Secretary for biosecurity, the rebuilding of the nation's 
public health infrastructure be given the highest priority. 
Communications, information technology, laboratories and 
associated technologies, hospital capacity, and trained 
professionals are essential elements of a national public 
health infrastructure which protects the civilian population 
against both bioterrorist threats and the rapid onset of 
naturally occurring diseases.
    Of the amount provided for bioterrorism in this account, 
the Committee has allocated: $120,000,000 for the Centers for 
Disease Control and Prevention, of which $30,000,000 is to be 
allocated for the Health Alert Network; $30,000,000 for the 
Office of the Secretary; and $25,000,000 for the Office of 
Emergency Preparedness. The Committee has deferred funding of 
$13,400,000 identified in the administration request for the 
Food and Drug Administration, whose appropriations are under 
the jurisdiction of a separate subcommittee. The Committee has 
chosen not to include bill language authorizing transfer 
authority for bioterrorism funds, and notes that any proposed 
transfers shall continue to be subject to the standing rules of 
the Committee regarding reprogramming requests. Elsewhere in 
the bill, the Committee has fully funded the administration 
requests for bioterrorism activities: $24,340,000 at NIH and 
$20,000,000 at CDC. In addition, $5,000,000 is available at 
AHCPR. The aggregate total for bioterrorism activities 
contained in the bill is $224,340,000.
    The Committee continues to be supportive of the Health 
Alert Network, which is administered by CDC and assists state 
and local public health entities to establish a working 
communications network dedicated to rapid response, analysis 
and information sharing.
    The Committee is concerned over the disparities of quality 
and capabilities of the American public health infrastructure. 
While biosecurity and bioterrorism threats should be 
confronted, there continues to be insufficient capital funding 
by private and public sources of hospitals, laboratories, 
clinics, information networks, and other necessary elements to 
the provision of public health services. The Committee intends 
that future funding for biosecurity purposes will incorporate a 
growing proportion dedicated to public health infrastructure 
needs. Therefore, the Committee requests a report that assesses 
the current state of the nation's public health infrastructure 
and makes recommendations on possible actions that could be 
taken to strengthen key components. Such a report should 
include: an identification of the components of the 
infrastructure, the operational capabilities of each component 
and their interrelationships, the desired goals and outcomes of 
the national infrastructure, and the suggested means to improve 
the system in ways that improve public health efficiently and 
effectively. In addition, the report should also assess global 
health factors that might influence the domestic public health 
infrastructure. The department should consult broadly within 
the public health, medical and international health communities 
to receive a diversity of viewpoints.
    The Committee recognizes the critical need to ensure a 
highly trained public health workforce in the United States, 
particularly in the event of a possible bioterrorist attack, 
and the important role public health officials play as first 
responders. The Committee encourages the Centers for Disease 
Control and Prevention to provide training for public health 
department employees nationwide using distance learning 
technologies. Such training should focus on detecting and 
responding to bioterrorist threats.
    The Committee is aware of the efforts of the BioMed 
Security Institute, a collaboration between the University of 
Pittsburgh, Carnegie Mellon University and the Pittsburgh 
Supercomputing Center in Pittsburgh, Pennsylvania, to address 
the national need for greater preparedness for bioterrorism. 
The Committee commends this Institute for its unique ability to 
combine the latest in information technology and biomedical 
research with the Pittsburgh Supercomputing Center to detect, 
identify, analyze, and respond to potential biological attack.
    HIV/AIDS in minority communities.--To address high-priority 
HIV prevention and treatment needs of minority communities 
heavily impacted by HIV/AIDS, the Committee allocates 
$35,000,000. These funds are available to key operating 
divisions of the department with capability and expertise in 
HIV/AIDS services to assist minority communities with 
education, community linkages, and technical assistance.
    The Committee is aware of efforts to establish a multi-
state HIV/AIDS technical assistance and resource center that 
would engage in capacity building and education among at-risk 
minority communities. The Committee is further aware of efforts 
to support the implementation of a perinatal HIV/AIDS 
educational, testing, and outreach demonstration that would 
serve providers and minority women of childbearing age. The 
Department should give careful consideration to incorporate 
these concepts into the next phase of the initiative.
    Year 2000 information technology compliance.--To support 
the efforts of the Health Care Financing Administration to 
secure compliance of all HCFA data systems with Y2K standards, 
the Committee allocates $150,000,000, which is the same as the 
administration request and is $39,053,000 less than the fiscal 
year 1999 level. Such funding will enable HCFA to meet its Y2K 
obligations to ensure that Medicare and Medicaid beneficiaries 
retain their access to quality care and that health care 
providers receive timely payment for services rendered to 
patients.

                           General Provisions

    The Committee recommendation includes language placing a 
$37,000 ceiling on official representation expenses (sec. 201), 
the same as existing law.
    The Committee recommendation includes language included in 
fiscal year 1999 which limits assignment of certain public 
health personnel (sec. 202).
    The Committee recommendation retains language carried in 
fiscal year 1999 regarding set-asides in the authorizing 
statute of the National Institutes of Health (sec. 203).
    The Committee recommendation retains a provision carried in 
fiscal year 1999 to limit use of grant funds to pay individuals 
more than an annual rate of Executive level III (sec. 204).
    The Committee recommendation retains language from fiscal 
year 1999 restricting the use of taps (sec. 205) for program 
evaluation activities by the Secretary prior to submitting a 
report on the proposed use of the funds to the Appropriations 
Committee. Section 241 of the Public Health Service Act 
authorizes the Secretary to redirect up to 1 percent of the 
appropriations provided for programs authorized under the act 
for evaluation activities. The Committee further expects that 
the report include a detailed itemization of the proposed use 
of evaluation funds for the Committee's review and approval.
    The Committee recommendation retains language included in 
fiscal year 1999 restricting transfers of appropriated funds 
among accounts and requiring a 15-day notification of both 
Appropriations Committees prior to any transfer (sec. 206).
    The Committee recommendation includes language included in 
fiscal year 1999 permitting the transfer of up to 3 percent of 
AIDS funds among Institutes and Centers (sec. 207) by the 
Director of NIH and the Director of the Office of AIDS Research 
of NIH. The recommendation also includes language included in 
fiscal year 1999 which directs that the funding for AIDS 
research as determined by the Directors of the National 
Institutes of Health and the Office of AIDS Research be 
allocated directly to the OAR for distribution to the 
Institutes and Centers consistent with the AIDS research plan 
(sec. 208).
    The Committee recommendation includes a provision (sec. 
209) regarding family planning applicants to certify to the 
Secretary to encourage family participation in the decision of 
a minor who seeks family planning services.
    The Committee recommendation includes a provision included 
in fiscal year 1999 which restricts the use of funds to carry 
out the MedicareChoice Program if the Secretary denies 
participation to an otherwise eligible entity (sec. 210).
    The Committee includes a provision to ensure that States 
receive no less than the amount they received in fiscal year 
1999 for substances abuse and mental health services. (sec. 
211).
    The Committee includes a provision (sec. 212) which states 
that no provider of services under Title X of the PHS Act 
except from State laws regarding child abuse.
    The Committee includes a provision (sec. 213) extending the 
refugee status for persecuted religious groups.
    The Committee recommendation includes a general provision 
prohibiting funding to implement or administer the Medicare 
Prepaid Competitive Pricing Demonstration Project in Arizona, 
and the Kansas City, Missouri or Kansas City, Kansas area 
through the balance of fiscal year 2000. The Committee 
recognizes that competitive pricing may provide an important 
tool for containing costs in the Medicare Program, but in this 
case believes that HCFA has proceeded with this project without 
sufficient input from the affected communities. The proposed 
plan could raise costs and reduce benefits for persons in 
markets where competition is already intense, federal costs are 
low, and senior participation in Medicare HMO programs is 
higher than the national average. The Committee expects that in 
the interim the Health Care Financing Administration will work 
to design and implement a more suitable plan in more 
appropriate sites (sec. 214).
    The Committee recommendation includes a provision which 
delays obligations at the National Institutes of Health (sec. 
215).

