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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 for Hawaiian and part-Hawaiian
children.--The importance of literacy for success in school has
been clearly demonstrated. Disadvantaged native Hawaiian and
part-Hawaiian children struggle for opportunities. The
Committee urges that students interested in becoming elementary
and high school teachers be strongly encouraged to pursue these
fields of study.
Prisoner education.--Native Hawaiians continue to represent
the largest ethnic group in that State's prison system. The
Committee recognizes the importance of reintegrating native
Hawaiian youth into school settings or onto a career path and
job placement through comprehensive, culturally sensitive
individual and family counseling; educational skills training;
and employment training/job placement. This project should
target native Hawaiian youth in districts with high percentages
of school dropouts and youth offenders.
Big Island astronomy project.--Mauna Kea is internationally
known for optical, infrared, and millimeter astronomy; is home
to all four of the new generation telescopes; and is a cultural
site of great importance to native Hawaiians. Given that very
few Hawaiians are employed by these programs, the Committee
understands the importance of developing educational programs
to encourage native Hawaiians to enter the field of astronomy,
with emphasis on astronomy as a profession; operation of
astronomical and observatory equipment; or scientific and
cultural expertise.
Indigenous health.--The Native Hawaiian Health Care
Improvement Act provides authority for inclusion of native
Hawaiian traditional healers in the comprehensive health care
delivery system. There is similar recognition of traditional
healing within the Indian Health Service health care delivery
system. Because of a lack of available instruction in
traditional medicine, this knowledge is being lost for younger
generations of native Americans and native Hawaiians. The
Committee is aware of the benefits of educating health care
practitioners in traditional medicines and techniques in native
Indian and native Hawaiian communities.
Hawaii Marine Resource Management.--The Committee notes
that the Hui Malama o Mo'omoni has been working to document the
traditional fishery management techniques used in the Hawaiian
culture. These techniques have both scientific and cultural
relevance to the efficient management of Hawaii's marine
resources. The Committee understands the value of a community-
based outreach program that could teach Hawaiian children these
traditional marine management practices and recognizes the
expertise that Hui Malama o Mo'omoni and their consortium
partners have in this area.
Alaska Native educational equity
The Committee recommends $13,000,000 for the Alaska Native
educational equity assistance program, authorized under title
IX, part C, of the Elementary and Secondary Education Act. This
amount is $3,000,000 over the 1999 appropriation and the budget
request. These funds address the severe educational handicaps
of Alaska Native schoolchildren. Funds are used for development
of supplemental educational programs to benefit Alaska Natives.
The Committee directs the Department to consult with the Alaska
Federation of Natives [AFN] in developing criteria for grant
proposals and consult with AFN in developing criteria for
evaluating projects.
It has been brought to the Committee's attention that in
urban areas, 60 percent of Alaska Natives entering high school
do not graduate, and that Alaska Natives test scores are on
average 40 percent lower than those of other students. In some
districts, none of the Alaska Native elementary students and 40
percent of Native high school students are performing at their
grade levels. The funds provided under the Alaska Native
educational equity assistance program will help to address some
of the barriers faced by Native Alaskan children and develop
programs tailored to the unique needs of these children to
improve performance levels.
Charter schools
The Committee recommends $100,000,000 for support of
charter schools, which is the same as the 1999 appropriation
and $30,000,000 below the budget request.
This program, authorized under title X, part C of the
Elementary and Secondary Act of 1965, as amended, provides
funds to the Secretary to make awards to State educational
agencies, which, in turn, make subgrants to partnerships of
developers and local education agencies or other public
entities that can authorize or approve a charter school. Grants
are limited to 3 years in duration, of which not more than 18
months may be used for planning and program design, not more
than 2 years for the initial implementation of a charter
school, and not more than 2 years to carry out dissemination
activities.
Unlike traditional public schools, charter schools operate
under charters or contracts with school districts, State
education agencies, or other public institutions. They are
designed by groups of parents, teachers, school administrators,
other members of the community, and private corporations and
are held accountable for student performance under the terms of
their contracts. Also, charter schools can operate with
considerable autonomy from external controls such as district,
State, and union requirements.
The Committee is encouraged by the rapid growth of charter
schools throughout the country as a means of education reform.
It has been brought to the Committee's attention that Central
Michigan University proposes to establish a national institute
for charter school development to disseminate information on
and assist schools with the design and implementation of
charter school models.
Comprehensive regional assistance centers
The Committee recommends $28,000,000 for the comprehensive
regional technical assistance centers. This recommendation is
the same as the fiscal year 1999 level. The administration
recommended $32,000,000 for this program. This program supports
15 regional centers that provide support, training, and
technical assistance to Department of Education grantees. Of
the amount recommended, up to $750,000 is for an evaluation to
collect performance indicator data that would improve the
delivery of technical assistance centers.
Advanced placement test fees
The Committee recommends $15,000,000 for the advanced
placement test fees program, $5,000,000 less than the amount
requested by the administration and an increase of $11,000,000
more than the amount appropriated in fiscal year 1999. This
program awards grants to States to enable them to cover part or
all of the cost of advanced placement test fees of low-income
individuals who are enrolled in an advanced placement class and
plan to take an advanced placement test.
Participation in advanced placement programs has helped
increase the post-secondary education enrollment rates of low-
income students. The Higher Education Amendments Act of 1998
allows states to use their additional grant funds for
supplemental activities, if low-income students do not pay more
than a nominal test fee. These activities must focus on
promoting educational excellence and providing equal access to
post-secondary education. The Committee believes that
additional funds should not be used for other activities, such
as professional development, which are unrelated to the goal of
expanding the availability of advanced placement courses to
low-income students.
reading excellence
Appropriations, 1999.................................... $260,000,000
Budget estimate, 2000................................... 286,000,000
Committee recommendation................................ 260,000,000
The Committee recommends $260,000,000 for Reading
Excellence Act programs, the same as the fiscal year 1999
appropriation and $26,000,000 below the budget request. These
funds support reading and literacy grants to State and local
educational agencies to build upon what they are already
providing to promote literacy and to establish new efforts to
link parents, teachers, trained reading professionals, and
trained tutors in school, library, and community literacy
efforts. In addition, the program includes an emphasis on
improving the quality of teaching in the area through
professional development and by using scientifically based
reading research.
indian education
Appropriations, 1999.................................... $66,000,000
Budget estimate, 2000................................... 77,000,000
Committee recommendation................................ 77,000,000
The Committee recommends $77,000,000 for Indian education
programs, an increase of $11,000,000 above the fiscal year 1999
appropriation and the same as the budget request.
Grants to local education agencies
For grants to local education agencies, the Committee
recommends $62,000,000, the same as the fiscal year 1999
appropriation and the same as the budget request. These funds
provide financial support to reform elementary and secondary
school programs that serve Indian students, including pre-
school children. Funds are awarded on a formula basis to local
educational agencies, the Bureau of Indian Affairs [BIA]-
supported schools and BIA operated schools.
Special programs for Indian children
The Committee recommends $13,265,000 for special programs
for Indian children, the same as the budget request and
$10,000,000 above the amount appropriated in fiscal year 1999.
Funds will be used for demonstration grants to improve Indian
student achievement through early childhood and preschool
education programs, and professional development grants for
training Indians who are preparing to begin careers in teaching
and school administration.
National activities
The Committee recommends $1,735,000 for national
activities, the same as the budget request and $1,000,000 more
than the fiscal year 1999 appropriation. Funds are used for
research, evaluation, and data collection to provide
information on the educational status for the Indian population
and on the effectiveness of Indian education programs.
bilingual and immigrant education
Appropriations, 1999.................................... $380,000,000
Budget estimate, 2000................................... 415,000,000
Committee recommendation................................ 394,000,000
The Committee recommends an appropriation of $394,000,000
for bilingual and immigrant education. This is $14,000,000
above the 1999 appropriation and $21,000,000 below the
administration's request.
The bilingual programs authorized by title VII of ESEA are
designed to increase the capacity of States and school
districts to provide special instruction to limited-English
proficient students.
Instructional services
The Committee bill includes $165,000,000 for bilingual
instructional programs, $5,000,000 above the 1999 level and
$5,000,000 below the President's request.
This activity provides competitive grants, primarily to
school districts, to improve the quality of instructional
programs for limited-English proficient students. Schools are
permitted to select the instructional approach best suited to
their students, except that no more than 25 percent of program
funds may be used to support instruction that does not make use
of the students' native language. Funds may also be used to
provide services for preschool children and parents to assist
in the education of their children.
Support services
The Committee has included $14,000,000 for support
services, the same as the fiscal year 1999 appropriation and
the administration's request. This program provides
discretionary grants and contracts in four specific areas:
research and evaluation; dissemination of effective
instructional models; data collection and technical assistance;
and a national clearinghouse to support the collection,
analysis, and dissemination of information about programs for
limited-English proficient students.
Professional development
The Committee recommends $55,000,000 for professional
development, an increase of $5,000,000 above the fiscal year
1999 appropriation and $20,000,000 below the budget request.
These funds support the training and retraining of
bilingual education teachers and teacher aides, graduate
fellowships related to the field of bilingual education, and
grants to institutions of higher education to improve bilingual
teacher training programs.
Immigrant education
The Committee recommends $150,000,000 for immigrant
education, the same as the administration request and the
fiscal year 1999 appropriation.
The Immigrant Education Program provides financial support
to offset the additional costs of educating recently arrived
immigrant students who often lack proficiency in English and
need special services to make the transition to the American
educational system. Federal dollars flow through State
educational agencies to school districts enrolling a minimum of
500 eligible immigrant students or where eligible immigrant
children represent at least 3 percent of the enrollment. The
Committee agrees with the administration and has included bill
language to permit States to allocate all or any part of the
funds to LEA's on a discretionary basis.
Foreign language assistance
The Committee recommends $10,000,000 for competitive
foreign language assistance grants, $4,000,000 above the amount
appropriated in fiscal year 1999 and requested by the
administration. This activity provides grants to increase the
quantity and quality of instruction in foreign languages.
The Committee is aware of the recent research indicating
that the optimum human learning time for all languages is
between birth to age ten. Further, children who study a second
language show greater cognitive development in areas such as
mental flexibility, creativity, tolerance, and higher order
thinking skills. The Committee is dismayed that in spite of
these findings, quality foreign language studies are not
reaching the nation's neediest students and schools. The
Committee urges the Secretary to improve the availability of
foreign language assistance by both increasing awareness of the
program and making use of the authority to waive the matching
grants requirement for local educational agencies who lack the
resources to pay the cost of the program.
Special education
Appropriations, 1999.................................... $5,124,146,000
Budget estimate, 2000................................... 5,449,896,000
Committee recommendation................................ 6,035,646,000
The Committee recommends a program level of $6,035,646,000
for special education. This is $911,500,000 more than the 1999
appropriation and $585,750,000 above the administration
request. This amount includes $2,201,059,000 advance funded in
fiscal year 2001.
These programs, which are authorized by the Individuals
with Disabilities Education Act [IDEA], provide assistance to
ensure that all children with disabilities have access to a
free, appropriate public education, and that all infants and
toddlers with disabilities have access to early intervention
services. This assistance is provided through State grants that
offset a portion of the costs incurred by States and local
educational agencies in educating children with disabilities
and in developing and implementing statewide systems of early
intervention services, and through six programs that provide a
streamlined structure to help States improve educational and
early intervention results for children with disabilities.
Grants to States
The Committee bill provides $4,989,685,000, including
$1,910,219,000 in advanced funding for fiscal year 2001 for
special education grants. The amount recommended is
$678,985,000 more than the fiscal year 1999 appropriation and
$675,685,000 above the budget request. This program supports
formula grants to States to finance a portion of the cost of
providing special education and related services for children
with disabilities.
The Committee's recommended funding level represents
approximately 13 percent of the estimated average per-pupil
expenditure and 11 percent of excess costs, and would provide
an estimated Federal share of $795 per child for the 6.3
million children expected to receive special education
services.
Preschool grants
The Committee recommends $390,000,000 for preschool grants,
an increase of $16,015,000 above the fiscal year 1999
appropriation and $12,435,000 below the budget request. The
preschool grants program provides formula grants to States
based on the amount of funding received in fiscal year 1997,
the number of preschool children aged 3 through 5 years, and
the number of preschool children aged 3 through 5 living in
poverty.
The amount provided by the Committee is approximately $672
per child for the 580,460 preschoolers expected to receive
special education and related services in the next school year.
States may retain an amount equal to 25 percent of their
1997 allocation, cumulatively adjusted upward by the lesser of
inflation or the percentage increase in the State's allocation,
of which 20 percent may be used for administration. These funds
may be used for direct and support services for 3- through 5-
year-olds; and, at a State's discretion, to serve 2-year-olds
with disabilities who will turn age 3 during the school year;
and for other purposes. The remaining funds must be distributed
to local educational agencies.
Grants for infants and families
The Committee bill provides $375,000,000 for the part C
grants for infants and families program, an increase of
$5,000,000 above the fiscal year 1999 appropriation and
$15,000,000 below the budget request. This program provides
formula grants to States to implement statewide systems of
coordinated, comprehensive, multidisciplinary interagency
programs to make available early intervention services to all
children with disabilities, ages birth through 2, and their
families.
State improvement
For State improvement, the bill provides $35,200,000, the
same as the fiscal year 1999 appropriation and $10,000,000
below the budget request. This program supports competitive
grants to State educational agencies to assist them, in
partnership with parents, teachers, institutions of higher
education, interest groups, and others, to improve results for
children with disabilities by reforming and improving their
educational systems. The funds provided include continuation
costs for the secondary and transitional service program, which
has now expired.
Research and innovation
The Committee has included $64,508,000 for research and
innovation, the same as the fiscal year 1999 appropriation and
the budget request. This program supports competitive awards to
produce and advance the use of knowledge to improve services
and results for children with disabilities.
The Committee commends the Office of Special Education for
its consistent efforts to support and conduct work on behalf of
individuals with learning disabilities. The Committee
encourages the Department to fund research and intervention
studies that are of the highest scientific quality and which
can lead to dissemination and program replication that produce
measurable positive improvements in student learning. The
Committee further encourages the Department to disseminate
information concerning best practices and effective
instructional measures associated with enhancing student
learning as well as coordinate research efforts with the
National Institutes of Health, the National Science Foundation,
and other Federal agencies working on related activities.
The Committee continues to be concerned about unmet needs
among children with disabilities in rural and extremely
impoverished areas, who must grapple with a lack of adequate
support and resources for parents, school personnel, and health
care providers. The Committee is pleased that the Early
Childhood Development Project of the National Easter Seal
Society for the Mississippi River Delta Region is developing a
mobile, multi-disciplinary team to serve disabled children and
improve early intervention throughout the disadvantaged States
of Arkansas, Louisiana, and Mississippi. Funds for this project
would be used to expedite placement of pediatric specialists
across the region, provide unduplicated early childhood
services to disabled children, ages birth through twelve years,
assist parents, and build lasting local capacity to sustain and
coordinate appropriate services.
The Committee supports the efforts of and is encouraged by
the planning and preparation devoted to the Special Olympics
World Winter Games to be held in 2001. The Committee is also
aware that funding is needed for the VIII Paralympic Winter
Games. The Paralympic Games offer an Olympic experience for
more than 1,000 disabled athletes from around the world.
Technical assistance and dissemination
The Committee bill provides $44,556,000, the same as the
fiscal year 1999 level and the budget request. These funds
provide technical assistance and information through
competitive awards that support institutes, regional resource
centers, clearinghouses, and efforts to build State and local
capacity to make systemic changes and improve results for
children with disabilities.
Personnel preparation
The Committee recommends $82,139,000 for the personnel
preparation program. The amount recommended is the same as the
fiscal year 1999 appropriation and the budget request. Funds
support competitive awards to help address State-identified
needs for qualified personnel to work with children with
disabilities, and to ensure that these personnel have the
skills and knowledge they need to serve these children.
The appropriation includes funds to provide personnel
preparation for personnel to serve children with high incidence
disabilities including grants for graduate support to ensure a
proper balance among all authorized grant categories.