                   TITLE III--DEPARTMENT OF EDUCATION

                            education reform

Appropriations, 1999....................................  $1,514,100,000
Budget estimate, 2000...................................   1,947,000,000
Committee recommendation................................   1,655,600,000

    The Committee has provided $1,655,600,000 in this account 
for education reform initiatives. The recommendation includes 
$494,000,000 for education reform activities authorized by the 
Goals 2000: Educate America Act, $55,000,000 to continue 
implementation of school-to-work transition systems authorized 
by the School-to-Work Opportunities Act, $706,600,000 for 
education technology authorized by the Elementary and Secondary 
Education Act and $400,000,000 for 21st century community 
learning centers.

Goals 2000: State and local education systemic improvement grants

    The Committee recommends $461,000,000 for State and local 
systemic education improvement grants authorized by title III 
of the Goals 2000: Educate America Act. This amount is the same 
as the fiscal year 1999 appropriation and the administration 
request.
    Goals 2000 funds provide incentives for States to devise 
their own strategies for comprehensive reform of elementary and 
secondary education. Grants are distributed to States through a 
formula based on relative shares each State received in the 
previous year under titles I and VI of the Elementary and 
Secondary Education Act. By law, 1 percent is reserved for the 
outlying areas, schools supported by the Bureau of Indian 
Affairs and the Alaska Federation of Natives.

Parental assistance

    The Committee recommends $33,000,000 for title IV of the 
Goals 2000: Educate America Act, which authorizes a variety of 
activities designed to improve parenting skills and strengthen 
the partnership between parents and professionals in meeting 
the education needs of their children, including those aged 
birth through 5.
    The increase of $3,000,000, which is above the 
administration request and the fiscal year 1999 amount, is 
provided as part of the Committee's Youth Violence Prevention 
Initiative. Sociological and scientific studies show that the 
first three years of a child's cognitive development sets the 
foundation for life-long learning and can determine an 
individual's emotional capabilities. Parents, having the 
primary and strongest influence on their child, play a pivotal 
role at this stage of development. Scientists have found that 
parental relationships affect their child's brain in many ways. 
Research further indicates that a secure connection with the 
parent will better equip a child to handle stressful events 
throughout life.
    Statistics show that the Department of Education's Parental 
Assistance Program in particular has helped to lower the 
incidence of child abuse and neglect, reduces placement of 
children in special education programs, and involves parents 
more actively throughout their child's school years. The 
Committee recognizes that early intervention activities 
conducted through the Parental Assistance Program can make a 
critical difference in addressing the national epidemic of 
youth violence, and therefore includes additional funds to 
expand its services to educate parents to work with 
professionals in preventing and identifying violent behavioral 
tendencies in their children.
    The Committee strongly urges the Department to stipulate 
that at least 50 percent of each grant award shall be used only 
for Parents as Teachers Programs.

School-to-work opportunities

    The Committee supports funds for the School-to-Work 
Opportunities Act, and has recommended $55,000,000 for the 
Department of Education's share of program funding. The amount 
recommended is $70,000,000 less than the 1999 appropriation and 
the same as the administration request. Fiscal years 1997-98 
were the peak years for Federal support. The decrease 
recommended in fiscal year 2000 reflects the decline planned in 
Federal support as States assume increased responsibility for 
implementing their school-to-work systems. This amount, 
together with $55,000,000 recommended for the Labor Department, 
will provide a total of $110,000,000 in direct funding to help 
States implement their plans for creating systems to improve 
the transition from school to work.
    Local school-to-work programs include a combination of 
work-based learning involving job training and school-based 
learning tied to both occupational skill standards and the 
voluntary academic standards States establish under Goals 2000. 
Students who complete a school-to-work program will receive a 
high school diploma, a certificate recognizing 1 or 2 years of 
postsecondary education, if appropriate, and a portable, 
industry-recognized skill certificate.

Technology literacy challenge fund

    The Committee recommends $425,000,000 for the technology 
literacy challenge fund authorized by section 3132 of the 
Elementary and Secondary Education Act, the same as the fiscal 
year 1999 appropriation and a decrease of $25,000,000 below the 
budget request.
    The fund helps States put into practice strategies to 
enable schools to integrate technology into school curricula. 
Funds are used to enhance students' critical thinking skills, 
support training for teachers, connect classrooms to the 
information superhighway, and purchase computers and software. 
Funds are distributed according to each State's share of title 
I, part A moneys. To be eligible for funds, a statewide 
technology plan describing long-term strategies for financing 
technology education in the State, including private-sector 
participation and targeting funds to school districts with the 
greatest need.

Regional technology consortia

    The Committee recommends $10,000,000, the same as the 
amount appropriated in fiscal year 1999 and the administration 
request, to continue the regional technology in education 
consortia. These consortia assist States and local educational 
agencies in the identification and procurement of resources 
necessary to implement technology plans; develop training 
resources for both elementary and secondary and adult 
education; provide referrals to sources of technical assistance 
and professional development; and assist institutions of higher 
education to establish preservice training programs in the 
appropriate use of educational technology.