Parent information centers
The Committee bill provides $18,535,000 for parent
information centers, the same as the fiscal year 1999
appropriation and $4,000,000 below the budget request. This
program makes awards to parent organizations to support parent
training and information centers, including community parent
resource centers. These centers provide training and
information to meet the needs of parents of children with
disabilities living in the areas served by the centers,
particularly underserved parents, and parents of children who
may be inappropriately identified.
Technology and media services
The Committee recommends $34,523,000 for technology and
media services, $1,500,000 above the fiscal year 1999
appropriation and same as the budget request. This program
makes competitive awards to support the development,
demonstration, and use of technology, and educational media
activities of value to children with disabilities.
The Committee recommends $7,500,000 for Recordings for the
Blind and Dyslexic, an increase of $1,500,000 above the amount
requested by the President and $1,000,000 more than the fiscal
year 1999 amount. These activities include production and
circulation of recorded textbooks, increased outreach
activities to print disabled students and their teachers, and
accelerated use of digital technology for recordings for the
blind and dyslexic products and services. This investment will
allow the organization to continue efforts to expand the number
of students served and to provide materials based on the latest
user friendly technologies.
Readline
The Committee recommends $1,500,000 for the Readline
Program. The amount recommended is the same as the fiscal year
1999 appropriation activity, which is authorized by section
687(b)(2)(G) of the Individuals With Disabilities Education
Act, as amended. This project would disseminate research
conducted by the National Institutes of Health, as well as
other research concerning effective teaching strategies, early
diagnosis of, and intervention for, young children with reading
disabilities.
Primary Education Intervention
The Committee defers action on the new primary education
intervention program pending enactment of authorizing
legislation. The administration requested $50,000,000 for this
purpose. The administration intended to provide these funds to
develop curricula for children with developmental delays, ages
3 through 9, with a specific focus on reading and behavior.
rehabilitation services and disability research
Appropriations, 1999.................................... $2,652,584,000
Budget estimate, 2000................................... 2,717,114,000
Committee recommendation................................ 2,692,872,000
The Committee recommends $2,692,872,000 for rehabilitation
services and disability research, $40,288,000 more than the
1999 appropriation and $24,242,000 below the administration
request.
Vocational rehabilitation State grants
The Committee provides $2,338,977,000 for vocational
rehabilitation grants to States, which is $34,566,000 more than
the fiscal year 1999 appropriation and the same as the budget
request.
Basic State grant funds assist States in providing a range
of services to help persons with physical and mental
disabilities prepare for and engage in meaningful employment.
Authorizing legislation requires States to give priority to
persons with significant disabilities. Funds are allotted to
States based on a formula that takes into account population
and per capita income, and States must provide a 21.3-percent
match of Federal funds, except the State's share is 50 percent
for the cost of construction of a facility for community
rehabilitation program purposes.
The Rehabilitation Act requires that no less than 1.0
percent and not more than 1.5 percent of the appropriation in
fiscal year 2000 for vocational rehabilitation State grants be
set aside for grants for Indians. Service grants are awarded to
Indian tribes on a competitive basis to help tribes develop the
capacity to provide vocational rehabilitation services to
American Indians with disabilities living on or near
reservations.
Client assistance
The Committee bill recommends $10,928,000 for the client
assistance program, the same as the fiscal year 1999
appropriation and the amount recommended by the administration
request.
The client assistance program funds State formula grants to
assist vocational rehabilitation clients or client applicants
in understanding benefits available to them and in their
relationships with service providers. Funds are distributed to
States according to a population-based formula, except that
minimum grants of $100,000 are guaranteed to each of the 50
States, the District of Columbia, and Puerto Rico and $45,000
is guaranteed to each of the outlying areas, if the
appropriation exceeds $7,500,000. States must operate client
assistance programs in order to receive vocational
rehabilitation State grant funds.
Training
The Committee provides $39,629,000 for training
rehabilitation personnel, the same as the 1999 appropriation
and $2,000,000 below the administration request.
The purpose of this program is to ensure that skilled
personnel are available to serve the rehabilitation needs of
individuals with disabilities. It supports training,
traineeships, and related activities designed to increase the
numbers of qualified personnel providing rehabilitation
services. The program awards grants and contracts to States and
public or nonprofit agencies and organizations, including
institutions of higher education, to pay all or part of the
cost of conducting training programs. Long-term, in-service,
short-term, experimental and innovative, and continuing
education programs are funded, as well as special training
programs and programs to train interpreters for persons who are
deaf, hard of hearing and deaf-blind.
The Committee is concerned about the shortage of skilled
personnel to provide nonvisual communications skills,
techniques of independent living, counseling education, and
other adjustment-to-blindness services. The training program
offered at the Louisiana Center for the Blind is an example of
a demonstration project that helps to improve the quality of
life for blind individuals by training them to serve as
mobility instructors for future center trainees.
Demonstration and training programs
The Committee bill includes $18,942,000 for special
demonstration programs for persons with disabilities, the same
as the fiscal year 1999 appropriation and $2,000,000 more than
the administration request.
This program awards grants to States and nonprofit agencies
and organizations to develop innovative methods and
comprehensive services to help individuals with disabilities
achieve satisfactory vocational outcomes. Special demonstration
programs support projects for individuals with a wide array of
disabilities.
It has been brought to the Committee's attention that the
Alaska Council for Independent Living wishes to implement its
Self-Directed Model for Personal Assistance Services for
Alaskans with disabilities. The model will train personal
assistants and clients on how to use individualized performance
plans of care to foster independence.
The Committee is aware that the Lighthouse for the Blind in
Seattle, Washington has more than thirty years experience in
this field and is expanding its interpreter, orientation,
mobility, and education services for deaf-blind and other
visually impaired adults.
The Committee commends multi-state and regional efforts to
deliver expanded and technologically advanced services to
disabled individuals. The Committee is aware of the education
and training project for deaf and hearing impaired children and
adults which provides professional development, and a medium
for individuals to acquire life and job skills. Initial testing
sites for this project are being established in the States of
Illinois, Pennsylvania, and Florida.
The Committee is troubled by the high rate of undiagnosed
vision problems among school children. Students experiencing
poor vision often become discouraged to continue their studies,
which ultimately hinders academic achievement. The Committee
recognizes Helen Keller International for its ChildSight
project, which is currently operating in 80 inner-city schools
to provide vision screening and prescription eyeglasses. The
project is expanding its services to students in economically
distressed school systems throughout the country.
Migrant and seasonal farmworkers
The Committee recommends $2,350,000 for migrant and
seasonal farmworkers, the same as the 1999 appropriation and
the same level as the budget request.
This program provides a 90-percent Federal match for
comprehensive rehabilitation services to migrant and seasonal
farm workers with disabilities and their families. Projects
also develop innovative methods for reaching and serving this
population. The program emphasizes outreach, specialized
bilingual rehabilitation counseling, and coordination of
vocational rehabilitation services with services from other
sources.
Recreational programs
The Committee provides $2,596,000 for recreational
programs, the same as the 1999 appropriation and the
administration request.
Recreational programs help finance activities such as
sports, music, dancing, handicrafts, and art to aid in the
employment, mobility, and socialization of individuals with
disabilities. Grants are awarded to States, public agencies,
and nonprofit private organizations, including institutions of
higher education. Grants are awarded for a 3-year period with
the Federal share at 100 percent for the first year, 75 percent
for the second year, and 50 percent for the third year.
Programs must maintain the same level of services over the 3-
year period.
Protection and advocacy of individual rights
The Committee recommends $10,894,000 for protection and
advocacy of individual rights, the same as the 1999
appropriation and the same as the budget request.
This program provides grants to agencies to protect and
advocate for the legal and human rights of persons with
disabilities.
Projects with industry
The Committee bill includes $22,071,000 for projects with
industry, the same as the 1999 appropriation and the
administration request.
The projects with industry [PWI] program is the primary
Federal vehicle for promoting greater participation of business
and industry in the rehabilitation process. PWI provides
training and experience in realistic work settings to prepare
individuals with disabilities for employment in the competitive
job market. Postemployment support services are also provided.
The program makes grants to a variety of agencies and
organizations, including corporations, community rehabilitation
programs, labor and trade associations, and foundations.
Supported employment State grants
The Committee's bill includes $38,152,000 for the supported
employment State grant program, the same as the 1999
appropriation and the budget request.
This program assists persons who may have been considered
too severely disabled to benefit from vocational rehabilitation
services by providing the ongoing support needed to obtain
competitive employment. Short-term vocational rehabilitation
services are augmented with extended services provided by State
and local organizations. Federal funds are distributed on the
basis of population.
Independent living State grants
The Committee recommends $22,296,000 for independent living
State grants, which is the same as the amount appropriated in
1999 and the budget request.
The independent living State formula grants program
provides funding to improve independent living services,
support the operation of centers for independent living,
conduct studies and analysis, and provide training and
outreach.
Independent living centers
For independent living centers, the Committee bill includes
$48,000,000, which is $1,891,000 more than the 1999
appropriation and $2,886,000 below the budget request.
These funds support consumer-controlled, cross-disability,
nonresidential, community-based centers that are designed and
operated within local communities by individuals with
disabilities. These centers provide an array of independent
living services.
Independent living services for older blind individuals
The Committee provides $15,000,000 for independent living
services to older blind individuals, an increase of $3,831,000
above the 1999 appropriation and $3,608,000 above the
administration request.
States participating in the program must match every $9 of
Federal funds with $1 in non-Federal resources. Assistance is
provided to persons aged 55 or older to adjust to their
blindness, continue living independently and avoid societal
costs associated with dependent care. Services may include the
provision of eyeglasses and other visual aids, mobility
training, braille instruction and other communication devices,
community integration, and information and referral. These
services help older individuals age with dignity, continue to
live independently and avoid significant societal costs
associated with dependent care. The services most commonly
provided by this program are daily living skills training,
counseling, the provision of low-vision devices community
integration, information and referral, communication devices,
and low-vision screening. The Committee notes that there are 5
million Americans in this country age 55 and older who are
experiencing vision loss and that the number of Americans in
this category is expected to double in the next 30 years. The
Committee recognizes the very important and cost-effective work
carried out through this program. By allowing older individuals
to remain in their homes and communities, substantial savings
are achieved. The Committee is informed that the yearly savings
to society for just ten percent of the clients now receiving
independent living services is $56,000,000. The Committee
believes this program is deserving of future increases.
Program improvement activities
For program improvement activities, the Committee provides
$1,900,000, the same as the budget request and the 1999
appropriation. In fiscal year 2000, funds for these activities
will continue to support technical assistance efforts to
improve the efficiency and effectiveness of the vocational
rehabilitation program and improve accountability efforts and
performance measures. The funds provided are sufficient to
support ongoing program improvement activities and to support a
national conference on the findings of the longitudinal study
of the vocational rehabilitation program.
Evaluation
The Committee recommends $1,587,000 for evaluation
activities, the same as the 1999 appropriation and the
administration request.
These funds support evaluations of the impact and
effectiveness of programs authorized by the Rehabilitation Act.
The Department awards competitive contracts for studies to be
conducted by persons not directly involved with the
administration of Rehabilitation Act programs.
Helen Keller National Center
The Committee bill includes $8,550,000 for the Helen Keller
National Center for Deaf-Blind Youth and Adults, the same as
the 1999 appropriation and the budget request.
The Helen Keller National Center consists of a national
headquarters in Sands Point, NY, with a residential training
and rehabilitation facility where deaf-blind persons receive
intensive specialized services; a network of 10 regional field
offices which provide referral and counseling assistance to
deaf-blind persons; and an affiliate network of 47 agencies. At
the recommended level, the center would serve approximately 102
persons with deaf-blindness at its headquarters facility and
provide field services to approximately 1,750 persons.
National Institute on Disability and Rehabilitation Research
The Committee recommends $81,000,000 for the National
Institute on Disability and Rehabilitation Research [NIDRR],
the same as the amount appropriated in 1999 and $9,964,000
below the budget request.
NIDRR develops and implements a comprehensive and
coordinated approach to the conduct of research, demonstration
projects, and related activities enabling persons with
disabilities to better function at work and in the community,
including the training of persons who provide rehabilitation
services or who conduct rehabilitation research. The Institute
awards competitive grants to support research in federally
designated priority areas, including rehabilitation research
and training centers, rehabilitation engineering research
centers, research and demonstration projects, and dissemination
and utilization projects. NIDRR also supports field-initiated
research projects, research training, and fellowships.
Learning disabilities occur with high frequency (30 to 65
percent) in children with Neurofibromatosis (NF1). The
Committee is aware that research in this area has opened up
exciting new opportunities to eliminate learning disabilities
in this population. The Committee encourages more research in
this area to learn more about NF1 and its connection to
learning disabilities. The Committee encourages the Department,
through the NIDRR, to coordinate and make use of various
research mechanisms such as Field-Initiated Projects Grants and
the Research and Rehabilitation Training Centers program to
support research in this area.
The Committee is aware of the successes over the past two
decades that the Cerebral Palsy Research Foundation and The
Wichita State University have had assisting people with
significant disabilities obtain self-sufficient employment.
Given their experience, the Committee believes that these
institutions are well-suited to serve as a rehabilitation
research and training center, and could conduct studies
identifying cost-effective incentives to employ people with
disabilities and make policy recommendations on their
implementation.
The Committee encourages the Department to provide funds
for research on postpolio syndrome. Specifically, this research
should focus on improved symptom assessment of postpolio
patients; identification of rehabilitation alternatives for
postpolio syndrome patients; and application to other muscular
disorders.
Assistive technology
The Committee bill provides $30,000,000 for assistive
technology, $15,000,000 below the budget request and the same
as the fiscal year 1999 appropriation.
The Assistive Technology Program is designed to improve
occupational and educational opportunities and the quality of
life for people of all ages with disabilities through increased
access to assistive technology services and devices. It
provides grants to States to develop comprehensive, consumer
responsive statewide programs that increase access to, and the
availability of, assistive technology devices and services. The
National Institute on Disability and Rehabilitation Research
administers the program.
Special Institutions for Persons With Disabilities
American printing house for the blind
Appropriations, 1999.................................... $8,661,000
Budget estimate, 2000................................... 8,973,000
Committee recommendation................................ 10,100,000
The Committee recommends $10,100,000 for the American
Printing House for the Blind [APH], $1,127,000 above the budget
request and an increase of $1,439,000 above the 1999
appropriation.
This appropriation helps support the American Printing
House for the Blind, which provides educational materials to
students who are legally blind and enrolled in programs below
the college level. The Federal subsidy provides about 44
percent of APH's total sales income. Materials are distributed
free of charge to schools and States through per capita
allotments based on the total number of students who are blind.
Materials provided include textbooks and other educational aids
in braille, large type, and recorded form and microcomputer
applications.
national technical institute for the deaf
Appropriations, 1999.................................... $45,500,000
Budget estimate, 2000................................... 47,925,000
Committee recommendation................................ 48,151,000
The Committee recommends an appropriation of $48,151,000
for the National Technical Institute for the Deaf [NTID], an
increase of $2,651,000 over the 1999 appropriation and $226,000
above the budget request.
The Institute, located on the campus of the Rochester
Institute of Technology, was created by Congress in 1965 to
provide a residential facility for postsecondary technical
training and education for persons who are deaf. NTID also
provides support services for students who are deaf, trains
professionals in the field of deafness, and conducts applied
research. Within the amount provided, $2,651,000 is for
construction.
gallaudet university
Appropriations, 1999.................................... $83,480,000
Budget estimate, 2000................................... 85,120,000
Committee recommendation................................ 85,500,000
The Committee recommends $85,500,000 for Gallaudet
University, an increase of $2,020,000 above the amount
appropriated in 1999 and $380,000 more than the administration
request.
Gallaudet University is a private, nonprofit institution
offering college preparatory, undergraduate, and continuing
education programs for students who are deaf, as well as
graduate programs in fields related to deafness for students
who are hearing-impaired. The university conducts basic and
applied research related to hearing impairments and provides
public service programs for the deaf community.