Technology innovation challenge grants

    The Committee recommends $115,100,000 for the technology 
challenge grants authorized under part A of title III of the 
ESEA, the same as the amount appropriated in fiscal year 1999 
and $5,100,000 more than the administration request.
    Technology innovation challenge grants support partnerships 
among educators, business and industry, and other organizations 
in the community to develop innovative new applications of 
technology and community plans for fully integrating technology 
into schools.
    It has been brought to the Committee's attention that 
grants issued since this program's creation in fiscal year 
1995, appear to be made disproportionately to States with high 
access to technology, high levels of private funding, and high 
concentrations of disadvantaged students, while the 
applications from predominantly rural, less populated States 
have been turned down, citing a lack of community resource 
contributions and low numbers of children benefiting from the 
proposals. The Committee encourages the Department to reexamine 
the criteria by which review panels score applications to 
ensure that the community resource contribution effort is taken 
into account and, that true innovation is also considered, such 
innovation might include new applications of software, state-
of-the-art professional training programs and multicounty and 
multistate consortia affecting underprivileged children in 
technologically underserved areas and rural demographic 
limitations, for example in Mississippi, are also considered.
    The Committee is pleased to see that schools are engaging 
in resource-sharing to build collaborations with nonprofit 
organizations and the business community to bring technology 
into the classroom. The Committee understands that technology 
training for school teachers is critical to the academic and 
occupational achievements of the nation's students. Several 
innovative projects that are currently being developed to meet 
specific regional needs and pursue the goals described above 
have been brought to the Committee's attention.
    The Committee acknowledges the Tupelo Public School 
District in the state of Mississippi for its hard work on the 
CREATE for Mississippi project to bring much needed 
technological education services to rural school children. This 
project will join teachers in several districts in a network to 
model successful, replicable technology application and 
utilization in classrooms throughout the state.
    The Committee recognizes Seton Hill College, located in 
Greensburg, Pennsylvania, for its collaboration with the local 
public school system to develop high-technology classrooms for 
the training of college faculty, students, and the region's K-
12 teachers. A similar effort on behalf of the Mississippi 
Delta Education Initiative has been brought to the Committee's 
attention. The Delta State University's School of Education is 
developing a comprehensive technology center to train 
preservice education majors and current school teachers and 
administrators to sharpen their technology skills which are 
requisite to becoming a master educator. It has been brought to 
the Committee's attention that the Los Angeles County Office of 
Education has undertaken a major regional telecommunications-
based learning model project to offer teacher training in urban 
centers. The model will serve 81 K-12 school districts and 
provide new and emergency teachers with practical classroom 
management and instructional skills to meet California State 
teaching standards.
    The Committee is encouraged by the partnership established 
between the University of Alaska and local school districts to 
develop a long-term teacher technology preparation program to 
increase the number of ethnic teachers in K-12 classrooms 
throughout the state. Practicing, expert school teachers will 
be connected with education majors by serving as adjunct 
faculty at the university and teachers in training will gain 
more classroom, hands-on exposure to students and lesson 
integration. The Committee is aware of the expansion of a 
multi-district technology education center for students in nine 
Puget Sound school districts that assist students in acquiring 
the skills necessary to take advantage of the abundance of high 
paying, high skill and high technology employment opportunities 
available in the growing information industry in the region. 
The Montana State University is working on a 2-year public-
private partnership to bring advanced internet capability to 
rural states by using a high-speed, high-performance connection 
for its four campuses to train school teachers in voice, data 
and video communications to develop research and instructional 
methodologies. The University also plans to provide coordinated 
technology services to the decentralized education system in 
the eastern part of the state, which spans dozens of school 
districts and five Indian reservations.
    The Committee is also aware of the Enterprise State Junior 
College's efforts to bring technology to rural residents in 
southeastern Alabama by developing the Center for High 
Technology which provides distance learning to K-12 educators 
and incorporates technology in undergraduate and graduate 
education courses. A technology consortium in the state of 
North Carolina assists schools through all processes of 
technology integration from the beginning stages of wiring 
classrooms and acquiring donated computers to training students 
to build and maintain computers on their own and become 
certified technicians. To date, nearly 2,000 students have been 
taught and they have rebuilt 5,500 computers that are in 
classrooms today. A collaborative information center for 
technology research, development, and training at the 
University of Illinois at Urbana-Champaign and Parkland Junior 
College using models designed by the Carnegie Mellon Software 
Engineering Institute will help these institutions train 
researchers and developers as part of the educational process. 
The higher education community throughout the state of Nebraska 
have identified technology training and technology-based 
curriculum development as their top priority to meet the 
educational needs of rural students and have developed the 
Future Leaders in Information Technology Education (FLITE) 
Program. The University of Nebraska-Lincoln is developing a 
certification process so that instructors possess the requisite 
qualifications to teach internet-based courses. Assumption 
College in Worcester, Massachusetts is establishing the 
Lieutenant Joseph P. Kennedy Jr. Center for Collaboration in 
Science and Technology to serve the Worcester public schools 
and other community organizations. The center will foster 
greater collaboration between science and non-science faculties 
through technological development and upgrades.
    The Committee is aware of the Iowa public school system's 
efforts to promote partnerships with the private sector. The 
Committee is encouraged that at least two elementary schools 
located in western Iowa will partner with a private company to 
integrate technology into the classroom and demonstrate the 
effective use of technology in grades one through three. The 
project would support the development of appropriate curricula 
as well as training of participating teachers and 
administrators.
    The Committee recognizes the Alaska Distance Education 
Technology Consortium for its efforts to serve students 
throughout the entire state, regardless of how remote the area. 
The consortium is establishing an advisory commission, which 
would include all the state's colleges, school district 
representatives and other educators, to determine the needs of 
distance education in Alaska by working with telecommunications 
companies, and government entities.
    The Committee is concerned about the absence of technology 
integration in the north central communities of Pennsylvania. 
The Committee notes the efforts of the Lock Haven University of 
Pennsylvania for its development of two regional networks to 
link these rural communities to meet the educational and health 
care needs of today's economy. The networks will provide 
distance education to non-traditional students in areas where 
educational resources are sparse and will also connect schools, 
government organizations, and businesses. The Committee is 
aware of the University of Idaho's collaboration with 
nationally recognized educators, scientists, and the Idaho 
State Board of Education to conduct research and develop a 
model interactive education system. The model will be used to 
fully evaluate and test the effectiveness of internet-delivered 
distance education to elementary and secondary schools in rural 
and outlying communities. The Committee recognizes Project 
Family Net: Linking Providence Students and Their Parents as 
Partners in Learning for its efforts to provide training and 
support for parents in low-income areas in computer technology, 
which ultimately improves their children's educational 
opportunities by bringing computers into the home. The 
Committee is pleased that Project Family Net has established a 
private-public partnership with the Metropolitan Regional 
Career and Technical Center in Rhode Island to bring these 
much-needed services to the city.
    The Committee recognizes Dominican College in New York 
State for its efforts to establish a technology infrastructure 
that will be used to improve telecommunications for blind 
individuals.
    The Technology Enhancement Initiative at Elmira College 
will establish a state-of-the-art network that will serve as a 
technology hub for 12 rural counties and 21 school districts. 
The initiative will also provide expanded library services for 
eight community colleges. The Lake Champlain Heritage Corridor 
Education Program, in conjunction with the University of 
Vermont, would generate education reform through the use of 
technology to develop and implement an elementary and higher 
education curriculum based on the history and geology of the 
Champlain Valley.
    The Committee recognizes Mansfield University for its 
continued efforts to provide students and community members 
with the opportunity to enhance learning through state-of-the-
art information technology systems. The information technology 
learning center for the public, equipped with high-technology 
instructional labs including networked computer work stations, 
overhead projection systems, and video-audio links to other 
sites to reach employers, employees, residents, and K-12 
students.
    It has been brought to the Committee's attention that the 
National Association of Computer Systems Engineers provides 
extensive services throughout the country to prepare, through 
training and re-training programs, individuals for the high-
technology jobs of today's workforce. The association works in 
conjunction with employers and educational institutions to 
deliver network communications.
    It has been brought to the Committee's attention that the 
Washington Virtual Classroom Consortium (WVCC), which consists 
of 9 school districts, is developing a model salmon restoration 
curriculum and water quality monitoring programs to teach 
students about the local ecological and economic systems. The 
lessons can be delivered to all corners of Washington State via 
technology currently in place in every school district 
throughout the state. The WVCC proposes to design, equip and 
implement two courses entitled ``Salmonid Ecology'' and 
``Salmonid Ecosystem Management,'' along with the creation of 
water quality monitoring partnerships with private industry and 
local, state, tribal and federal government agencies.
    The Committee is aware of the continuation of the 
Interactive Computer Aided Natural Learning project to 
electronically deliver textbook materials and integrate 
technology into eighth grade algebra courses, which is being 
used on a statewide basis in Louisiana.
    The Committee recommends that funds be used to support 
grants for the purchase of assistive technology for persons 
with disabilities to become employable and live independently. 
This technology can improve the lives of over 50 million 
Americans with physical or mental disabilities.
    The Southeast Missouri State University is currently 
training students to be successful in seeking employment with 
high tech manufacturing companies in the region. The University 
is currently seeking ways to equip their classrooms with 
equipment to aid in the training of these students.
    It has been brought to the Committee's attention that the 
Oklahoma State University Education and Research Foundation has 
undertaken a program to develop, test, and make available to 
schools, as a curricular enhancement, an interactive electronic 
version of the exercise in Hard Choices. This proven 
educational tool enhances subject matter expertise and teaches 
consensus--building skills, constructive conflict resolution 
and civics. It will enable the expansion of constructive 
debates on major public policy issues of students and citizens 
across the country.
    The Committee commends the effort of Halifax County to work 
with four institutions of higher learning to create a 
Continuing Education Center (CEC) and Teachers' Institute in 
South Boston, Virginia. The purpose of the CEC and the 
Institute will be to increase the economic competitiveness of 
the area by offering residents expanded opportunity to obtained 
advanced education and to improve the use of education 
technology.
    The Committee is aware of the Puget Sound Center for 
Teaching, Learning and Technology (PSC), a collaborative 
partnership of Shoreline Community College, Edmonds Community 
College, and the Morgridge Family Foundation. The PSC will 
engage in K-20 faculty development activities involving the use 
of technology in the classroom, on-line instruction, and 
information technology faculty training in current software and 
hardware applications.

National activities

    The Committee recommends $87,000,000 for the educational 
technology national activities, the same as the fiscal year 
1999 appropriation. The administration requested $177,000,000 
for the activities authorized by title III, part A of the ESEA. 
Funds support Federal leadership activities that promote the 
use of technology in education, and may be used for teacher 
training technology, community-based technology, and technology 
leadership activities.

Middle School Teacher Training

    The Committee has deferred action on the new Middle School 
Teacher Training Program pending enactment of authorizing 
legislation. The administration requested $30,000,000 for this 
purpose. The Department planned to provide funds to states that 
agree to establish technology literacy as a requirement for 
middle school graduation.

Software Development Initiative

    The Committee has deferred action on the new Software 
Development Initiative pending enactment of authorizing 
legislation. The administration requested $5,000,000 for this 
purpose. The Department intended to fund a competitive grants 
program for middle and high school students to develop 
educational software and internet websites.

Star schools

    For the star schools program, the Committee recommends 
$45,000,000, the same as the administration request and the 
1999 appropriation.
    This program is designed to improve instruction in math, 
science, foreign languages, and other subjects such as 
vocational education, to underserved populations by means of 
telecommunications technologies. The program supports eligible 
telecommunications partnerships to develop and acquire 
telecommunications facilities and equipment, instructional 
programming, teacher training programs and technical 
assistance.
    The Committee recognizes the efforts of the Star Schools 
Program to provide educational resources for traditionally 
underserved populations, including disadvantaged, illiterate, 
and limited-English proficient persons, and individuals with 
disabilities through the use of distance learning technologies. 
The Committee urges the Department to support 
telecommunications initiatives through the Star Schools Program 
that provide a model of a comprehensive approach to the school-
to-work transition for high school youth with serious learning, 
emotional, neurological, and developmental disabilities. The 
Committee notes the successes of the Kennedy Krieger Institute 
in this area.
    The Committee is aware that inner-city and rural students 
are often restricted from having access to state-of-the-art 
technologies, which, therefore, puts them at an academic and 
ultimately an economic disadvantage. The Committee is 
encouraged by efforts that set out to equalize access to 
technology for students of all socioeconomic backgrounds. The 
Committee is pleased that these efforts place a special focus 
on the advancement of students in core subjects.
    Statewide educational networks provide great promise for 
expanding access to high quality academic programs for all 
students, especially students in rural areas. The Committee has 
been impressed by the activities of the Iowa Communications 
Network, which now includes over 650 interactive classrooms 
throughout the state. However, few of those classrooms are 
located in elementary or middle schools and further assistance 
is needed to make connections to those schools. These 
connections would provide elementary and secondary schools with 
high-speed internet access; desktop conferencing capabilities; 
connections to digital libraries, teacher training, and other 
educational resources.
    The Committee is impressed by the Franklin Institute in the 
city of Philadelphia for its development of a new exhibit, the 
``Kids Science'' exhibit, which will create a museum-based 
learning environment for the interactive study of basic science 
by children ages five to eight, in keeping with the promotion 
of national science standards. The exhibit will rely heavily on 
collaborative efforts of the school district of Philadelphia, 
the Temple University School of Education, and other area 
museums. The New York Historical Society is expanding its 
services, which currently reach more than 50,000 school 
children from 146 different schools, and includes class visits, 
tours, and teacher training workshops. The society is 
developing curriculum and an internet database for schools to 
use as a resource when teaching students about the American 
Revolutionary War, which will include specialized fields of 
study such as: commerce during the period, the establishment of 
colonial New York, and the role of African-Americans and women 
during the revolution.
    It has been brought to the Committee's attention that the 
Technology Literacy Center at Chicago's Museum of Science and 
Industry has collaborated with the Chicago Public School 
System, universities, research laboratories, and businesses in 
the area to provide a resource center with the latest 
technology for teachers, parents, and children in the community 
who would not ordinarily have access to such resources.
    The Vermont Gateway, established by the University of 
Vermont, has also created a similar service on the elementary 
and secondary educational levels to integrate software and 
technology systems. The Committee recognizes Rutgers State 
University of New Jersey's efforts to deliver services to low-
income students through its RuNet 2000 Project, which is 
developing a comprehensive and integrated voice, video, and 
data communications network that will permit easy access from 
both on-and off-campus locations, including local educational 
agencies. The project includes statewide access to faculty, 
research and library resources, teacher training, and distance 
learning for elementary and secondary students.
    It has been brought to the Committee's attention that the 
Anchorage School District, the University of Alaska, and 
Providence Hospital have collaborated to provide a distance 
education program for elementary and secondary students to 
learn about medical education and gain further access to the 
constantly developing and upgraded high-technology used in this 
field.
    The Committee is encouraged by the many projects that build 
a technology infrastructure for severely economically 
distressed school districts. The Committee is also encouraged 
by technology development plans which are complemented with 
electronically delivered and other instructional materials to 
expose students to the most beneficial learning experiences 
distance learning can offer. The Committee is aware of the 
Houston Independent School District's efforts to use technology 
to improve student performance and make systemic educational 
reforms in one of the largest and most disadvantaged school 
districts, which serves high concentrations of at-risk youth 
and encompasses empowerment zones and enterprise communities. 
The Committee recognizes the Oakland School District and the 
KDOL-TV station for its partnership in undertaking a 
comprehensive school reform initiative. The initiative will 
bring distance learning and other technologies to low-income 
students and their families as well as ensure high quality 
professional development for teachers and encourage involvement 
of parents in the community.

Ready to learn television

    The Committee recommends an appropriation of $16,000,000 
for the ready to learn television program, an increase of 
$5,000,000 over the amount appropriated in fiscal year 1999 and 
$9,000,000 more than the administration request.
    This program has supported the development and distribution 
of educational television programming designed to improve the 
readiness of preschool children to enter kindergarten and 
elementary school, consistent with the first national education 
goal that all children should start school ready to learn. The 
program supported the development, production, and 
dissemination of educational materials designed to help 
parents, children, and caregivers obtain the maximum advantage 
from educational programming. Since its inception in 1994, 
participation in the program has grown from 10 to 128 local 
public television stations. Local educational workshops have 
reached over 4 million children, and research indicates that 
the program is meeting its goals in encouraging family literacy 
activities. Increased funding is needed to meet the growth in 
demand for local educational activities, improve training for 
professional caregivers, provide new Spanish language 
translations of children's programs, enhance the internet 
components of the program, and demonstrate the use of digital 
broadcasting to provide programming and training to underserved 
populations.