The Model Secondary School for the Deaf serves as a
laboratory for educational experimentation and development,
disseminates models of instruction for students who are deaf,
and prepares adolescents who are deaf for postsecondary
academic or vocational education. The Kendall Demonstration
Elementary School develops and provides instruction for
children from infancy through age 15.
The Committee recommendation includes $2,500,000 for
construction at Gallaudet University.
VOCATIONAL AND ADULT EDUCATION
Appropriations, 1999.................................... $1,564,970,000
Budget estimate, 2000................................... 1,750,250,000
Committee recommendation................................ 1,676,750,000
The Committee recommendation includes a total of
$1,676,750,000 for vocational and adult education, consisting
of $1,169,750,000 for vocational education and $488,000,000 for
adult education, and $19,000,000 for State grants for
incarcerated youth offenders.
Vocational education
The Committee recommendation of $1,169,750,000 for
vocational education is $6,500,000 more than the
administration's request and $6,503,000 above the fiscal year
1999 amount.
Basic grants.--The Committee has included $1,030,650,000
for basic grants, the same as the 1999 appropriation and the
administration request.
Funds provided under the State grant program assist States,
localities, and outlying areas to expand and improve their
programs of vocational education and provide equal access to
vocational education for populations with special needs.
Persons assisted range from secondary students in prevocational
courses through adults who need retraining to adapt to changing
technological and labor market conditions. Funds are
distributed according to a formula based on State population
and State per capita income.
Under the Indian and Hawaiian natives programs, competitive
grants are awarded to federally recognized Indian tribes or
tribal organizations and to organizations primarily serving and
representing Hawaiian natives for services that are in addition
to services such groups are eligible to receive under other
provisions of the Perkins Act.
Tech-prep education.--The Committee recommends $106,000,000
for tech-prep programs. This is the same as the 1999
appropriation and $5,000,000 less than the administration
request. This program is designed to link academic and
vocational learning and to provide a structured link between
secondary schools and postsecondary education institutions.
Funds are distributed to the States through the same formula as
the basic State grant program. States then make planning and
demonstration grants to consortia of local educational agencies
and postsecondary institutions to develop and operate model 4-
year programs that begin in high school and provide students
with the mathematical, science, communication, and
technological skills needed to earn a 2-year associate degree
or 2-year certificate in a given occupational field.
Tribally controlled postsecondary vocational
institutions.--The Committee has provided $4,600,000 on a
current-funded basis for tribally controlled postsecondary
vocational institutions. This is an increase of $500,000 over
the fiscal year 1999 appropriation and the administration
recommendation. This program provides grants for the operation
and improvement of tribally controlled postsecondary vocational
institutions to ensure continued and expanded educational
opportunities for Indian students. Grantee institutions may use
the funds for costs connected with training teachers, providing
instructional services, purchasing equipment, administration,
and operating and maintaining the institution.
National programs, research.--The Committee recommends
$19,500,000 for national research programs, an increase of
$6,003,000 above the 1999 appropriation and $2,000,000 above
the administration request.
The National Center for Research in Vocational Education is
the only federally funded center charged with the
responsibility to conduct research and provide technical
assistance to vocational educators. The results of the applied
research done by the Center are converted into technical
assistance to reform and improve vocational education
instruction in our schools and colleges. The Committee believes
that the work of the Center is critically important to the
provision of state-of-the-art job-related instruction that, in
turn, will strengthen our Nation's economy.
The amount of $9,000,000 is provided to cover basic
National Occupational Information Coordinating Committee
(NOICC) and State Occupational Information Coordinating
Committees (SOICC) activities, including the development and
delivery of occupational and career information to students,
job seekers, employers, education and employment and training
programs (especially one-stop centers), school-to-work
transition systems, military transition and staffing
initiatives, and welfare-to-work efforts. At least 85 percent
of this amount will pass through to State SOICC's. Of the
total, up to $2,000,000 will support continuation of national
and State career development and related capacity building
programs that train personnel in assisting students and adults
to understand themselves in the context of their career
development and career transition, to be aware of the world of
work, to understand the linkage between academic skills and
work-related skills, to understand the linkages among related
occupations and their skill requirements, and to make more
informed and effective career decisions. In addition, NOICC is
allowed to charge fees for publications and delivery of
technical assistance and training, and the revenues raised from
these sources are to be directed to NOICC to cover the costs of
authorized activities.
As a result of the reauthorization of the Carl D. Perkins
Vocational and Applied Technology Act, new Federal and state
entities will be established to carry out the provisions of
section 118 (Occupational and Employment Information) of the
Act. The National Occupational Information Coordinating
Committee previously authorized by the Job Training Partnership
Act, and State Occupational Information Coordinating Committees
will be phased out. The Committee urges the Department to
ensure that the transition from the Department of Labor to the
Department of Education maintains a smooth and efficient
delivery of network services. Therefore, the Committee strongly
encourages the Department to staff the Federal entity with
NOICC personnel, who have both technical and programmatic
expertise that will be useful in implementation of section 118
of the Carl D. Perkins Vocational and Applied Technology
Education Amendments Act of 1998.
Adult Education
The Committee has included $488,000,000 for adult
education, $87,000,000 less than the administration request and
$103,000,000 above the 1999 appropriation.
Adult education State programs.--For adult education State
programs, the Committee recommends $468,000,000, which is the
same as the administration request and $103,000,000 above the
1999 appropriation. These funds are used by States for programs
to enable economically disadvantaged adults to acquire basic
literacy skills, to enable those who so desire to complete a
secondary education, and to make available to adults the means
to become more employable, productive, and responsible
citizens.
Leadership activities.--The Committee has included
$14,000,000, the same as the 1999 appropriation and a decrease
of $87,000,000 below the administration request.
National Institute for Literacy.--The Committee recommends
$6,000,000 for the National Institute for Literacy, authorized
under section 242 of the Adult Education and Family Literacy
Act, the same amount appropriated in 1999 and the budget
request. The Institute provides leadership and coordination for
the national literacy effort by conducting research and
demonstrations on literacy, providing technical assistance
through a State capacity building grant program, establishing
and maintaining a national center for adult literacy and
learning disabilities, and awarding fellowships to outstanding
individuals in the field to conduct research activities under
the auspices of the Institute.
State grants for incarcerated youth offenders
The Committee has included $19,000,000 for a program
authorized by part D of title VIII of the Higher Education Act,
$2,277,000 above the amount appropriated in fiscal year 1999
and $7,000,000 more than the administration requested. This
program provides grants to State correctional education
agencies to assist and encourage incarcerated youth to acquire
functional literacy, life and job skills, through the pursuit
of a postsecondary education certificate or an associate of
arts or bachelor's degree. Grants will also assist correction
agencies in providing employment counseling and other related
services that start during incarceration and continue through
prerelease and while on parole. Each student is eligible for a
grant of not more than $1,500 annually for tuition, books, and
essential materials, and not more than $300 annually for
related services such as career development, substance abuse
counseling, parenting skills training, and health education. In
order to participate in a program, a student must be no more
than 25 years of age and be eligible to be released from prison
within 5 years. Youth offender grants are for a period not to
exceed 5 years, 1 year of which may be devoted to study in
remedial or graduate education.
The Committee is concerned about the low academic
achievement of youth offenders and their subsequent difficulty
in obtaining gainful employment or pursue a postsecondary
education upon release, which comes at pivotal stage of
adulthood. One of the most immediate and basic needs for
youthful offenders is remedial education and high school or GED
preparation. The Committee believes that research into this
program is necessary to determine its effectiveness and to
identify areas in need of improvement, including achievement
rates, recidivism, employment after release and behavior during
incarceration.
The Committee also has included bill language providing
$5,000,000 to continue the prison literacy program as a part of
the Youth Violence Prevention Initiative. The Committee notes
that the extremely high rates of illiteracy or marginal reading
skills among inmates is a national problem and therefore
encourages the development of a uniform model to evaluate
literacy programs across the country.
STUDENT FINANCIAL ASSISTANCE
Appropriations, 1999.................................... $9,348,000,000
Budget estimate, 2000................................... 9,183,000,000
Committee recommendation................................ 9,498,000,000
The Committee recommends an appropriation of $9,498,000,000
for student financial assistance, an increase of $150,000,000
over the fiscal year 1999 appropriation and $315,000,000 over
the administration request.
Federal Pell Grant Program
For Pell grant awards in the 2000-2001 academic year, the
Committee recommends $7,778,000,000, of which $1,176,400,000
will become available October 1, 2000, for the 2000-2001
academic year.
Pell grants provide need-based financial assistance that
helps low- and middle-income undergraduate students and their
families pay the costs of postsecondary education and
vocational training. Awards are determined according to a
statutory need analysis formula that takes into account a
student's family income and assets, household size, and the
number of family members attending postsecondary institutions.
Pell grants are considered the foundation of Federal
postsecondary student aid.
The amount recommended is sufficient to raise the maximum
Pell grant to $3,325 the highest level in the program's history
and an increase of $200 over the maximum grant for the 1999-
2000 academic year.
Federal supplemental educational opportunity grants
The Committee recommends $631,000,000 for Federal
supplemental educational opportunity grants [SEOG], an increase
of $12,000,000 above the 1999 appropriation level and the same
as the budget request.
This program provides funds to postsecondary institutions
for need-based grants to undergraduate students. Institutions
must contribute 25 percent of SEOG awards, which are subject to
a maximum grant level of $4,000. School financial aid officers
have flexibility to determine student awards, though they must
give priority to Pell grant recipients.
Federal work-study programs
The Committee bill provides $934,000,000 for the Federal
Work-Study Program, an increase of $64,000,000 above the 1999
level and the same as the administration request. This program
provides grants to approximately 3,400 institutions to help an
estimated 1 million undergraduate, graduate, and professional
students meet the costs of postsecondary education through
part-time employment. Work-study jobs must pay at least the
Federal minimum wage and institutions must provide at least 25
percent of student earnings. Institutions also must use at
least 7 percent of their grants for community-service jobs.
The Committee supports continuing funding for the work
colleges authorized in section 448 of the Higher Education Act.
These funds help support comprehensive work-service-learning
programs at qualifying institutions around the Nation. Of the
funds provided, the Committee has included $3,000,000 to
continue and expand the work colleges program.
The Committee is aware of an important work colleges
program at Blackburn College in Carlinville, IL. Blackburn
College is one of a small number of institutions that meet the
criteria to participate in this work-learning program. The
Blackburn program provides critical assistance to help students
meet the increasing costs of post-secondary education and
provides valuable work and public service experiences which
enhance the education opportunities provided to students.
Federal Perkins loans
The Committee bill includes $100,000,000 for Federal
Perkins loans capital contributions, which is the same as the
1999 appropriation and the budget request. The amount
recommended when combined with institutional revolving funds,
would maintain the 2000 loan volume at the current estimated
level of $1,058,000,000. At this funding level nearly 700,000
loans would be made, the same number awarded in fiscal year
1999.
The Federal Perkins Loan Program supports student loan
revolving funds built up with capital contributions to about
2,000 participating institutions. Institutions use these
revolving funds, which also include Federal capital
contributions (FCC), institutional contributions equal to one-
third of the FCC, and student repayments, to provide low-
interest (5 percent) loans that help financially needy students
pay the costs of postsecondary education. The Committee has
included the amount necessary to maintain the current loan
volume level.
The Committee bill also includes $30,000,000 for loan
cancellations, the same as the 1999 level and the amount
requested by the administration. These funds reimburse
institutional revolving funds on behalf of borrowers who
perform statutorily specified types of public or military
service, such as working in a Head Start Program, serving in
the Peace Corps or VISTA, or teaching in a qualified low-income
school.
Leveraging educational assistance partnership program
For the Leveraging educational assistance partnership
[LEAP] program, formerly known as the State Student Incentive
Grant Program [SSIG], the Committee includes $25,000,000, the
same as the 1999 appropriation and the administration request.
This program provides a Federal match to States as an incentive
for providing need-based grant and work-study assistance to
eligible students.
FEDERAL FAMILY EDUCATION LOAN PROGRAM
Appropriations, 1999.................................... $47,276,000
Budget estimate, 2000................................... 48,000,000
Committee recommendation................................ 48,000,000
The Committee recommends $48,000,000 for discretionary
Federal administrative expenses related to the Federal Family
Education Loan [FFEL] Program, formerly known as the Guaranteed
Student Loan Program. The amount recommended is the same as the
budget request and, excluding year 2000 computer conversion
funding, $724,000 above the amount appropriated in fiscal year
1999.
Funds appropriated for Federal administrative expenses will
partially cover the fiscal year 2000 salaries and benefits,
travel, printing, contracts, and other expenses associated with
the program, including payment and claims processing, reducing
loan default costs, and program monitoring. This discretionary
administrative funding is included in the ``Federal family
education loans'' appropriation account rather than under the
Department's ``Salaries and expenses'' account pursuant to a
requirement of the Federal Credit Reform Act of 1990.
The FFEL Program is administered through State and private
nonprofit guaranty agencies that insure loans directly, collect
defaulted loans, and provide various services to lenders. The
Federal Government supports the guaranty agencies by providing
loan advances and reinsurance payments for borrower default,
death, disability, and bankruptcy. The Federal Government also
pays guaranty agencies loan processing and issuance fees out of
the FFEL subsidy and account maintenance fees in the
administrative funds under section 458 of the Higher Education
Act.
The Federal Government also pays an interest subsidy to
lenders, based on the borrower's interest rate, on behalf of
Stafford loan student borrowers while they are in school and
during certain grace and deferment periods. To be eligible for
this subsidy, students must demonstrate financial need, be
enrolled at least half time, and not be incarcerated. Federal
Stafford loans may be borrowed by eligible students, regardless
of their school year or dependency status. Borrowing limits are
tied to the extent of need, for the cost of attendance minus an
expected family contribution, and other aid as determined by a
statutory need analysis system.
An unsubsidized Stafford Loan Program for middle-income
borrowers provides federally reinsured loans to borrowers who
do not qualify for Federal interest subsidy payments under the
need-based Stafford Loan Program. Except for the interest
benefit and certain loan limits, all other terms and conditions
of the Federal Stafford Loan Program apply to the unsubsidized
Stafford loans.
Federal PLUS loans are made to parents of dependent
undergraduate students. Interest rates for PLUS loans are
usually higher than those for Federal Stafford loans, and the
Federal Government does not pay the interest during in-school,
grace, and deferment periods. No need analysis is required, but
borrowing cannot exceed cost of attendance minus other aid.
HIGHER EDUCATION
Appropriations, 1999.................................... $1,292,623,000
Budget estimate, 2000................................... 1,579,206,000
Committee recommendation................................ 1,404,631,000
The Committee recommends an appropriation of $1,404,631,000
for higher education programs, $112,008,000 more than the 1999
amount and $174,575,000 below the budget request.
Aid for institutional development
The Committee recommends $286,000,000 for aid for
institutional development authorized by title III of the Higher
Education Act, $25,750,000 above the 1999 appropriation and
$7,575,000 below the budget request.
Strengthening institutions.--The Committee bill includes
$60,250,000 for the part A strengthening institutions program,
the same as the 1999 level and $1,325,000 below the budget
request. The part A program supports competitive, 5-year
development grants for institutions with a significant
percentage of financially needy students and low educational
and general expenditures per student in comparison with similar
institutions. Applicants may use part A funds to develop
faculty, strengthen academic programs, improve institutional
management, and expand student services.
Hispanic-serving institutions [HSI].--The Committee
recommends $42,250,000 for institutions at which Hispanic
students make up at least 25 percent of enrollment, $14,250,000
above the 1999 level and the same as the administration
request. Institutions applying for title V funds must meet the
regular part A requirements and show that at least one-half of
their Hispanic students are low-income, first-generation
college students. Funds may be used for acquisition of
scientific or laboratory equipment, renovation of instructional
facilities, and purchase of educational materials. Title V
recipients are not eligible for other awards provided under
title III, parts A and B.