Telecommunications demonstration project for mathematics

    The Committee recommends $8,500,000 for the continuation of 
this PBS initiative called Mathline, $6,500,000 more than the 
amount recommended by the administration and $3,500,000 more 
than the fiscal year 1999 appropriation. Funds are used to 
carry out a national telecommunication-based demonstration 
project designed to train elementary and secondary school 
teachers in preparing all students for achieving State content 
standards in mathematics.
    This is a highly effective program which provides state-of-
the-art training for math teachers through video, print, and 
online, leader-led, group discussions. The Committee is pleased 
with the independent research that indicates that teachers 
value the program highly because it allows them to improve 
their teaching skills on their own schedules, and it breaks 
down the isolation of the classroom. The project has begun to 
expand to pre-service, as well as in-service teacher training 
in technology through the existing PBS satellite links at 
colleges and schools across the country. The Committee is 
encouraged by the effectiveness of the program and its 
potential to reach most of our nation's current teachers, as 
well as those undergoing training in colleges and universities.
    Increased funding is needed to expand the program to reach 
30,000 teachers directly, make additional resources available 
online and on-demand through new school networks, update 
materials for new mathematics teaching standards, and continue 
to offer pre-service and in-service training in the use of 
technology in the classroom.

21st Century Community Learning Centers

    The Committee recommends an appropriation of $400,000,000 
for the 21st Century Community Learning Centers program, an 
increase of $200,000,000 over the amount appropriated in 1999 
and $200,000,000 below the administration request.
    The Committee urges the Department to support projects that 
emphasize safety, crime awareness, and substance abuse 
prevention in their after-school plans. The Committee provides 
an additional $200,000,000 for the 21st Century Community 
Learning Centers Program to conduct such activities as part of 
the Youth Violence Prevention Initiative.
    The purpose of the program is to support rural and inner-
city public elementary and secondary schools, or consortia of 
such schools, to implement or expand projects that benefit the 
educational, health, social service, cultural, and recreational 
needs of the community.
    The Committee has been alerted to the increasing demands 
made by parents and school administrators for after-school 
programming and encourages local innovation to remedy the 
multitude of social problems that arise after school hours. The 
Committee encourages the Secretary to target funds to areas of 
high need that have low-achieving students and lack resources 
to establish after-school centers. The Committee notes that 
successful after-school programs often combine academic 
enrichment, through the use of supplementary educational 
materials and instruction, with other extracurricular 
activities.
    The Committee is encouraged by the city of Miami Beach's 
use of after-school programming as a crime prevention tool 
through its development of a coordinated at-risk youth and 
school support strategy which links local law enforcement 
officials with students and teachers to provide mentoring, 
training, and employment opportunities. The Committee is aware 
of two promising after-school projects being developed in the 
state of Nebraska. The Omaha and Lincoln public school systems 
have established a partnership with community organizations to 
create healthy and stable environments for underserved children 
both before and after the school day. The City of Portland, 
Oregon has embarked on an extensive, city-wide after-school 
program to provide a safe haven for children after the regular 
school day ends.

                    Education for the Disadvantaged

Appropriations, 1999....................................  $8,426,897,000
Budget estimate, 2000...................................   8,743,920,000
Committee recommendation................................   8,750,986,000

    The Committee recommends an appropriation of $8,750,986,000 
for education for the disadvantaged. This is $324,089,000 more 
than the fiscal year 1999 appropriation and $7,066,000 more 
than the administration request. In fiscal year 1999, 
$6,204,763,000 was made available for this account in fiscal 
year 2000 funds. This year, the Committee recommendation again 
advances funds for fiscal year 2001. The Committee took this 
action because of the severe budget constraints facing the 
Committee in fiscal year 2000.
    Programs financed under this account are authorized under 
title I of the Elementary and Secondary Education Act [ESEA] 
and section 418A of the Higher Education Act. ESEA title I 
programs provide financial assistance to State and local 
educational agencies [LEAs] to meet the special educational 
needs of educationally disadvantaged children, migrant 
children, neglected and delinquent children in State 
institutions, and juveniles in adult correctional institutions. 
In addition, the Even Start Program supports projects that 
integrate early childhood education with parenting and adult 
literacy training. Funds for most of these programs are 
allocated through formulas that include the number of eligible 
children and each State's average per-pupil expenditure. Even 
Start funds are allocated according to each State's proportion 
of title I grants to LEAs.

Grants to local educational agencies

    Title I grants to local educational agencies provide 
supplemental education funding to LEAs and schools, especially 
in high-poverty areas, to help low-income, low-achieving 
students learn to the same high standards as other children. 
The program currently provides services to more than 11 million 
children. The formula for basic grants is based on the number 
of children from low-income families in each LEA, weighted by 
per-pupil expenditures for education in the State. The 
Department makes Federal allocations to the LEA level. States 
have the option to reallocate funds to LEAs serving areas with 
fewer than 20,000 residents using the best data available on 
the number of poor children. States are also required to 
reserve funds generated by counts of children in correctional 
institutions to make awards to LEAs for dropout prevention 
programs involving youth from correctional facilities and other 
at-risk children. By law, 1 percent of the total LEA grant 
appropriation is set aside for the Bureau of Indian Affairs and 
the outlying areas.
    For title I basic grants, including the amount transferred 
to the Census Bureau for poverty updates, the Committee 
recommends an appropriation of $6,894,000,000. This amount is 
$320,000,000 more than appropriated in fiscal year 1999 and 
$754,000,000 more than the budget request.
    The Committee has provided no funding for the targeted 
grants program. The administration requested $756,020,000 for 
this program which distributes funds in a manner that provides 
higher per-child amounts for LEAs with the highest percentage 
of poor children.
    The Committee recommends $1,158,397,000 for concentration 
grants, the same amount appropriated in fiscal year 1999 and 
$58,397,000 more than the budget request. Funds under this 
program are distributed according to the basic grants formula, 
except that they only go to LEAs where the number of poor 
children equals at least 6,500, or 15 percent, of the total 
school-aged population. Approximately 66 percent of LEAs 
nationally receive funds.
    The Committee has again included bill language providing 
that no local educational agency receive an allocation under 
title I, part A that is less than its allocation of the 
previous year, regardless of eligibility as determined by the 
Department. For fiscal year 1999, the Department has, for the 
first time, made allocations directly to local educational 
agencies. The Committee will continue to consider additional 
steps that can be taken to target title I aid on States and 
local educational agencies in greatest need. The Committee 
added additional funds to accommodate the hold-harmless 
provision.

Capital expenses for private school students

    The Committee recommends $15,000,000 for the capital 
expenses program, a decrease of $9,000,000. The Administration 
has requested no funds and has proposed eliminating the 
program. It has been brought to the Committee's attention that 
several states require continued assistance under this program 
and in some cases, states have declared a need for additional 
funds to cover administrative costs incurred in serving private 
school students.
    The Supreme Court's 1985 Aguilar v. Felton decision 
prohibited districts from sending public schoolteachers or 
other employees to private sectarian schools for the purpose of 
providing title I services. The capital expenses program has 
helped districts comply with Felton by paying a portion of the 
additional capital costs associated with serving religious 
school students outside school premises. Funds are used by 
districts for noninstructional goods and services such as 
renting classroom space in neutral sites, renting or purchasing 
mobile vans for title I instruction, or transporting private 
schoolchildren to the place of title I instruction.
    On June 23, 1997, the Court reversed its earlier ruling, 
and districts may now provide title I instruction in private 
schools. However, many school districts will continue, over the 
short term, to incur costs as a result of the original 1985 
decision. For example, some may have entered into multiyear 
leases for vans, portable classrooms, or other neutral 
instructional sites. The Committee, therefore, has recommended 
continuation of this program until an assessment has been made 
as to what the final costs are for Felton compliance.
    Funds are allocated to States according to the proportion 
of nonpublic school students served under the title I LEA 
grants program in the most recent year for which satisfactory 
data are available.