Strengthening historically black colleges and
universities.--The Committee provides $141,500,000 for part B
grants, $5,500,000 above the 1999 level and $7,250,000 below
the administration request. The part B strengthening
historically black colleges and universities [HBCU] program
makes formula grants to HBCU's that may be used to purchase
equipment, construct and renovate facilities, develop faculty,
support academic programs, strengthen institutional management,
enhance fundraising activities, provide tutoring and counseling
services to students, and conduct outreach to elementary and
secondary school students. The minimum allotment is $500,000
for each eligible institution. Part B recipients are not
eligible for awards under part A.
Strengthening historically black graduate institutions.--
The Committee bill includes $31,000,000 for the part B, section
326 program, $1,000,000 above the 1999 level and $1,000,000
below the administration request. The section 326 program
provides 5-year grants to strengthen historically black
graduate institutions [HBGI's]. The Higher Education Amendments
of 1998 increased the number of recipients to 18 named
institutions, but reserved the first $26,600,000 appropriated
each year to the first 16 institutions included in the previous
authorization. Grants may be used for any part B purpose and to
establish an endowment.
Strengthening tribal colleges and universities
The Committee recommends $6,000,000, $3,000,000 more than
the fiscal year 1999 appropriation and the same as the budget
request for strengthening tribal colleges and universities.
Funds are used to improve the academic quality, technical
capacity, institutional management, and fiscal stability of
eligible tribal colleges and universities to strengthen their
ability to make a substantial contribution to higher education.
Strengthening Alaska native and native Hawaiian-serving institutions
The Committee recommends $5,000,000 for this program, an
increase of $2,000,000 over the fiscal year 1999 appropriation
and the budget request. The purpose of this program is to
improve and expand the capacity of institutions serving Alaska
Native and Native Hawaiian students. Funds may be used to plan,
develop, and implement activities that encourage: faculty and
curriculum development; better fund and administrative
management; renovation and improvement of instructional
facilities, student services, and the purchase of library books
and other educational materials.
Fund for the improvement of postsecondary education
The Committee recommends $27,500,000 for the fund for the
improvement of postsecondary education [FIPSE], which is
$22,500,000 less than the 1999 appropriation and the same as
the administration request. FIPSE stimulates improvements in
education beyond high school by supporting exemplary, locally
developed projects that have potential for addressing problems
and recommending improvements in postsecondary education. The
fund is administered by an independent board that provides
small, competitive grants and contracts to a variety of
postsecondary institutions and agencies, including 2- and 4-
year colleges and universities, State education agencies,
community-based organizations, and other non-profit
institutions and organizations concerned with education beyond
high school. The Committee has included a number of report
language items and requests that the Department afford them the
opportunity to compete through the regular peer review
competitive process.
The Committee understands the need to strengthen American
students' interest and skills in science and to prepare them
for science-based careers as they begin to compete with their
international counterparts in the global economy. Excellence in
science education begins with improving the ways in which
programs are delivered and teachers are trained to instruct
students in this subject area. The National Teachers Academy is
a professional and curriculum development project designed to
ensure that teachers entering the classroom are qualified in
the very subjects they teach to students. Student teachers from
the University of Illinois will complete their certification
requirements in laboratory settings at Chicago public schools.
It has been brought to the Committee's attention that
Muhlenberg College in the state of Pennsylvania is developing a
national model for advancing contextual learning in an
environmental science classroom. The Committee is also aware of
a large scale project which coordinates six universities,
seventeen public school systems, and organizations in the state
of Louisiana to provide professional development for life
science and biology middle school teachers.
It has also been brought to the Committee's attention that
Hampshire College in the state of Massachusetts is developing a
National Center for Science Education to offer year-round
workshops. The University of Missouri-St. Louis has established
an urban education reform program by using cultural diversity
and social issues as the knowledge base from which to build
lesson plans and standards-based science and math education for
students in grades 6-12.
The Committee recognizes that the use of technology in the
classroom captivates students and increases their interest in
learning. Technology has been especially helpful in assisting
disabled students to excel in their schoolwork. It has been
brought to the Committee's attention that the Montana State
University-Billings is developing a distance learning project
specifically designed to train teachers to better serve
disabled students and their families.
The Committee notes the difficulty many students experience
when continuing their education and trying to balance the
demands of family and work in today's highly competitive job
market. The National Guard in the state of Montana has improved
access to a college education by providing on-site courses for
employees. The Committee understands that the National Guard is
now expanding its services by partnering with small businesses
and agricultural producers to provide professional development
and computer training. The Committee recognizes Vorhees College
for its efforts on behalf of national welfare reform, which has
increased the demand for nontraditional college programming.
The college's integrated education program prepares students
for current workforce demands and supports the permanent self-
sufficiency of single mothers in Allendale, Bamberg and
Barnwell Counties of South Carolina. The project will target
150 participants from the Tri-County area, a region with the
highest concentration of poverty, long-term welfare dependence
and unemployment in the state. Vorhees College will educate
participants to pursue baccalaureate degrees, and will
collaborate with community agencies to establish a
comprehensive network to provide child care, health care, and
transportation services to ensure that students can complete
their degree programs. In the state of Virginia, four
institutions of higher education have collaborated to form the
Continuing Education Center which offers area residents skills
and technology training for employment within the region. The
Committee is aware of the North Dakota State University's
Career Program for Dislocated Farmers and Ranchers, which
provides academic programming and other educational services to
prepare agricultural workers for a non-farm career. The Black
Hills State University of South Dakota is establishing a
cooperative education program that will integrate classroom
studies with a series of work experiences for economically
disadvantaged, rural, and Native American college students to
better connect employers and graduates to the needs of the
community.
The Committee recognizes the social and economic gains of
diversified populations entering underrepresented occupational
fields such as teaching and medicine. Psychology is one such
field which plays an important role in the promotion of health
and prevention of disease. The 5 to 7-year doctoral degree,
which is required to become a professional psychologist, is
often too financially burdensome for minority and disadvantaged
individuals. The Committee is aware of a university-based
program in the state of Montana which recruits American Indians
into careers in psychology and supports both undergraduate and
graduate American Indian students. The Committee is also aware
of the national shortage for bilingual education teachers,
particularly in rural and urban areas, and notes the Western
Oregon University's response to this critical shortage through
a training program for individuals who speak English as a
second language to become bilingual and multilingual assistants
and ultimately teachers to receive Bachelor's degrees and
teaching licenses for careers in bilingual education.
The Committee understands that the quality of postsecondary
education can be enhanced when various fields of study are
integrated into coursework and experts come together to
exchange their knowledge with students. The University of New
Mexico has been working with Sandia Laboratories on the
development of a rigorous science sequence for teaching
candidates. The Lehigh University in the state of Pennsylvania
has developed a unique Integrated Product Development [IPD]
program, which draws over 35 faculty members from three
different colleges to prepare students for employment in
industry by providing a complete, interdisciplinary education
in industrial design, engineering, and business. The Committee
is aware that the University of Idaho is expanding its student
capacity for its interdisciplinary Ecohydraulic Research
program. The program coordinates four different departments of
the institution and has academic links with regional federal
laboratories to train undergraduate and graduate students to
respond to the severe waste management and water resources
issues facing the Northwest.
The Committee is impressed by the Philadelphia University's
development of a state-of-the-art education center for future
professionals in business, science, architecture, design and
healthcare.
The Committee is encouraged by the partnership established
between the United Negro College Fund and the University of
Alaska higher education system to advance curriculum for
minority-serving institutions. The UNCF will conduct research,
train higher educational professionals in resource management,
provide teacher training, and support mentor programs to
improve educational opportunities and outcomes for minority and
underrepresented populations.
The Committee notes that continuous curriculum development
of information technology courses and resources improves
student preparedness for the advanced technological needs of
the workforce. The Committee is aware of the higher education
community's commitment to this endeavor. The Western Governors
University [WGU] is a degree-granting, internet-based
institution of higher education offering distance learning to
students who do not have the resources to travel and attend
college away from their residences. The WGU currently serves
nineteen states and territories of the United States and plans
to enhance its library, information, and telecommunications
systems. The Rural Education Technology Center at Western
Montana College will work in cooperation with the Western
Governors' Association by providing teacher education,
instructional design, student support, and computer and
connectivity assistance. It has been brought to the Committee's
attention that the Central Oregon University Center in Bend,
Oregon, is integrating computer technology to create ``smart
classrooms'' to ensure that advanced equipment and resources
reach its students and meet the demands of a high-technology
workforce. The Committee acknowledges that for six years, the
Central Oregon University Center has been a nationally proven
leader in distance education, delivering more than 20 Master's
and baccalaureate degree programs from nine public and private
Oregon colleges and universities to 600 students in the 1998-
1999 academic year.
The Committee commends the work of the Polytechnic
Institute at Southeast Missouri State University, which will
serve a 24-county area located in the Lower Mississippi Delta
region. The Lower Mississippi Delta Development Commission has
identified it as the poorest region in the United States,
lagging in industrial development, having high dropout rates,
and limited technical educational opportunities. The Southeast
Missouri State University's planned technical education center
is serving as a regional staging point for the coordinated
delivery of technical education in cooperation with community
colleges and vocational technical schools.
The University of North Carolina at Greensboro and the
historically-black North Carolina Central University have
formed a series of interrelated programs to improve the
competitiveness of small and minority-owned businesses. Loyola
University in Chicago is developing new multi-media computer
centers which will offer professional development and computer
science outreach to area high schools and community colleges.
The Committee is also aware of the comprehensive technology
project being developed and implemented by the Fairbanks North
Star Borough School District and the University of Alaska to
provide technology training beginning in high school and
finishing in a one to two year degree program to prepare
students for existing and emerging jobs in the area. More than
900 young adults will be served by the project.
The Committee is encouraged by efforts to improve access to
and availability of technology in rural areas. The Center for
the Advancement of Distance Learning in Rural America is making
progress in this area and can serve as a national model by
applying its demonstration project which has connected rural
Americans to new distance education and online technologies by
incorporating career training and the best educational methods.
A collaboration of three institutions in the state of Indiana
is also working on a widespread technology program called
DegreeLink to bring new educational opportunities to
nontraditional adult students living in underserved parts of
the state. Several community colleges throughout the state of
Nebraska have collaborated to bring technology to rural
residents through professional development and advanced
computer linkages.
The North Dakota State University has been nationally
recognized for its Technology-Based Industry Traineeship and
intends to expand its program to establish a new center
available to students from all of the State's institutions of
higher education for traineeships with area businesses. It has
been brought to the Committee's attention that the Dakota
Wesleyan University has begun to develop an advanced
telecommunications system to provide library services for
faculty development, student support and an overall resource
for community residents. The University of South Carolina-
Spartanburg has also begun expanding its library services for
faculty and students as well as the regional business community
through state-of-the-art telecommunications. Innovative
information services would include information literacy
training, access to information resources and research
assistance for technical and management needs. The State of
Vermont and the Chancellor of State Colleges has initiated a
program to link Vermont's network of two and four colleges with
distance learning classrooms. Since residents of the state
attending 2-year community colleges are unable financially to
travel the distance to one of the 4-year colleges, the network
will increase the number of graduates who pursue a Bachelor's
degree. The Committee is aware of the Pennsylvania
Telecommunications Exchange Network's (PETENET) efforts to
implement a resource-sharing video conferencing network to
provide educational resources throughout the state. PETENET
will technologically link public elementary and secondary
schools with institutions of higher education and other
information-based organizations.
The Committee is also aware of the efforts on behalf of the
Calhoun County Community College in the state of Alabama to
provide 2-year college students with satellite communications,
advanced video production capability, and other interactive
distance educational services. Northern Kentucky University's
Metropolitan Educational Training Services Center has joined
forces with the private sector to provide timely and
critically-needed educational programs to develop a qualified
and flexible workforce for the area. The center will include
classrooms with full multi-media capabilities that will be able
to provide individuals with the necessary technical skills to
meet the needs of the local economy.
The Committee commends the collaboration formed between the
University of South Florida, Florida A&M; University, and
Florida International University to expand global access to
higher education students through distance education
technologies. The Committee is pleased with the collaboration
the Concord College in the state of West Virginia has formed
with the higher education community and local elementary and
secondary schools to develop an innovative program designed to
better equip new teachers with the technical skills essential
for the utilization of information technologies in the
classroom. The program will use campus-based and distance
education to train teachers, placing a special emphasis on math
and science instruction.
It has been brought to the Committee's attention that the
Association of Vermont Independent Colleges has proposed a
model program for implementing a consortium approach to
identifying, developing, evaluating and applying Internet
technologies and education software to the needs of students
and educators in Vermont's independent colleges and
universities
The Southeastern Pennsylvania Consortium for Higher
Education, which is composed of eight small colleges, is
developing the Institute for Lifelong Learning, which is
designed to prepare faculty and students for a technology-based
future. The new institute will actively promote opportunities
for faculty to modify their teaching methods through the use of
technology with the goal to provide outreach to and training
for K-12 teachers in the Greater Philadelphia area.
The Committee is also aware that institutions of higher
education need to improve their retention rates, especially for
minority and low-income students who are often first-generation
college students or may have received inadequate college
preparation in high school. The Committee recognizes Columbia
College in downtown Chicago for its efforts in establishing a
Coordinated Freshman Retention Program to better retain and
ultimately graduate its students and improve the ways in which
freshman are integrated into the collegiate community.
The Committee recognizes the direct correlation between
teacher quality and student achievement and therefore
encourages professional and curriculum development to instruct
students in emerging fields of study and to better prepare them
for novel career opportunities in the 21st century workforce.
The Committee is aware that these fast-growing disciplines may
include health professions, legal and paralegal studies and
conflict management. The Committee recognizes the Northwestern
School of Law for its response to the victims' rights movement
by establishing a one-of-a-kind Crime Victim Law Institute,
which will not only promote education about victims' rights in
law school curricula, but will provide the first comprehensive
collection of victim material, historical documents, and state
statutes available to the public. In response to the increased
demands for quality and the improved availability of child
care, the Texas A&M; University in Corpus Christi is developing
an early childhood center that will simultaneously provide
services and train early childhood professionals. This
comprehensive center will include teacher resource and literacy
centers to serve as a hub for professionals and all interested
community members to access instructional and other staff
development materials.
The Committee is aware that the National Association for
Equal Opportunity in Higher Education is establishing an
Historically Black Colleges and Universities Technical
Assistance and Resource Center to disseminate best practices
information on the most cost-effective use of Title III
funding, reducing student loan default rates, increasing
graduation rates, and grant writing.
The Committee recognizes the development of a technology
proficiency component for state teacher certification programs,
especially for states where distance learning is utilized. Such
a program should lead to preservice competence in areas such as
distance learning, instructional television, web-based and
multimedia instruction. The Utah Education Network is
conducting such a project.
The Committee recognizes that Portland State University and
Clackamas Community College has developed an innovative
undergraduate partnership project to demonstrate effective
approaches to connecting community colleges to 4-year
institutions through a cooperative curriculum, shared student
services, and faculty collaborations.
The Great Cities Universities Teacher Preparation
Initiative and the Great Cities' Universities Evaluation is
conducting a program to develop a standard based, urban
oriented pre-service and in-service training program for
teachers with am emphasis on science, math and technology.
Minority science and engineering improvement
The Committee recommends $7,500,000 for the minority
science and engineering improvement program [MSEIP], the same
as the 1999 level and $1,000,000 below the administration
request. This program provides discretionary grants to
institutions with minority enrollments greater than 50 percent
to purchase equipment, develop curricula, and support advanced
faculty training. Grants are intended to improve science
education programs and increase the number of minority students
in the fields of science, mathematics, and engineering.
International education and foreign language studies
The bill includes a total of $69,022,000 for international
education programs, $1,486,000 above the 1999 level and the
same as the budget request.
Domestic programs.--The Committee recommends $61,320,000
for domestic program activities related to international
education and foreign language studies, including international
business education, under title VI of the HEA, $1,320,000 more
than the 1999 appropriation and the same as the administration
request. Domestic programs include national resource centers,
undergraduate international studies and foreign language
programs, international research and studies projects,
international business education projects and centers, American
overseas research centers, language resource centers, foreign
language and area studies fellowships, and technological
innovation and cooperation for foreign information access.
Overseas programs.--The bill includes $6,680,000 for
overseas programs authorized under the Mutual Educational and
Cultural Exchange Act of 1961, popularly known as the
Fulbright-Hays Act. This is $144,000 above the 1999 level and
the same as the budget request. Under these overseas programs,
grants are provided for group and faculty research projects
abroad, doctoral dissertation research abroad, and special
bilateral projects. Unlike other programs authorized by the
Fulbright-Hays Act and administered by the U.S. Information
Agency, these Department of Education programs focus on
training American instructors and students in order to improve
foreign language and area studies education in the United
States.
Institute for International Public Policy.--The Committee
bill recommends $1,022,000 for the Institute for International
Public Policy. This is $22,000 above the 1999 level and the
same as the budget request. This program is designed to
increase the number of minority individuals in foreign service
and related careers by providing a grant to a consortium of
institutions for undergraduate and graduate level foreign
language and international studies. An institutional match of
50 percent is required.
Urban community service
The Committee recommendation does not include funds for
this program, which is consistent with the administration
request and $4,637,000 less than the fiscal year 1999 level.
Fiscal year 1999 funding was sufficient to complete the last
year of activities for the program's grantees. Funds were used
to provide grants to urban universities or consortia of
universities to help urban areas solve local community
problems. Resources were not requested or provided in fiscal
year 2000, because the program's objective is more
appropriately addressed by other Federal, State and local
activities.
Interest subsidy grants
The Committee recommends $12,000,000 for interest subsidy
grants, the same as the administration request and $1,000,000
less than the 1999 level. This appropriation is required to
meet the Federal commitment to pay interest subsidies on
approximately 202 loans made in past years for constructing,
renovating, and equipping postsecondary academic facilities. No
new interest subsidy commitments have been entered into since
1973 but subsidy payments on existing loans are expected to
continue until the year 2013.
Federal TRIO programs
The Committee bill includes $630,000,000 for Federal TRIO
programs, an increase of $30,000,000 above the fiscal year 1999
appropriation and the same as the administration request.
TRIO programs provide a variety of services to improve
postsecondary education opportunities for low-income
individuals and first-generation college students: Upward Bound
offers disadvantaged high school students academic services to
develop the skills and motivation needed to continue their
education; student support services provides remedial
instruction and counseling to disadvantaged college students to
help them complete their postsecondary education; talent search
identifies and counsels individuals between ages 11 and 27
regarding opportunities for completing high school and
enrolling in postsecondary education; educational opportunity
centers provide information and counseling on available
financial and academic assistance to adults who are low-income
and first-generation college students; and the Ronald E. McNair
Postbaccalaureate Achievement Program supports research
internships, seminars, tutoring, and other activities to
encourage disadvantaged college students to enroll in graduate
programs.
The Committee notes that the recent study of the Student
Support Services Program commissioned by the Department of
Education indicated that students served by the TRIO Program
had higher retention rates in colleges, and earned better
grades and more academic credits; and that these successes were
most evident where the intensity of services were highest. A
similar study of the Upward Bound Program found that
participating students completed a much more intensive academic
program in high school.
Gaining Early Awareness and Readiness For Undergraduate Programs [GEAR
UP]
The Higher Education Amendments of 1998 established the
GEAR UP program.
The Committee recommends $180,000,000, $60,000,000 more
than the amount provided as initial funding in fiscal year
1999. The administration requested $240,000,000 for this
program. Under this program funds would be used to assist
middle schools serving a high percentage of low-income students
and the high schools that these students would later attend.
Services provided would help students to prepare for and pursue
a postsecondary education.
Byrd honors scholarships
The Committee recommends $39,859,000 for the Byrd honors
scholarship program, $571,000 more than the 1999 appropriation
and the same as the budget request.
The Byrd honors scholarship program is designed to promote
student excellence and achievement and to recognize
exceptionally able students who show promise of continued
excellence. Funds are allocated to State education agencies
based on each State's school-aged population. The State
education agencies select the recipients of the scholarships in
consultation with school administrators, teachers, counselors,
and parents. The funds provided will support a new cohort of
first-year students in 2000, and continue support for the 1997,
1998, and 1999 cohorts of students in their fourth, third and
second years of study, respectively. The amount recommended
will provide scholarships of $1,500 to 26,572 students.
Graduate assistance in areas of national need [GAANN]
The Committee recommends $51,000,000 for graduate
assistance in areas of national need, $20,000,000 more than the
1999 level and $10,000,000 more than the request. This program
awards competitive grants to graduate academic departments and
programs for fellowship support in areas of national need as
determined by the Secretary. The program is currently
supporting study in mathematics, physics, biology, chemistry,
engineering, geology and related sciences and computer and
information sciences. Recipients must demonstrate financial
need and academic excellence, and seek the highest degree in
their fields.
Within this amount, the Committee provides $10,000,000 to
fund the Javits fellowships under the GAANN program. The Javits
program is of particular importance as a mechanism for
supporting America's next generation of leaders in the arts,
humanities, and social sciences. The Committee has consolidated
funding within GAANN to streamline programs.
Learning anytime anywhere partnerships
The Committee recommends $10,000,000 for the learning
anytime anywhere partnerships (LAAP), the same as the fiscal
year 1999 level. The administration requested $20,000,000 for
this program. Funds support projects using technology and other
innovations to enhance the delivery of postsecondary education
and lifelong learning opportunities.
LAAP will develop an on-line internet based university
curriculum for learners of all ages, create and assess
appropriate teaching methodologies for distance learning,
develop an appropriate method for testing the knowledge of
students who learn through distance education, and create a
computerized assessment method for this and other learning
models. The partnership will consist of universities, community
colleges, secondary schools, NASA, and may include private
companies and other community based groups. The Committee is
interested in the on-going research of the computer science
department at the University of Mississippi in the area of
nontraditional distance learning and innovative on-line
assessment of skills and knowledge of any student.
Teacher quality enhancement grants
The Committee recommends $80,000,000 for the teacher
quality enhancement grants program, $35,000,000 below the
budget request. The fiscal year 1999 appropriation provided
one-year funding in the amount of $2,212,000 for the now-
replaced Minority Teacher Recruitment Program, in addition to
$75,000,000 for the broader and newly authorized Teacher
Quality Enhancement Grants Program through the Higher Education
Amendments of 1998. The program was established to support
statewide initiatives that best meet their specific teacher
preparation and recruitment needs. Further, the Act provides
and designates funding for the program in three focus areas: 45
percent of resources support a state grant program, 45 percent
of funds are used for a partnership program, and 10 percent is
designated for a recruitment grant program.
Within this amount, the Committee recommends $36,000,000
for the state grant program. Funds may be used for a variety of
state-level reforms, including more rigorous teacher
certification and licensure requirements; provision of high-
quality alternative routes to certification; development of
systems to reward high-performing teachers and principals; and
development of efforts to reduce the shortage of qualified
teachers in high-poverty areas.
The Committee also recommends that $36,000,000 shall be
used for the teacher training partnership grants, which are
awarded to local partnerships comprised of at least one school
of arts and science, one school or program of education, a
local education agency, and a K-12 school.
Within this amount, the Committee has provided sufficient
funds to include teacher partnership grant activities as part
of the Youth Violence Prevention Initiative. Funds will be
expended to 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.
Partnerships may work with other entities, with those
involving businesses receiving priority consideration.
Partnerships are eligible to receive a one-time-only grant to
encourage reform and improvement at the local level. Funds may
be used for a variety of activities designed to improve teacher
preparation and performance, including efforts to provide
increased academic study in a proposed teaching specialty area;
to prepare teachers to use technology effectively in the
classroom; to provide preservice clinical experiences; and to
integrate reliable research-based teaching methods into the
curriculum.
The Committee is concerned that Hawaiian students are
significantly behind in quantitative literacy and encourages
the Department to promote teacher training in this area. The
Committee is aware that the Hawaii State Department of
Education, the American Statistical Association and the
Kamehameha school district have collaborated to design and
implement workshops for teachers in quantitative literacy.
The Committee recommends $8,000,000 for the teacher
recruitment grants. The recruitment grant program supports
efforts to reduce shortages of qualified teachers in high-need
school districts as well as provide assistance for high-quality
teacher preparation and induction programs to meet the specific
educational needs of the local area.
The Committee recognizes the urgent need for teachers in
school districts that are plagued with crime, poverty, drugs
and other social ills that seriously impede educational
opportunities for the children of this nation. The Mississippi
Delta Education Initiative of Delta State University has been
brought to the Committee's attention. This teacher quality
project is designed to meet the critical needs of the region
and pursue the overarching goals of the Teacher Quality
Enhancement Grant program. The University of Notre Dame is also
recognized for its national program which brings highly
motivated and committed young educators to meet the needs of
our country's most underserved public elementary and secondary
schools. The innovative Soldiers to Scholars Program,
implemented by the University of Central Florida, has also been
brought to the Committee's attention. This program focuses on
the recruitment of minorities ending their military careers who
wish to become teachers, serve in the inner city, and volunteer
an additional 20 hours per week as role models for at-risk
youth. The Loyola University of Chicago is designing an
intensive 4-year teacher preparation and recruitment program to
attract undergraduate and inner-city students who are committed
to teaching in the Chicago public school system. New teacher
candidates would also be placed in outlying rural areas.
Child care means parents in schools
The Committee recommends an appropriation of $5,000,000 for
the Child Care Access Means Parents in School (CAMPUS) program,
which is the same as the 1999 appropriation and the budget
request. This program was established in the Higher Education
Amendments of 1998 to support the efforts of a growing number
of non-traditional students who are struggling to complete
their college degrees at the same time they take care of their
children. For these student-parents, finding appropriate,
affordable child care is a major barrier to higher education.
Not surprisingly, studies indicate that access to campus-based
child care increases the educational and occupational success
of student-parents. It is estimated that the 2,500 campus-based
child care centers across the country only meet 10 to 25
percent of the demand for services. The CAMPUS program provides
colleges serving low-income students with grants to develop and
improve campus-based child care programs targeted at meeting
the needs of low-income students. While the fiscal year 1999
appropriation is expected to support 40 projects, 215 colleges
and universities applied for assistance under the CAMPUS grants
program.
Demonstration projects to ensure quality higher education for students
with disabilities
The Committee recommends $5,000,000 for this program, the
same as the budget request and the fiscal year 1999
appropriation. This program's purpose is to ensure that
students with disabilities receive a high-quality postsecondary
education. Grants are made to support model demonstration
projects that provide technical assistance and professional
development activities for faculty and administrators in
institutions of higher education.
Underground railroad program
The Committee recommends $1,750,000, the same as the budget
request and the fiscal year 1999 appropriation. The program was
newly authorized by the Higher Education Amendments Act of 1998
and was funded for the first time in fiscal year 1999. Grants
are provided to research, display, interpret, and collect
artifacts relating to the history of the underground railroad.
Educational organizations receiving funds must demonstrate
substantial private support through a public-private
partnership, create an endowment fund that provides for ongoing
operation of the facility, and establish a network of satellite
centers throughout the United States to share information and
teach people about the significance of the underground railroad
in American history.
Preparing for College
The Committee defers action on the new Preparing for
College Program, pending enactment of authorizing legislation.
The administration requested $15,000,000 for this purpose. The
Department planned to use these funds to develop and
disseminate information about college and increase college
awareness among middle and high school students in high-poverty
areas and adults who want to continue their education.
College Completion Challenge Grants
The Committee has deferred action on the new College
Completion Challenge Grants Program, pending enactment of
authorizing legislation. The administration requested
$35,000,000 for this purpose. The administration proposed to
establish an experimental new program that would provide
discretionary grants to institutions of higher education to
help increase the retention of students who are at risk of
dropping out.
District of Columbia Resident Tuition Support
The Committee recommends no funds for the District of
Columbia Resident Tuition Support Program. The Committee
recognizes this request to be within the jurisdiction of the
Subcommittee on the District of Columbia. The administration
requested $17,000,000 to make up the difference for the cost of
out-of-state tuition for District of Columbia high school
graduates attending school in a Virginia or Maryland public
institution of higher education.
Higher Education Act Program Evaluation
The Committee recommends no funds for the Government
Performance and Results Act data collection for Higher
Education Act Program Evaluation program. No authorization
exists for this program. The administration requested
$4,000,000 for this purpose. No funds were appropriated in
fiscal year 1999. The administration requested these additional
funds to comply with the Government Performance and Results
Act, which requires the collection of data and evaluation of
Higher Education programs and the performance of recipients of
Higher Education funds.
howard university
Appropriations, 1999.................................... $214,489,000
Budget estimate, 2000................................... 219,444,000
Committee recommendation................................ 219,444,000
The Committee recommends an appropriation of $219,444,000
for Howard University, which is the same as the budget request
and an increase of $4,955,000 over the fiscal year 1999
appropriation. Howard University is located in the District of
Columbia and offers undergraduate, graduate, and professional
degrees through 12 schools and colleges. The university also
administers the Howard University Hospital, which provides both
inpatient and outpatient care, as well as training in the
health professions. Federal funds from this account support
about 54 percent of the university's projected educational and
general expenditures, excluding the hospital. The Committee
agrees with the administration and recommends, within the funds
provided, $3,530,000 for the endowment program.
Howard University Hospital.--Within the funds provided, the
Committee recommends $30,374,000 for the Howard University
Hospital, the same as the budget request and $885,000 above the
fiscal year 1999 level. The hospital serves as a major acute
and ambulatory care center for the District of Columbia and
functions as a major teaching facility attached to the
university that trains physicians in 17 specialty areas. The
Federal appropriation provides partial funding for the
hospital's operations.
college housing and academic facilities loans
Appropriations, 1999.................................... $698,000
Budget estimate, 2000................................... 737,000
Committee recommendation................................ 737,000
Federal administration.--The Committee bill includes
$737,000 for Federal administration of the CHAFL program,
$39,000 above the 1999 level and the same as the administration
request.
These funds will be used to reimburse the Department for
expenses incurred in managing the existing CHAFL loan portfolio
during fiscal year 2000. These expenses include salaries and
benefits, travel, printing, contracts (including contracted
loan servicing activities), and other expenses directly related
to the administration of the CHAFL Program.
historically black college and university capital financing program
Appropriations, 1999.................................... $96,000
Budget estimate, 2000................................... 207,000
Committee recommendation................................ 207,000
Federal administration.--The Committee recommends $207,000
for Federal administration of the Historically Black College
and University [HBCU] Capital Financing Program, the same as
the administration request and an increase of $111,000 above
the 1999 level.
The HBCU Capital Financing Program makes capital available
to HBCU's for construction, renovation, and repair of academic
facilities by providing a Federal guarantee for private sector
construction bonds. Construction loans will be made from the
proceeds of the sale of the bonds.
education research, statistics, and improvement
Appropriations, 1999.................................... $456,867,000
Budget estimate, 2000................................... 540,282,000
Committee recommendation................................ 468,867,000
The bill includes $468,867,000 for educational research,
statistics, assessment, and improvement programs. This amount
is $12,000,000 above the 1999 appropriation and $71,415,000
below the administration request. This account supports
education research, statistics, and assessment activities, as
well as a variety of other discretionary programs for
educational improvement.
Research, development, and dissemination
The Committee recommends $82,567,000 for educational
research and national dissemination activities, the same as the
1999 appropriation level and $50,715,000 below the budget
request. The Committee has also included $65,000,000 for
regional educational laboratories, the same as the
administration request and $4,000,000 above the 1999
appropriation. These activities are administered by the Office
of Educational Research and Improvement [OERI], which was
reauthorized by the Educational Research, Development,
Dissemination, and Improvement Act of 1994.
These funds support research, development, dissemination,
and technical assistance activities which are aimed at
expanding fundamental knowledge of education and promoting the
use of research and development findings in the design of
efforts to improve education.