Even Start

    For the Even Start program, the Committee recommends 
$145,000,000, an increase of $10,000,000 above the fiscal year 
1999 appropriation and the same as the budget request.
    The Even Start program provides grants for family literacy 
programs that serve disadvantaged families with children under 
8 years of age and adults eligible for services under the Adult 
Education and Family Literacy Act. Programs combine early 
childhood education, adult literacy, and parenting education.
    States receive funds on the basis of their proportion of 
title I LEA grant allocations and make competitive 4-year 
grants to partnerships of local educational agencies and 
community-based organizations. Grant funds must be equitably 
distributed among urban and rural areas and the local share of 
program costs increases from 10 percent in the first year to 40 
percent in the fourth year.

Migrant

    For the State agency migrant program, the Committee 
recommends $354,689,000, the same as the amount appropriated in 
fiscal year 1999. The administration requested $380,000,000 for 
this program.
    The title I migrant program authorizes grants to State 
educational agencies for programs to meet the special 
educational needs of the children of migrant agricultural 
workers and fishermen. Funds are allocated to the States 
through a statutory formula based on each State's average per-
pupil expenditure for education and counts of migratory 
children aged 3 through 21 residing within the States. Only 
migratory children who have moved within the last 3 years are 
generally eligible to be counted and served by the program. 
Currently, this program serves approximately 624,000 migrant 
students; however, 735,000 are eligible to receive services and 
that number is increasing since states have been actively 
identifying and recruiting migrant children into educational 
programs.
    This appropriation also supports activities to improve 
interstate and intrastate coordination of migrant education 
programs.

Neglected and delinquent

    The Committee recommends $42,000,000 for the title I 
neglected and delinquent program, the same amount recommended 
by the administration and $1,689,000 more than the fiscal year 
1999 level. The Committee recognizes this program as an 
essential component of the Youth Violence Prevention 
Initiative.
    This program provides financial assistance to State 
educational agencies for education services to neglected and 
delinquent children and youth in State-run institutions and for 
juveniles in adult correctional institutions.
    Funds are allocated to individual States through a formula 
based on the number of children in State-operated institutions 
and per-pupil education expenditures for the State.
    States are authorized to set aside up to 10 percent of 
their neglected and delinquent funds to help students in State-
operated institutions make the transition into locally operated 
programs. Transition activities are designed to address the 
high failure and dropout rate of institutionalized students and 
may include alternative classes, counseling and supervisory 
services, or educational activities in State-supported group 
homes.

Evaluation

    The Committee bill includes $8,900,000 for title I 
evaluation activities, $1,400,000 more than the amount 
appropriated in fiscal year 1999. The amount recommended is the 
same as the budget request.
    Evaluation funds are used to support large-scale national 
surveys that examine how the title I program is contributing to 
student performance. The recommended amount will provide 
sufficient funds to design, implement, and produce multiyear 
evaluations that will assess the effects of the changes made in 
the reauthorization of the title I program.

Comprehensive school reform

    The Committee recommends $120,000,000, the same as the 1999 
amount, for the comprehensive school reform program which was 
created through the fiscal year 1998 appropriations act and is 
funded under the title I demonstration authority. The 
administration requested $150,000,000 for this purpose in 
fiscal year 2000. This program provides schools with funding to 
develop or adopt, and implement, comprehensive school reforms 
based on reliable research and effective teaching practices.

High school equivalency program

    The Committee bill includes $9,000,000 for the high school 
equivalency program [HEP]. This amount is the same as the 
amount appropriated in fiscal year 1999 and $6,000,000 below 
the amount requested by the administration.
    This program provides 5-year grants to institutions of 
higher education and other nonprofit organizations to recruit 
migrant students aged 16 and over and provide the academic and 
support services needed to help them obtain a high school 
equivalency certificate and subsequently gain employment, win 
admission to a postsecondary institution or a job-training 
program, or join the military. Projects provide counseling, 
health services, stipends, and placement assistance. HEP serves 
about 3,600 migrants.

College assistance migrant program

    For the college assistance migrant program [CAMP], the 
Committee recommends $4,000,000, the same as the fiscal year 
1999 appropriation and $3,000,000 below the amount requested by 
the administration.
    Funds provide 5-year grants to institutions of higher 
education and nonprofit organizations for projects that provide 
tutoring, counseling, and financial assistance to migrant 
students during their first year of postsecondary education. 
Projects also may use up to 10 percent of their grants for 
followup services after students have completed their first 
year of college, including assistance in obtaining student 
financial aid. CAMP serves about 375 students.

                               impact aid

Appropriations, 1999....................................    $864,000,000
Budget estimate, 2000...................................     736,000,000
Committee recommendation................................     892,000,000