Statistics
The Committee recommends $70,000,000 for data gathering and
statistical analysis activities of the National Center for
Education Statistics [NCES], $2,000,000 above the fiscal year
1999 appropriation and a decrease of $7,500,000 below the
administration request.
NCES collects, analyzes, and reports statistics on
education in the United States. Activities are carried out
directly and through grants and contracts. The Center collects
data on educational institutions at all levels, longitudinal
data on student progress, and data relevant to public policy.
Technical assistance to State and local education agencies and
postsecondary institutions is also provided by the Center.
Assessment
The Committee recommends $40,500,000 for assessment,
$500,000 above the amount appropriated in fiscal year 1999 and
$4,000,000 below the administration request.
The National Center for Education Statistics uses these
funds to administer the national assessment of educational
progress [NAEP], a 20-year-old congressionally mandated
assessment created to measure the educational achievement of
American students. The primary goal of NAEP is to determine and
report the status and trends over time in educational
achievement, subject by subject. NAEP has been expanded in
recent years to include State representative assessments as
well.
Also included is $4,500,000 for the National Assessment
Governing Board, the same amount as the administration request
and $500,000 above the fiscal year 1999 appropriation.
Fund for the improvement of education
The Committee bill provides $139,500,000 for the fund for
the improvement of education [FIE], which is $500,000 above the
1999 appropriation and the same as the administration request.
This program provides the Secretary with broad authority to
support nationally significant programs and projects to improve
the quality of education, help all students meet high academic
standards, and contribute to the achievement of the national
education goals. The statute also authorizes support for
specific activities, such as counseling and mentoring,
comprehensive health education, and environmental education.
Within the amounts provided, the Committee has included
$1,500,000 to continue the violence prevention initiative begun
in fiscal year 1999, an increase of $500,000. 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.
The Committee recognizes that the Postsecondary Education
Quick Information System was established to collect timely data
on focused issues needed for program planning and policy
development. The Committee urges the Department to use this
system to gather data to better understand the needs of
institutions so that effective educational programs can be
introduced to address student gambling problems.
Within the amount recommended, the Committee includes
sufficient funds for the Elementary School Counseling
Demonstration Program to establish or expand counseling
programs in elementary schools as part of the Youth Violence
Prevention Initiative. The Committee is concerned about the
inaccessibility of school counselors for young children. 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 mental health care professionals
would legitimize their role as part of the school's
administrative framework, thereby, encouraging students to seek
assistance before resorting to violence.
The Committee encourages the Secretary of Education to
establish a national clearinghouse on effective school dropout
prevention, intervention and reentry programs. The
clearinghouse will collect and disseminate to educators,
parents, and policy makers information on research, effective
programs, best practices, and available Federal resources with
respect to school dropout prevention, intervention and reentry
programs, and provide technical assistance regarding securing
resources with respect to, and designing and implementing,
effective and comprehensive school dropout prevention,
intervention and reentry programs.
Within the amount recommended, the Committee has included
$10,300,000 for character education partnership grants, the
same amount requested by the administration. Of that amount,
the Committee recommends $4,000,000 be designated to conduct
activities as part of the Youth Violence Prevention Initiative.
The 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 and
the effects they may impose on family and society.
The Committee acknowledges that school districts nationwide
are striving to end the social promotion of students into
higher grade levels when they lack the appropriate skills.
Thus, the demand for emergency and supplemental educational
services to assist academically struggling students has
increased. It has been brought to the Committee's attention
that Southwest Texas State University is establishing a
National Center for School Improvement to train elementary
school teachers to provide tutorial and mentoring programs for
students in low-performing and failing school systems.
The Committee has included sufficient funds to continue and
expand the Student/Parent Mock Election, a national,
nonpartisan organization noted for its achievements in
promoting voter education activities for students and their
parents. In 1996, 6 million students and parents participated
in the Presidential Mock Election, and with more than 70
million youths in our country today, the Mock Election of 2000
has the potential to engage more youth in the political process
than any time in the program's history.
The Committee is encouraged by the continued development of
the National Constitution Center. Funds will support the
design, planning and operation of the center, which is
incorporated by the National Park Service as a part of the
Independence National Historical Park.
The Committee urges the Department to provide sufficient
funds for scholar-athlete competitions.
The Committee encourages the use of diverse and innovative
resources to enhance children's educational experiences such as
lessons that go beyond the classroom and allow students to
learn about subjects through first-hand experiences. The
Indianola School District along with the Delta State University
is creating a program that will utilize all existing medical
and service agencies and nationally acclaimed experts to work
with community and educational leaders to create equitable
opportunities for all children, beginning at birth, to develop
at rates which will enable them to function at comparable
levels upon entering school and throughout their academic
career. The ``Pathways to Freedom'' program of the Rosa and
Raymond Parks Institute for Self-Development exemplifies
innovation by teaming young people with elderly Americans to
learn about the civil rights movement.
The Trexler-Lehigh Game Preserve, and educational
institution dedicated to the conservation and study of wildlife
and nature, has partnered with the Pennsylvania Department of
Education, school districts throughout 13 counties, and higher
education institutions to utilize the 1,200 acre site as a
living and environmental classroom that will provide hands-on
learning to improve student performance in all curricula
subjects. The Preserve is developing a unique educational model
for using the environment as an integrated context for
learning, which will align with the new State education
standards for environmental science and ecology.
The Montana State University is developing a series of
virtual field trips for elementary and secondary students
throughout the state by using video network technology which
enables students in their classrooms to connect to multiple
sites such as museums and institutes across the country.
Lafayette College is establishing a community-based program in
the visual arts. The program will offer junior high and high
school students of the economically-distressed area of Easton,
Pennsylvania, with workshops, classes, gallery exhibitions, and
opportunities to interact with visiting artists and Lafayette
faculty and students. The Virginia Living Museum in Newport
News works with schools to meet state academic standards by
providing students with a hands-on approach to science
education.
The Council for Educational Advancement in St. Louis,
Missouri has created the Econometrics Model for kindergartners
through the twelfth grade which provides students with a
quantitative and objective tool to analyze and make public
policy decisions. The Save A Life Foundation in Chicago,
Illinois provides a series of invaluable lessons for school
children through its safety courses. The foundation brings
firefighters, paramedics, police officers, and other expert
rescue workers to classrooms to instruct children on life
saving techniques.
In the state of Alaska, the Division of Historic
Preservation, the state Department of Commerce, and public
secondary schools have collaborated to supplement high school
history curricula with new and enriching materials on the 1899
Harriman Alaska Expedition. The materials provided to teachers
and students will include a internet-accessible site so that
students can engage in interviews with project participants, a
study guide, a documentary film, and a CD-ROM to compile the
educational elements and interactive activities of the project.
The National Liberty Museum, the newest addition to the
city of Philadelphia's Liberty Trail, is developing the Kids'
Vote interactive exhibit to teach school children civics,
history, and violence prevention. Twenty-first century
technology will be used to engage students in the governmental
and election process. The anti-violence gallery is designed to
help children identify and channel aggression into civic
responsibilities and activities.
The Committee notes that because of Alaska's immense size
and lack of transportation, its urban residents rarely have an
opportunity to visit and experience the culture that exists in
most of its remote villages. A greater awareness and
understanding by urban residents of the rural and Native way of
life in some of the state's more than 200 villages will broaden
the educational experiences for the children of Alaska. The
Committee commends the establishment of the Urban Rural Alaska
Partnership Program, created by the Alaska Humanities Forum,
which would take urban youth to rural villages. Prior to their
departure, students and their parents would be exposed to a
curriculum designed to teach the culture and challenges faced
by rural residents.
The Committee notes the coordinated efforts of the cross-
regional technology development LINKS Project (Linking
Educational Technology and Educational Reform). The State of
Washington, in collaboration with educational entities in the
states of Arkansas, California, Illinois, and Pennsylvania, are
establishing a multimedia network to improve student learning
and achievement in the United States.
The Committee recognizes the Museums and Universities
Supporting Educational Enrichment Inc., for its efficient
introduction of technology to classrooms across the country
through a traveling exposition which showcases high technology
software and instructional programs for teachers, students and
other sectors of the population.
The Committee recognizes that music and the arts provide a
creative outlet for students, which can enhance their abilities
in all academic fields. The Committee is discouraged to learn
that performing arts programs have been significantly limited,
if not eliminated, especially in financially ailing and
overcrowded school districts. The Committee commends programs
that give children the opportunity to experience the performing
arts and preserve music and arts education. The Committee is
aware that the Jazz-In-The-Schools Outreach Project in
Philadelphia, Pennsylvania has responded to this need by
engaging inner-city high school students in a hands-on program
that uses jazz, as America's classic music, as a means to
maintain student interest in academic subjects in the core
curriculum. The Committee recognizes the Boston Music Education
Collaborative for developing curricula that uses music to
foster high levels of student academic achievement. For the
past 14 years, the Rock School has provided community outreach
to inner-city, at-risk, and developmentally disabled children
with innovative arts education through an after school and
summer program. The Committee commends its work in this area.
The Rock School will be extending its outreach to disadvantaged
children in the surrounding areas of Camden, New Jersey and
Greater Philadelphia. The ``From the Top'' national radio
program is expanding its program to bring talented children,
their stories, and their musical performances to public radio.
The program is designed to promote greater awareness of how
music can catalyze young people to be creative and learn. The
program is also developing an internet site so that students,
parents, and teachers may benefit from a full array of
information and resources on music education.
The Committee is concerned about the lack of progress made
in the area of preventing students from dropping out of high
school and is particularly troubled by the unchanged dropout
rates among certain ethnic and racial groups over the past
twenty years. Educational opportunities continue to lag for
young Hispanic Americans, especially in the areas of literacy
and high school retention. It has been brought to the
Committee's attention that the National Council of La Raza is
conducting an initiative to replicate successful community-
based approaches to improving the academic achievement of
Hispanic children from early childhood through college. The New
Mexico Department of Education has developed a nationally
recognized program for dropout prevention which entails
accountability and high standards for all schools through a
reward and incentive initiative.
The Committee is also aware of the Puerto Rico/New York
City Educational Linkages Demonstration Project which
implements effective educational models in Hispanic communities
and school districts with significant concentrations of Puerto
Rican students.
The Committee supports efforts to encourage parental
involvement and adult mentoring, which have proven to play a
key role in a child's scholastic achievement and emotional
growth. Connecting caring, positive role models with young
people at school has been especially effective in improving
attendance, enhancing academic performance, and reducing the
influence of peer pressure and the incidence of high-risk
behavior, and motivating children to attend college and pursue
professional careers.
Big Brothers/Big Sisters of Siouxland, Iowa is planning to
implement such a program throughout 54 counties in Iowa,
Nebraska, South Dakota, and Minnesota. A survey sent to over
600 parents in one school district in one of these counties
generated over 400 positive responses, indicating a tremendous
need for mentoring programs to reach children in rural areas,
who are at-risk of the universal problems facing youth today
such as violence.
The Committee is aware of the efforts of the Allegheny
County Family Support Centers, which have partnered with school
districts, the Allegheny Intermediate Unit, neighborhood
organizations, and local universities to provide coordinated
services which help families succeed and stay together.
The ``An Achievable Dream'' project in the city of Newport
News, Virginia has been a successful model in teaching positive
life skills and raising academic performance of at-risk youth.
In the District of Columbia, Project 2000 provides homework
assistance through peer tutoring in study halls five days a
week, a Saturday Academy, and other support services for low-
income and inner-city students. Project 2000 has attracted an
overwhelming number of adult volunteers to serve as mentors and
provide the supplementary educational services necessary to
ensure that students graduate from high school at the
appropriate age and meet the standards required for admission
to college.
``Say YES To A Youngster's Future,'' implemented by the
National Urban Coalition, is a large-scaled project that has
also placed an intensified focus on our nation's inner cities.
The project targets 25 cities with the highest African-American
and Latino populations of elementary school children and
provides teacher training and parental involvement activities
to improve academic performance in science and mathematics.
The Kansas Mentoring Partnership, led by the Southeast
Kansas Education Service Center in conjunction with Big
Brothers/Big Sisters of Kansas and Youthfriends Kansas is
expanding its mentoring program on a statewide level to pursue
the goals described above.
The Committee is also aware of the Urban College's efforts
to improve academic programs through tutoring and mentoring for
educationally disadvantaged students in Boston, Massachusetts.
The City of Santa Ana has embarked on a career-centered
mentoring project with the city school district, the University
of California Institute School of Arts, and the Santa Ana
Community College to introduce students (grades 2 through 12)
to the career opportunities available to them in the
technological art industry. The college student participants
will mentor the school-age children in the field of art
technology.
The Committee also notes an innovative project in
Smithfield, Rhode Island, the Linking International Trade
Education Program [LITE] at Bryant College which provides a
stimulating way for elementary and secondary students to learn
about trade and economics and increase their global awareness
through mentoring and the use of interactive video conferencing
and an international trade database. The Committee is
encouraged by the national effort of Big Brothers/Big Sisters
Of America to assist organizations in the implementation of a
school-based mentoring program to be replicated throughout the
United States. The Committee is also aware of the Big Brother/
Big Sisters Marin Chapter's efforts to expand its services to
at-risk youth in the city of San Francisco.
The Committee recognizes the Milton S. Eisenhower
Foundation for its scientific evaluation of public schools
which have established partnerships with local health, social
service, and other community agencies to meet the myriad needs
of children and their families. The study will specifically
evaluate and replicate full community school programs that
emphasize the school as the central point of the community,
particularly schools which have extended hours and remain open
on the weekends and the summer.
The Committee is committed to ensuring that an appropriate
and high quality education is available to all children,
including children with disabilities. Recent research by the
National Institutes of Health suggests that reading
difficulties which are often manifestations of learning
disabilities are treatable, and most important, preventable in
a large portion of the population. The Committee recognizes the
unique and progressive work of the University of Southern
Mississippi's Center for Literacy and Assessment. For over 30
years, this center has served as the South's only comprehensive
resource for reading disabled students. The National Reading
Panel is currently assessing and establishing a measurable
evaluation of research based practices in the teaching of
reading. In providing Federal assistance to broaden the scope
of the Southern Mississippi's Center for Literacy and
Assessment to a national level, the Center will use the
information provided by the National Reading Panel. The Center
will also increase its research dissemination, teacher and
parent training, development of replicable models for reading
assessment and intervention. It has also been brought to the
Committee's attention that the University of Northern Iowa is
improving the delivery of educational services through the
establishment of a National Institute of Technology for
Inclusive Education to disseminate adaptive technologies to
enable the integration of disabled students with their peers in
general educational settings. The Minot State University is
developing an Institute for Rural Human Services to study and
develop systems designed to meet the unique needs of persons
with disabilities living in rural communities, with a special
emphasis on working with hearing-impaired children who live in
remote areas.
It has been brought to the Committee's attention that the
availability of research findings, data collection, and
therefore, the evaluation and information-sharing of successful
student academic achievement models is limited. The University
of Notre Dame is establishing a research center for a standard
assessment of the practices and policies of schools in the
nation in order to replicate programs that have proven to
enhance the academic performance of disadvantaged students. The
National Four-H Council has partnered with the Washington State
Office of the Superintendent of Public Instruction to increase
the instances of meaningful youth involvement in local schools
and communities. The partnership will provide information and
training on the best practices of engaging youth as partners in
their education and community. The Committee recognizes the
University of Maryland's Center for Quality and Productivity,
for its development of a model to link the Blue Ribbon Schools
Initiative with the Malcolm Baldridge Criteria for Performance
Excellence, an evaluation methodology used in the business
world to enhance competitiveness. The University is developing
this model to accelerate rates of student achievement, improve
education management within school systems, and to foster
business-education partnerships throughout the community.
The Committee is troubled by the low literacy skills that
continue to challenge and often discourage American youth from
continuing their education, which ultimately prevents them from
entering productive and gainful employment in their older
years. It has been brought to the Committee's attention that
the state of Alaska expects that fewer than 50 percent of its
students will pass the graduation qualifying exam. The
Committee is encouraged by the Alaska Department of Education's
committed response to this problem by providing an intense
summer reading program for high school students to graduate on
time and with their classmates.
The Committee is aware of the benefits of peer tutoring in
the area of literacy. The Committee is encouraged that teachers
and students have come together to design the Reading Together
USA tutoring program to improve reading fluency and
comprehension skills before a pattern of continued long-term
failure is established, and identify as well as eliminate the
gap between students with reading problems and skilled readers.
The Reading Together USA project has been training fifth grade
tutors to assist second grade students to improve their reading
skills and ultimately read independently.
The Committee commends the Reach Out and Read program which
has identified a unique way to promote literacy and increase
health awareness for at-risk families. ROR programs are now
operating in 46 states and serve nearly one million children
per year. The program is seeking to expand its services which
allow doctors and nurses, during health care visits, to provide
books and talk with parents about the benefits of reading to
their children at a young age.
The Committee recognizes that there continues to be a gap
in the reading and writing scores of African American students
and other student populations. According to research at the
University of Pennsylvania, no matter what teaching methods are
used and even when minority children from inner cities begin
school at the same level as others, reading scores continue to
lag until graduation. The Committee commends the work of the
University of Pennsylvania in finding ways to successfully
teach reading skills. The Committee is aware that the
University has collaborated with the Oakland School District
and Stanford University in California to conclude its efforts
in raising literacy scores for African American students in
grades two to five. The Collaboration has set out to expand
vocabulary, teach standard English grammar, bring teachers into
the research framework, and enlist parental support for
reading. The Committee is aware of Howard University's interest
in reestablishing their gifted and exceptional minority student
program to improve the academic skills of elementary and
secondary school-age children.
The Committee is encouraged by the Partners for Literacy
demonstration project in Columbia, South Carolina, which aims
to promote reading and writing proficiency among children from
a wide range of socioeconomic levels, including at-risk, low-
income children, who speak English as a second language. The
literacy project uses long-range strategies of ongoing
professional development and parent education that improves the
understanding of child literacy development among the adults
who care for, and teach infants, toddlers, and preschoolers,
including school personnel, child caregivers, and family
members.
The New England Regional Center in Learning and Literacy is
responding to the alarming numbers of students who experience
difficulties in comprehending basic textbook instructions. The
center has partnered with a national reading research
institution and the Universities of Connecticut and Rhode
Island to develop a model of life-long reading skills beginning
in kindergarten through higher education, which will provide a
training ground for school teachers.
The Committee is aware of the various ways in which schools
of government can contribute to all levels of education from
teaching elementary students about the history of our country
to encouraging high school and college students to enter public
service. The University of Tennessee is establishing the Howard
Baker School of Government, which will consolidate the existing
political and social science, public administration and
regional planning programs, house manuscript collections of
public figures, and offer a lecture series on public issues.
The University of Washington's Daniel J. Evans School of Public
Administration has educated 1500 graduates and numerous
Northwest leaders and plans to expand its programs to include
experiential studies in public and private problem solving
partnerships and specialized research in fiscal policymaking.
The Snelling Center for Government has developed a model
program known as the Vermont School Leadership Project that
brings educators and business leaders together to improve the
delivery of education and is now expanding its programs to
provide leadership training to superintendents and principals
as well as teachers. The University of Virginia's Center for
Governmental Studies is conducting a Youth Leadership
Initiative to assess the problems facing today's political
system, improve student knowledge and awareness of the
governmental system, and encourage voter turnout and political
participation. The Thomas S. Foley Institute at Washington
State University, which was established in 1995, fosters civic
education through lessons on the role of Congress and the
legislative process, public policy research, and public
service. The Institute is expanding its programs to increase
public access to the Foley congressional papers and enhance
policy research in areas such as international trade and
agriculture; develop programs to improve voter literacy; and
help communities and tribes with local environmental problem
solving. The Ohio State University plans to establish the John
Glenn Institute for Public Service and Public Policy to promote
interest in public service and train students to develop skills
needed for success in public service. The Institute will
provide seminars on topics like budgeting and finance, ethics,
personnel management, policy evaluations, and regulatory issues
as well as national conferences, publications, and forums on
public issues.
The Committee is concerned about the lack of high quality
early childhood education programs that provide a jump start on
education for all children in an integrated setting. The
Committee is aware of the efforts to create such a facility in
Waterloo, Iowa. In partnership with the Waterloo Community
Schools, and with the help of private donations, University of
Northern Iowa is creating a state of the art facility that
provides early childhood services to all children and their
families in Waterloo, and provides professional development for
teachers across Iowa in early childhood education. This project
could provide a model for collaborations between institutions
of higher education and public school districts across the
country.
The Committee has been informed that one-third of
Louisiana's children face a high risk of poverty, illiteracy,
incarceration, and premature death. The Committee recognizes
the efforts of Steps to Success, a public-private collaborative
program that is working to address the scholastic and social
needs of these children and their families.
It has been brought to the Committee's attention that the
Houston Public Library is developing the ``After School
Programs Inspire Reading Enrichment'' [ASPIRE] which provides
after-school programs at targeted branch libraries in low-
income neighborhoods. The Committee is aware that the Learn to
Earn program, a consortium composed by the Vermont Department
of Education, regional development centers and high-tech
companies, provides supplemental science and math educational
services through early exposure and application, which help to
foster future interest and achievement in these fields. The
Committee is aware that Semos Unlimited, Inc., in the state of
New Mexico, is coordinating an effort to preserve Hispanic
culture by providing students with educational materials for
the classroom and the public.
The Committee is concerned about the increasing rates of
obesity among children as well as the overall lack of activity
and physical fitness in today's lifestyle, which can lead to
obesity and other health risks. The Committee believes that the
strengthening of physical education programs for elementary and
secondary school students could improve academic achievement,
prevent health problems, and deter children from crime. The
Committee encourages the Department to demonstrate programs
that reintroduce physical education into our nation's schools.
The Committee is aware of the development and
implementation of the DOD and Labor Departments of
``intelligent'' computer learning systems developed at the Air
Force Research Lab at Brooks Air Force Base, and encourages the
Department of Education to explore that application and use of
these systems in K-12 schools.
The Committee understands the importance of research
analyzing globalization and its implications for U.S.
interests, and the benefits that can be realized by making
findings available to the nation's teachers. Through innovative
uses of the Internet, this information can be disseminated to
classrooms in a timely manner. The Committee is aware of the
University of Hawaii's interest in conducting research and
training on the international aspects of trade, commerce,
technological development and trends affected by global change.
The Committee recognizes the innovative educational
programs that the National Museum of Women in the Arts offers
to residents of and visitors to our Nation's capitol. The
Museum has utilized technology to improve access to and enhance
quality of its programs. The Committee understands that the
Museum will expand its ``Discovering Art'' program to
elementary and secondary schools and other educational
organizations.
It has been brought to the Committee's attention that a
program to enhance educational opportunities for qualified
resident student/athletes training at established United States
Olympic Training or Education Centers would be useful. The
project would make use of academic advising, counseling,
tutoring, psychological, and distance learning services to
support the special needs of these students, many of whom come
from disadvantaged backgrounds and who compete in sports that
commonly do not have college scholarship opportunities. The
Committee is aware that the United States Olympic Education
Center at Northern Michigan University has developed such a
program.
The Committee is aware of MICROSOCIETY's work in providing
a replicable, comprehensive school reform model. MICROSOCIETY
is recognized through the Northwest Regional Educational Lab's
Catalog of School Reform as a whole school reform model meeting
the nine criteria establishing the Comprehensive School Reform
Model Program.
The Committee recognizes the importance of the support and
involvement of business with local school districts. The
Committee is aware of a proposal by Partners in Education,
which represents these business-school partnerships to conduct
a survey of such programs throughout the country to enable
other school districts to replicate successful partnerships
with businesses.
International education exchange
The Committee has provided $7,000,000 for the International
Education Exchange Program authorized by section 601(c) of
Public Law 103-227. These funds are the same as the amount
recommended by the administration and appropriated in fiscal
year 1999. The program provides funds to support democracy and
free market economies in Eastern Europe, the Commonwealth of
Independent States, and other countries that formerly were part
of the Soviet Union, by providing educators and other leaders
from those countries curricula and teacher training programs in
civic and economic education, as well as the opportunity to
exchange ideas and experiences with teachers in the United
States and other participating countries.
Included within this amount is $1,000,000 to continue a
civic education program begun in fiscal year 1999 for the
Republic of Ireland and Northern Ireland and the civic
education assistance programs in developing countries. The
Committee also provides sufficient funds for the initiative
underway in Bosnia-Herzegovina.
Civic education
The Committee recommends $9,500,000 for the Center for
Civic Education, $2,000,000 more than in fiscal year 1999 and
the same as the administration request. The Committee intends
that the authorized programs be funded at least at the fiscal
year 1999 level. This program provides a course of instruction
at the elementary and secondary level on the basic principles
of our constitutional democracy and the history of the
Constitution and the Bill of Rights. Funds also may be used to
provide advanced training for teachers concerning the
Constitution and the Bill of Rights.
The Committee recognizes the need to update and convert
materials used to educate middle and high school students about
the United States Constitution and encourages the
implementation of a CD-ROM interactive education program.
The Committee believes that students and teachers from
tribally controlled schools should be actively involved in the
We The People Program. The Committee recommends the
distribution of textual materials to these schools, to train
teachers from the tribally controlled schools, and to engage
students in the We The People instructional program.
Eisenhower professional development Federal activities
The Committee recommends $23,300,000 for the Eisenhower
Professional Development Federal Activities Program, $6,700,000
below the budget request and the same as the 1999
appropriation.
This program supports activities of national significance
contributing to the development and implementation of high-
quality professional development in the core academic subjects.
Projects may include development of teacher training programs,
or dissemination of information about exemplary programs of
professional development.
The Committee has included $18,500,000 for the National
Board for Professional Teaching Standards, the same as the
fiscal year 1999 appropriation and the administration request.
The Committee has included $4,800,000 for the National
Clearinghouse for Mathematics and Science Education, the same
amount provided for this purpose in 1999. The clearinghouse
maintains a permanent repository of mathematics and science
education instructional materials and programs for elementary
and secondary schools; disseminates information, programs, and
instructional materials to the public, information networks,
and regional consortiums; and coordinates with existing data
bases containing mathematics and science curriculum and
instructional materials.
Eisenhower regional mathematics and science education consortia
The Committee has included $15,000,000 for the Eisenhower
regional mathematics and science education consortia, the same
amount appropriated in fiscal year 1999 and $2,500,000 below
the amount recommended by the administration. This program
supports grants to establish and operate regional consortia to
disseminate exemplary mathematics and science instructional
materials and provide technical assistance in the use of
improved teaching methods and assessment tools to benefit
elementary and secondary school students, teachers, and
administrators.
Javits gifted and talented students education
The Committee has included $6,500,000 for the Javits Gifted
and Talented Students Education Program, the same amount
recommended by the administration and the same amount as the
fiscal year 1999 appropriation.
This program authorizes awards to State and local education
agencies, institutions of higher education, and public and
private agencies for research, demonstration, and training
activities designed to enhance the capability of elementary and
secondary schools to meet the special educational needs of
gifted and talented students. Priority is given to projects
that identify and serve gifted and talented students who may
not be identified and served through traditional assessment
methods, including those who are economically disadvantaged or
limited English proficient, or have disabilities. Some funds
are set aside for a national center for research and
development in the education of gifted and talented children
and youth, which researches methods and techniques for
identifying and teaching gifted and talented students.
National writing project
The Committee bill provides $10,000,000 for the national
writing project, an increase of $3,000,000 above the 1999
appropriation and the same as the administration request.
These funds are awarded to the national writing project in
Berkeley, CA, which in turn funds projects in 47 States to
train teachers of all subjects how to teach effective writing.
The writing project is the only federally funded program
for the teaching of writing skills at all grade levels. The
additional funds provided will expand the sites from 160 to
over 200, creating the ability to reach almost every teacher in
the Nation. The Committee is pleased with the continued success
of this program, and for its ability to leverage up to seven
times its Federal appropriation from State, local, and private
funds. The Committee encourages the Department to continue its
close association with this project, and to use it as a model
for teacher training initiatives in other disciplines, taking
advantage of the infrastructure and network of facilities and
personnel already in place.
Departmental Management
program administration
Appropriations, 1999.................................... $364,521,000
Budget estimate, 2000................................... 386,000,000
Committee recommendation................................ 378,184,000
The Committee recommends $378,184,000 for program
administration, an increase of $13,663,000 above the 1999
appropriation and $7,816,000 below the budget request.
Funds support personnel compensation and benefits, travel,
rent, communications, utilities, printing, equipment and
supplies, automated data processing, and other services
required to award, administer, and monitor approximately 170
Federal education programs. Support for program evaluation and
studies and advisory councils is also provided under this
activity. Within the funds provided, the Committee encourages
the Department to provide at least $2,709,000 for the National
Advisory Council on Indian Education.
office for civil rights
Appropriations, 1999.................................... $66,000,000
Budget estimate, 2000................................... 73,262,000
Committee recommendation................................ 71,200,000
The Committee bill includes $71,200,000 for the Office for
Civil Rights [OCR], $5,200,000 above the 1999 appropriation and
$2,062,000 below the budget request.
The Office for Civil Rights is responsible for the
enforcement of laws that prohibit discrimination on the basis
of race, color, national origin, sex, disability, and age in
all programs and institutions funded by the Department of
Education. To carry out this responsibility, OCR investigates
and resolves discrimination complaints, monitors desegregation
and equal educational opportunity plans, reviews possible
discriminatory practices by recipients of Federal education
funds, and provides technical assistance to recipients of funds
to help them meet civil rights requirements.
The Committee is concerned about the Department's
interpretation and application of title IX of the 1972
Education Amendments Act with regard to same gender education
programs. The Committee, therefore, urges the Department to
review its regulations and policies to ensure that if funds are
used for students to participate in any education reform
projects that provide same gender schools or classrooms,
comparable educational opportunities are offered for students
of both sexes. The Committee further directs the Department to
report to Congress within 90 days of enactment of this act on
the actions taken on this issue.
office of the inspector general
Appropriations, 1999.................................... $31,242,000
Budget estimate, 2000................................... 34,000,000
Committee recommendation................................ 34,000,000
The Committee recommends $34,000,000 for the Office of the
Inspector General, $2,758,000 above the 1999 appropriation and
the same as the administration request.
The Office of the Inspector General has the authority to
investigate all departmental programs and administrative
activities, including those under contract or grant, to prevent
and detect fraud and abuse, and to ensure the quality and
integrity of those programs. The Office investigates alleged
misuse of Federal funds, and conducts audits to determine
compliance with laws and regulations, efficiency of operations,
and effectiveness in achieving program goals.
General Provisions
The Committee bill contains language which has been
included in the bill since 1974, prohibiting the use of funds
for the transportation of students or teachers in order to
overcome racial imbalance (sec. 301).
The Committee bill contains language included in the bill
since 1977, prohibiting the transportation of students other
than to the school nearest to the student's home (sec. 302).
The Committee bill contains language which has been
included in the bill since 1980, prohibiting the use of funds
to prevent the implementation of programs of voluntary prayer
and meditation in public schools (sec. 303).
The Committee bill includes a provision giving the
Secretary of Education authority to transfer up to 1 percent of
any discretionary funds between appropriations (sec. 304).
The Committee bill includes language prohibiting the use of
funds to field test, implement, or administer any federally
sponsored national test (sec. 305).
TITLE IV--RELATED AGENCIES
Armed Forces Retirement Home Board
Appropriations, 1999.................................... $70,745,000
Budget estimate, 2000................................... 68,295,000
Committee recommendation................................................
The Committee recommendation does not include resources for
the Armed Forces Retirement Home Board. However, the Committee
provided $68,295,000 for the Armed Forces Retirement Home Board
in the Department of Defense Appropriations Bill, 2000, S.
1122.