    The Committee recommends an appropriation of $892,000,000 
for impact aid for the Department of Education. This amount is 
$28,000,000 above the 1999 appropriation and $156,000,000 above 
the administration request.
    Impact aid provides financial assistance to school 
districts for the costs of educating children when enrollments 
and the availability of revenues from local sources have been 
adversely affected by the presence of Federal activities. 
Children who reside on Federal or Indian lands generally 
constitute a financial burden on local school systems because 
these lands do not generate property taxes--a major revenue 
source for elementary and secondary education in most 
communities. In addition, realignments of U.S. military forces 
at bases across the country often lead to influxes of children 
into school districts without producing the new revenues 
required to maintain an appropriate level of education. During 
the current school year, approximately 1,500 school districts 
will receive payments on behalf of 1.3 million eligible 
children.
    The Committee has not included the following language 
provisions proposed by the Administration: Language specifying 
that payments under section 8003 be made only for children of 
federal employees both living and working on Federal property, 
children of foreign military officers living on Federal 
property, children living on Indian lands and children of 
members of the uniformed services living on Federal property; 
language overriding the section 8003 threshold eligibility 
requirements for LEAs; language specifying that payments under 
section 8003(d) be made only for children of foreign military 
officers living on Federal property, children living on Indian 
lands, and children of members of the uniformed services living 
on Federal property; language specifying the maximum Basic 
Support Payment formula for which an LEA is eligible; language 
changing the learning opportunity threshold reduction 
methodology; and language overriding the hold-harmless 
provision that precludes distribution of funds by formula.
    Basic support payments.--The Committee recommends 
$725,000,000 for basic support payments, $21,000,000 more than 
the amount appropriated in fiscal year 1999 and $41,000,000 
above the amount recommended by the administration. Under 
statutory formula, payments are made on behalf of all 
categories of federally connected children.
    It has come to the Committee's attention that, in the 
middle of the current fiscal year, the Department notified 
school districts that utilized special additional factors in 
their application that it will no longer consider these factors 
when computing their basic support payment amounts. The 
Department has used special additional factors to compute basic 
support payment amounts for the past 20 years. This change of 
policy, undertaken without advance notification, will create a 
significant hardship for school districts that utilized special 
additional factors, and budgeted for basic support payment 
amounts based on that computation. More than 20 school 
districts included special additional factors in their 
application, including one that is among the poorest in the 
United States. The Committee urges the Department to reconsider 
this change of policy and its resultant consequences and 
encourages it to continue to utilize the approach that it has 
for the past 20 years. The Committee believes instead that this 
issue should be addressed during reauthorization of the Impact 
Aid program.
    Payments for children with disabilities.--Under this 
program additional payments are made for certain federally 
connected children eligible for services under the Individuals 
with Disabilities Education Act. The Committee bill includes 
$50,000,000 for this purpose, the same as the 1999 level and 
$10,000,000 more than the administration request.
    Payments for heavily impacted districts.--These payments 
provide additional assistance to certain local educational 
agencies that enroll large numbers or proportions of federally 
connected children. The Committee recommends $75,000,000, an 
increase of $5,000,000 over the amount appropriated in fiscal 
year 1999. No funds were requested by the administration for 
this activity.
    Facilities maintenance.--This activity provides funding for 
maintaining certain school facilities owned by the Department 
of Education. The Committee recommends $5,000,000 for this 
purpose in fiscal year 2000, the same as the budget request and 
the amount appropriated in fiscal year 1999.
    Construction.--Payments are made to eligible LEA's to be 
used for construction and renovation of school facilities, or 
for debt service related to the construction of school 
facilities. The Committee recommends $7,000,000 for this 
program, the same amount appropriated in fiscal year 1999 and 
requested by the administration.
    The Committee is aware of unfavorable learning environments 
at two school districts in Montana. The Hays/Lodge Pole School 
District elementary school, located on Fort Belknap 
Reservation, has been closed sporadically throughout the last 2 
school years due to health and safety concerns. Students have 
been transported offsite during the periods of closure. 
Overcrowded conditions at the Harlem Elementary School in north 
central Montana persist and some students continue to be taught 
in temporary facilities. The Committee requests that the 
Department work with both school districts to find remedies for 
these situations.
    The Committee is aware of the critical construction needs 
at Fort Sam Houston Independent School District, a coterminous 
military post school district. The Committee requests that the 
Department work with this school district to address this issue 
and ensure that all possible solutions are explored.
    Payments for Federal property.--These payments compensate 
local educational agencies in part for revenue lost due to the 
removal of Federal property from local tax rolls. Payments are 
made to LEA's that have a loss of tax base of at least 10 
percent of assessed value due to the acquisition since 1938 of 
real property by the U.S. Government. The Committee recommends 
$30,000,000 for this activity in 2000, $2,000,000 more than the 
fiscal year 1999 amount. No funds were requested by the 
administration for this activity.
    It has come to the Committee's attention that Hot Springs 
School District in South Dakota, a school district having 
previously met and continuing to meet all of the eligibility 
criteria for this program, was not found eligible for fiscal 
year 1994 due to circumstances outside of its control. The 
Committee encourages the Department to work with the School 
District to address this issue.
    The Committee has become aware of a situation at Wall and 
Hill City School Districts, South Dakota, where the school 
districts cannot prove their eligibility because the requisite 
documents are no longer available. The Committee understands 
that both school districts met eligibility criteria for fiscal 
year 1994 and continue to meet all of the eligibility criteria 
of the program. The Committee encourages the Department to work 
with both school districts and local officials to resolve this 
situation.

                      school improvement programs

Appropriations, 1999....................................  $2,811,134,000
Budget estimate, 2000...................................   2,722,534,000
Committee recommendation................................   2,886,634,000

    The Committee recommends an appropriation of $2,886,634,000 
for school improvement programs. This amount is $75,500,000 
more than the 1999 appropriation and $164,100,000 more than the 
administration's request.
    Eisenhower professional development State grants.--The 
Committee recommends $335,000,000 for Eisenhower professional 
development State grants, the same as the fiscal year 1999 
appropriation and the same amount requested by the 
administration. This program provides formula grants to States 
to support sustained and intensive high-quality professional 
development activities in the core academic subjects at the 
State and local levels.
    The Committee emphasizes the priority of professional 
development in the fields of Math and Science. It also 
encourages state and local educational agencies to scrutinize 
the appropriateness and quality of training in all fields to be 
funded by this program.
    Innovative education program strategies State grants.--The 
Committee recommends $375,000,000 for innovative education 
program strategies State grants, the same as the fiscal year 
1999 appropriation. The administration proposed to eliminate 
funding for this program. This program makes grants to State 
and local educational agencies for activities intended to help 
meet the national education goals and assist in their reform of 
elementary and secondary education. Funds are awarded to States 
by a formula based on school-aged population and then to local 
districts under a State-determined formula. State and local 
funds may be used for acquisition of instructional materials 
such as library books, curricular materials, and computer 
software and hardware; improving educational services to 
disadvantaged children and dropout prevention; combating 
illiteracy among children and adults; programs for gifted and 
talented children; and reform activities consistent with Goals 
2000. Teacher training and other related activities in support 
of any of these purposes is also authorized.

Teacher assistance initiative

    The Committee recommendation includes $1,200,000,000 for a 
teacher assistance initiative pending enactment of authorizing 
legislation. Of the funds provided, $900,000,000 will become 
available on October 1, 2000 for the 2000-01 academic year.

Safe and drug free schools and communities

    The Committee remains extremely concerned about the 
frequent and horrific occurrence of violence in our Nation's 
schools. Last year, the Committee provided $125,000,000 within 
this account for a school violence prevention initiative. As 
part of an enhanced and more comprehensive effort, the 
Committee has provided $160,000,000 within the safe and drug 
free schools and communities program to support activities that 
promote safe learning environments for students. Such 
activities should include: targeted assistance, through 
competitive grants, to local educational agencies for community 
wide approaches to creating safe and drug free schools; and 
training for teachers and school security officers to help them 
identify students who exhibit signs of violent behavior, and 
respond to disruptive and violent behavior by students. The 
Committee also encourages the Department to coordinate its 
efforts with children's mental health programs.
    The Committee urges the Department to include in their 
research on risk behavior, students from both the elementary 
and secondary grades. The Committee also urges the Department 
to expand studies to include research on gambling attitudes and 
behavior.
    State grant program.--The Committee bill provides 
$451,000,000 for the safe and drug free schools and communities 
State grant program. The amount recommended is $10,000,000 more 
than the fiscal year 1999 appropriation and $12,000,000 more 
than the budget request. Of the funds provided, $339,750,000 
will become available on October 1, 2000 for the 2000-01 
academic year.
    National programs.--The Committee has included $100,000,000 
for the national programs portion of the safe and drug free 
schools program, $10,000,000 more than the budget request and 
the fiscal year 1999 appropriation. The Committee has provided 
resources for this program as part of its youth violence 
prevention initiative. Funds for this program are used for 
discretionary grants, joint projects with other Federal 
agencies, development and dissemination of materials, data 
collection and evaluation and a variety of other activities 
designed to improve the field of drug and violence prevention 
at the elementary and secondary school level. Discretionary 
grants also are provided for campus-based projects.
    The Committee recognizes an innovative anti-drug program 
developed by the Chicago Public Schools to combat the dangers 
of alcohol and drug abuse to youth. Specifically, the program 
involves aggressive intervention, treatment opportunities, 
recovery support, parental involvement, and prevention. It is 
implemented through three models: Saturday Morning Alternative 
Reach-out and Teach Program, Alternative Safe Schools, and 
Healthy Kids . . . Healthy Minds.
    The Committee is extremely concerned about the high 
incidence of alcohol abuse among America's college students and 
the overwhelming deaths and injuries resulting from abusive 
alcohol consumption. In 1998, 34 students throughout the United 
States died from alcohol-related accidents on college campuses. 
The Committee, therefore, includes $850,000 within the national 
programs to continue the National Recognition Awards program to 
provide models of alcohol and drug abuse prevention and 
education at the college level. This amount is $100,000 more 
than the administration request and the fiscal year 1999 level.

Coordinator initiative

    The Committee has included $60,000,000 for the Coordinator 
Initiative. This is an increase of $25,000,000 more than the 
fiscal year 1999 appropriation and $10,000,000 more than the 
budget request. The Committee has provided resources for this 
program as part of its youth violence prevention initiative. 
The Committee recommendation will enable the Department to 
provide assistance to LEAs to recruit, hire, and train drug 
prevention and school safety program coordinators in middle 
schools with significant drug and school safety problems. These 
coordinators will be responsible for developing, conducting and 
analyzing assessments of their school's drug and crime 
problems, and identifying promising research-based drug and 
violence prevention strategies and programs to address these 
problems.

Project SERV

    The Committee has deferred action for the new Project SERV 
(School Emergency Response to Violence), pending enactment of 
authorizing legislation. The Administration requested 
$12,000,000 for this purpose in fiscal year 2000.
    Under this initiative, the Department would collaborate 
with the Departments of Justice and Health and Human Services 
and the Federal Emergency Management Administration to help 
school districts respond to major crises.

Inexpensive book distribution

    For the inexpensive book distribution program, the 
Committee provides $21,500,000, an increase of $3,500,000 over 
the 1999 appropriation and the amount recommended by the 
administration has been provided as part of the Committee's 
youth violence prevention initiative. This program is operated 
by Reading Is Fundamental [RIF], a private nonprofit 
organization associated with the Smithsonian Institution. RIF 
supports over 4,500 projects at over 15,000 sites to distribute 
books to children from low-income families to help motivate 
them to read. In 1999, an estimated 10.2 million books will be 
distributed to 3.2 million children. This program has been 
successful in motivating children to read, increasing the use 
of libraries, increasing parental involvement in schools, and 
contributing to improved reading achievement. As mentioned 
earlier, the Committee believes that literacy promotion is an 
important to preventing violence among youth.

Arts in education

    For the arts in education program, the Committee recommends 
$12,500,000, an increase of $2,000,000 more than the 1999 
appropriation and the administration request. The amount 
recommended will support grant awards: $5,746,000 for a grant 
to very special arts [VSA], which supports the development of 
programs to integrate the arts into the lives of children and 
adults with disabilities; and $4,754,000 for a grant to the 
John F. Kennedy Center for the Performing Arts, which supports 
a variety of activities through its education department that 
promote the arts throughout the Nation, and $2,000,000 for 
youth violence prevention activities.
    The Committee has provided sufficient resources for 
additional grants to support programs targeting youth violence, 
delinquency and substance abuse, both in-school and during the 
after school hours, through innovative arts programming and 
youth arts education initiatives.

Magnet schools assistance

    For the magnet schools assistance program, the Committee 
bill provides $112,000,000, $2,000,000 below the amount 
recommended by the administration and an increase of $8,000,000 
over the 1999 appropriation.
    This program supports grants to local educational agencies 
to establish and operate magnet schools that are part of an 
approved desegregation plan and are designed to attract 
substantial numbers of students of different social, economic, 
ethnic, and racial backgrounds. Grantees may use funds for 
teacher salaries, purchase of computers, and other educational 
materials and equipment.
    The Committee recommendation will enable 58 current 
grantees in the third and final year of their grant to achieve 
greater academic excellence with increased funding for 
professional development and related activities. The 
recommendation also provides funds for an additional regular 
magnet schools assistance competition in fiscal year 2000. The 
Committee recommendation does not include resources for the 
Administration's proposed inter-district magnet initiative.
    Within the amount provided, the Committee has included 
$5,200,000 for innovative programs, the same as the budget 
request and $50,000 more than the fiscal year 1999 
appropriation.

Education for homeless children and youth

    For carrying out education activities authorized by part B, 
subtitle B of the Stewart B. McKinney Homeless Assistance Act, 
the Committee recommends $28,800,000, the same as the fiscal 
year 1999 amount and $2,900,000 below the budget request.
    This program provides assistance to each State to support 
an office of the coordinator of education for homeless children 
and youth, to develop and implement State plans for educating 
homeless children, and to carry out other activities to ensure 
that all homeless children and youth in the State have access 
to the same free, appropriate public education, including a 
public preschool education, as provided to other children and 
youth. Grants are made to States based on the total that each 
State receives under the title I program.

Women's educational equity

    The Committee recommends $3,000,000 for the women's 
educational equity program, the same as the fiscal year 1999 
appropriation and the same as the amount requested by the 
administration. The program supports projects that assist in 
the local implementation of gender equity policies and 
practices.

Training and advisory services

    For training and advisory services authorized by title IV 
of the Civil Rights Act, the Committee recommends $7,334,000, 
the same as the fiscal year 1999 appropriation and the 
administration's request.
    The funds provided will continue the 10 regional equity 
assistance centers [EACs] formerly known as regional 
desegregation assistance centers. Each EACs provides services 
to school districts upon request. Activities include 
disseminating information on successful practices and legal 
requirements related to nondiscrimination on the basis of race, 
color, sex, or national origin in education programs. No funds 
are included for civil rights units in State education 
agencies.

Ellender fellowships

    For Ellender fellowships, the Committee bill includes 
$1,500,000, the same as the 1999 appropriation. The 
administration recommended no funding for this program. The 
Ellender fellowship program makes an award to the Close Up 
Foundation of Washington, DC, to provide fellowships to 
students from low-income families and their teachers to enable 
them to participate with other students and teachers for 1 week 
of seminars on Government and meetings with representatives of 
the three branches of the Federal Government.

Education for native Hawaiians

    For programs for the education of native Hawaiians, the 
Committee bill includes $23,000,000, which is $3,000,000 above 
the 1999 appropriation and the administration request.
    The Committee urges the Department when allocating these 
funds to provide the following: $5,500,000 for curricula 
development, teacher training, and recruitment programs, 
including native language revitalization and encourages 
priority be given to the University of Hawaii at Hilo Native 
Language College, aquaculture, prisoner education initiatives, 
waste management, computer literacy, big island astronomy, and 
indigenous health programs; $1,100,000 for the community based 
learning centers; $2,700,000 for the Hawaii higher education 
program; $2,200,000 for the gifted and talented programs; 
$2,200,000 for the special education programs; $400,000 for the 
native Hawaiian education councils; and $8,900,000 for family 
based education centers.
    Native Hawaiian agriculture partnership.--The Committee is 
aware of the dismal economic and social conditions in the rural 
areas of Hawaii resulting from the closure of several sugar 
cane plantations that formerly provided infrastructure for 
these communities. The Committee favors and continues to 
support the expansion of the partnerships between community-
based agricultural businesses and cooperating high schools, 
where agricultural and business practices are integrated into 
the curriculum and products that are ultimately purchased by 
the cooperating businesses.
    Waste management innovation.--Preservation of the 
environment is an important underpinning of Hawaiian culture, 
however, little is known of the historical practices used by 
the Hawaiian people to manage waste and guard against 
overexploitation. The Committee urges the study and 
documentation of traditional Hawaiian practices of sustainable 
waste management and preparation of teaching materials for 
educational purposes and notes the unique qualifications of a 
consortium involving Partners in Development (a Hawaiian 
nonprofit corporation) and the Bishop Museum for such a 
purpose.
    Computer literacy and access fo