Corporation for National and Community Service
domestic volunteer service programs
Appropriations, 1999.................................... $276,839,000
Budget estimate, 2000................................... 299,532,000
Committee recommendation................................ 293,261,000
The Committee recommends an appropriation of $293,261,000
for the domestic volunteer service programs of the Corporation
for National and Community Service. The Committee
recommendation is $16,422,000 above the 1999 comparable level,
including a one-time appropriation for year 2000 computer
needs, and $6,271,000 less than the budget request.
The Committee applauds the exemplary work of America's
Promise led by retired General Colin Powell and his efforts to
provide after school programs through Boys and Girls Clubs. The
Committee notes that Boys and Girls Clubs are one of the most
effective volunteer organizations in the country with the
highest rate of volunteers in the nation. With 100,000
volunteers, it operates 2,300 clubs in all 50 states and serves
3 million at risk children, three-quarters of whom are from
families with incomes below the poverty level. The goal of Boys
and Girls Clubs is to serve 5 million of the nation's 14
million at risk children by the year 2006. The Committee notes
that with additional resources, Boys and Girls Clubs could come
close to meeting its goal. The Committee believes that
increased support through the Corporation's volunteer programs
could be provided to augment resources for Boys and Girls
Clubs, recognizing that these clubs provide youth the
opportunities for positive social and emotional development.
VISTA
The Committee bill provides $81,000,000 for the Volunteers
in Service to America [VISTA] Program, $8,000,000 above the
fiscal year 1999 level and the same amount as the budget
request.
VISTA is a 30-year-old program which provides capacity
building for small community-based organizations. VISTA
volunteers raise resources for local projects, recruit and
organize volunteers, and establish and expand local community-
based programs in housing, employment, health, and economic
development activities.
National Senior Volunteer Corps
The Committee bill provides $183,132,000 for the National
Senior Volunteer Corps programs, $9,222,000 above the fiscal
year 1999 level and $1,900,000 less than the budget request.
The Committee has included $3,100,000 for senior
demonstration programs. The Committee has provided these
resources solely for the purpose of continuing grants for
existing demonstration activities and its recommendation does
not include resources for any new grants or activities.
The Committee recognizes the valuable contributions of
seniors participating in the Foster Grandparent (FGP), Retired
and Senior Volunteer (RSVP) and Senior Companion Programs
(SCP). In accordance with the Domestic Volunteer Service Act
(DVSA), the Committee intends that one-third of each program's
increase over the fiscal year 1999 level shall be used to fund
Program of National Significance (PNS) expansion grants to
allow existing FGP, RSVP and SCP programs to expand the number
of volunteers serving in areas of critical need as identified
by Congress in the DVSA. Within the appropriation, sufficient
funding has been included to provide adequate resources for
administrative cost increases realized by all current grantees
in each DVSA program. Remaining funds should be used to begin
new FGP, RSVP and SCP programs in geographic areas currently
underserved. The Committee expects these projects to be awarded
via a nationwide competition among potential community-based
sponsors.
The Committee supports the Corporation's strategic goals,
including one for meeting the unmet education, public safety,
environmental and other human needs. In furtherance of this
goal, the Committee believes the Corporation should not
restrict the use of funding increases provided for the National
Senior Service Corps to America Reads activities. Further, the
Committee believes the Corporation should not stipulate a
minimum or maximum amount for Programs of National Significance
grant augmentations.
The Committee understands that many studies have shown that
well-trained volunteer tutors can improve mastery of academic
skills and that a large number of senior volunteers are
available to be volunteer tutors of students. All school
districts, and low-performing schools in particular, can
benefit from a coordinated and comprehensive approach to
volunteer tutor training. The Committee is aware that the
Northwest Regional Educational Laboratory has a proven track
record in designing and conducting training for individuals
that train volunteer tutors in reading.
Foster Grandparent Program
The Committee recommends $95,000,000 for the Foster
Grandparent Program, $1,744,000 above the fiscal year 1999
appropriations level and the same as the budget request.
This program provides volunteer opportunities to seniors
age 60 and over who serve at-risk youth. This program involves
seniors in their communities and provides a host of services to
children.
Senior Companion Program
For the Senior Companion Program, the Committee bill
includes $39,031,000, an increase of $2,458,000 over the fiscal
year 1999 appropriations level and the same as the budget
request.
This program enables senior citizens to provide personal
assistance and companionship to adults with physical, mental,
or emotional difficulties. Senior companions provide vital in-
home services to elderly Americans who would otherwise have to
enter nursing homes. The volunteers also provide respite care
to relieve care givers.
Retired and Senior Volunteer Program
The Committee bill provides $46,001,000 for the Retired and
Senior Volunteer Program [RSVP], $3,000,000 above the fiscal
year 1999 level and the same as the budget request.
This program involves persons age 55 and over in volunteer
opportunities in their communities.
Program support
The Committee bill includes $29,129,000 for program
support, the same amount as the fiscal year 1999 appropriation
and $4,371,000 less than the budget request.
Corporation for Public Broadcasting
Appropriations, 2000.................................... $300,000,000
Appropriations, 2001.................................... 340,000,000
Budget estimate, 2002................................... 350,000,000
Committee recommendation................................ 350,000,000
The Committee recommends an appropriation of $350,000,000
for the Corporation for Public Broadcasting [CPB], an advance
appropriation for fiscal year 2002. This amount is $10,000,000
more than the fiscal year 2001 appropriation and the same as
the budget request.
The Committee is deeply concerned about the decisions made
by certain public broadcasting stations to exchange membership
lists with political organizations. These activities undermine
the political neutrality of public broadcasting that the
Congress envisioned when agreeing to funding for the
Corporation for Public Broadcasting. The Committee, therefore,
has included bill language prohibiting public broadcasting
stations that receive any Federal funds provided in
appropriations bills from exchanging member lists with
political organizations.
This prohibition includes the, direct or indirect, selling
or sharing of any current or former member or donor personal
information to any political organization. Furthermore, the
Committee has included bill language stipulating that public
broadcasting stations that sell, share or transfer member or
donor personal information to any political organization will
be ineligible to receive Federal funds from the Corporation in
fiscal years 2000 and 2001 and all subsequent appropriations.
These prohibitions apply to both direct and indirect transfer,
including the use of third party list brokers.
The Committee does not recommend any funds for the
conversion to digital broadcasting. The recommendation is
$20,000,000 less than the administration request for fiscal
year 2000 and $15,000,000 less than provided last year,
contingent upon enactment of specific authorization.
Federal Mediation and Conciliation Service
Appropriations, 1999.................................... $34,620,000
Budget estimate, 2000................................... 36,834,000
Committee recommendation................................ 36,834,000
The Committee recommends an appropriation of $36,834,000
for the Federal Mediation and Conciliation Service [FMCS]
$2,214,000 above the fiscal year 1999 appropriation and the
same as the budget request.
The FMCS was established by Congress in 1947 to provide
mediation, conciliation, and arbitration services to labor and
management. FMCS is authorized to provide dispute resolution
consultation and training to all Federal agencies.
Federal Mine Safety and Health Review Commission
Appropriations, 1999.................................... $6,060,000
Budget estimate, 2000................................... 6,159,000
Committee recommendation................................ 6,159,000
The Committee recommends an appropriation of $6,159,000 for
the Federal Mine Safety and Health Review Commission, an
increase of $99,000 over the fiscal year 1999 appropriation and
the same as the budget request.
The Federal Mine Safety and Health Review Commission
provides administrative trial and appellate review of legal
disputes under the Federal Mine Safety and Health Act of 1977.
The five-member Commission provides administrative appellate
review of the Commission's administrative law judge decisions.
Office of Library Services: Grants and Administration
Appropriations, 1999.................................... $166,175,000
Budget estimate, 2000................................... 154,500,000
Committee recommendation................................ 154,500,000
The Committee recommends an appropriation of $154,500,000
for the Office of Library Services: Grants and Administration.
This is $11,675,000 less than the 1999 level and the same
amount as the administration request.
Office of Library Services State Grants
The Committee recommends $138,118,000 for State grants.
Funds are provided to States by formula to carry out 5-year
State plans. These plans must set goals and priorities for the
State consistent with the purpose of the act, describe
activities to meet the goals and priorities and describe the
methods by which progress toward the goals and priorities and
the success of activities will be evaluated. States may
apportion their funds between two activities, technology and
targeted services. For technology, States may use funds for
electronic linkages among libraries, linkages to educational,
social and information services, accessing information through
electronic networks, or link different types of libraries or
share resources among libraries. For targeted services, States
may direct library and information services to persons having
difficulty using a library, underserved urban and rural
communities, and children from low income families. Within the
total recommended, $2,616,000 has been provided for library
services to Native Americans and Native Hawaiians.
National leadership projects
The Committee recommends $10,606,000 for national
leadership projects. These funds support activities of national
significance to enhance the quality of library services
nationwide and to provide coordination between libraries and
museums. Activities are carried out through grants and
contracts awarded on a competitive basis to libraries,
agencies, institutions of higher education and museums.
Priority is given to projects that focus on education and
training of library personnel, research and development for the
improvement of libraries, preservation, digitization of library
materials, partnerships between libraries and museums and other
activities that enhance the quality of library services
nationwide.
The Committee does not accept the President's request for
$5,000,000 under National Leadership Projects for the National
Education Library for Education. Funding requested for this new
program should be used for new awards under the regular program
competition.
The programs described in subsequent paragraphs under this
account have been brought to the Committee's attention. The
Committee believes that each will support improvements to the
quality of services provided to communities, consistent with
the priorities of the Institute.
The Committee is aware of the unique, collaborative
initiative between Peabody-Essex Museum, the Alaska Native
Heritage Center and the Bishop Museum to establish an
educational and cultural demonstration project to help youth
strengthen their appreciation and knowledge of regional
heritage. The three institutions will participate in the
resource-sharing of educational materials, telecommunications
technology, and Alaska Native art.
It has come to the Committee's attention that adequate,
quality library services are not readily available to
individuals in some rural and hard to reach communities. The
Vermont Department of Libraries has developed and will
coordinate a demonstration program to address this issue. The
project will improve delivery of and access to library services
for children, families, and senior citizens and other
individuals lacking easy access to library services.
The Committee recognizes the Library and Archives of New
Hampshire's Political Tradition, located in the New Hampshire
State Library in Concord, as an invaluable resource, for not
only New Hampshire, but for the entire United States. The
Library is expanding the programs and services that it provides
to residents of New Hampshire and visitors and patrons from
throughout the United States.
The Millar Library at Portland State University's
``Creating the Library of the Future: Building Research
Capacity for the Metropolitan Region'' will make the library
more accessible to students and the region by expanding
computer systems and increasing technology-based information
and research networks. The library also will establish an
interactive Northwest Social Work Learning Center to support
and more effectively serve growing statewide Graduate School of
Social Work programs.
The Fitchburg Art Museum is of value to the City of
Fitchburg through the many educational programs and services
offered to students of the community. Planned technological
upgrades will enable the museum to better serve the local
school district as a cultural resource and support the museum's
ability to reach out to the racially diverse and economically
impoverished student population.
New York City's American Museum of Natural History's 32
million specimens and artifacts, collected over 128 years, form
the cornerstone of its scientific research, exhibitions, and
educational programs and all are located on-site to allow ease
of access to scientists and others. The Museum's ongoing
efforts to develop and expand model digitization initiatives
and to improve collection storage capabilities will enable the
Museum to share their collections with a broader audience while
protecting its integrity for years to come.
The Kellogg-Hubbard Library has a longstanding commitment
to Montpelier, Vermont and surrounding communities and is
planning to expand the programs and educational opportunities
that it offers. The Library is renown for the services provided
through its children's programs, as well as its other
outstanding programs.
The Mississippi River Museum in Dubuque, Iowa is enhancing
its exhibits and library services which will enable it to
better reach thousands of school children. These improvements
are essential to expanding the learning opportunities that the
Museum can provide to its visitors.
The Natural History Museum of Los Angeles County contains a
diverse collection that includes natural and cultural history,
paleontology, automotive history and western history. The
Museum plans to enhance visitor learning opportunities through
technology-based educational experiences and an integrated
program of collections, education, exhibits and research.
The City of Miami Beach and Miami-Dade County are
collaborating in an effort to develop and expand innovative
library services to their communities. This effort is
highlighted by investments in computer infrastructure and other
technologies that will increase public access to library
services.
The Alabama A&M; University, Alabama State Black Archives
Research Center and Museum has attracted researchers and
visitors from throughout the country. The Research Center and
Museum has undertaken an innovative initiative to enhance
public awareness, disseminate educational information, and
preserve archival materials related to African-American history
and culture through the improved use of technology.
The University of Miami Library has been entrusted with the
largest collection of Cuban heritage materials in existence
outside of Cuba. Currently, the materials are housed as
separate collections in different locations. The Library
intends to consolidate these materials and utilize updated
technologies to preserve and improve access to this unique
collection.
The Women's Museum: An Institute for the Future, in Dallas,
Texas, is a first of its kind institution. The Museum, which
will open in the year 2000, will utilize technology-based
exhibits and programs to educate the public about the evolving
contributions and role of women in society.
Many young people and adults in the inner cities of this
Nation lack access to information and learning opportunities. A
community-library collaborative which links underserved
communities with educational and informational resources,
promotes community ownership and demonstrates the potential of
the library as an information and services hub could contribute
to individual and community development. The Committee is aware
that the Libraries of the Future, currently operating in
Washington, D.C., has developed a program that will improve
access to information utilizing a national network of
community-library information collaboratives.
It has been brought to the Committee's attention that a
collaborative effort at Chadron State College in Nebraska will
celebrate the works of the Great Plains author Mari Sandoz. The
initiative will incorporate the latest technology for archiving
and preservation, and will be linked to computer access
networks and video/cable systems, making Sandoz's works
accessible to students around the world.
Administration
The Committee recommends $3,160,000 for program
administration, the same as the budget request. Funds support
personnel compensation and benefits, travel, rent,
communications, utilities, printing, equipment and supplies,
automated data processing, and other services.
Medicare Payment Advisory Commission
Appropriations, 1999.................................... $7,015,000
Budget estimate, 2000................................... 7,015,000
Committee recommendation................................ 7,015,000
The Committee recommends an appropriation of $7,015,000 for
the Medicare Payment Advisory Commission, the same as the
fiscal year 1999 appropriation and the same as the budget
request.
The Medicare Payment Advisory Commission [MedPAC] was
established by Congress as part of the Balanced Budget Act of
1997 (Public Law 105-33). Congress merged the Physician Payment
Review Commission with the Prospective Payment Assessment
Commission to create MedPAC.
National Commission on Libraries and Information Science
Appropriations, 1999.................................... $1,000,000
Budget estimate, 2000................................... 1,300,000
Committee recommendation................................ 1,300,000
The Committee recommends an appropriation of $1,300,000 for
the National Commission on Libraries and Information Science,
an increase of $300,000 over the fiscal year 1999 appropriation
and the same as the budget request.
The Commission determines the need for, and makes
recommendations on, library and information services, and
advises the President and Congress on the development and
implementation of national policy in library and information
sciences.
National Council on Disability
Appropriations, 1999.................................... $2,344,000
Budget estimate, 2000................................... 2,400,000
Committee recommendation................................ 2,400,000
The Committee recommends an appropriation of $2,400,000 for
the National Council on Disability, $56,000 above the fiscal
year 1999 appropriation and the same as the budget request.
The Council is mandated to make recommendations to the
President, the Congress, the Rehabilitation Services
Administration, and the National Institute on Disability and
Rehabilitation Research, on the public issues of concern to
individuals with disabilities. The Council gathers information
on the implementation, effectiveness, and impact of the
Americans With Disabilities Act and looks at emerging policy
issues as they affect persons with disabilities and their
ability to enter or reenter the Nation's work force and to live
independently.
National Education Goals Panel
Appropriations, 1999.................................... $2,100,000
Budget estimate, 2000................................... 2,250,000
Committee recommendation................................ 2,250,000
The Committee recommends $2,250,000 for the national
education goals panel, $150,000 above the 1999 appropriation
and the same as the budget request.
Following the 1989 education summit in Charlottesville, the
Governors and President Bush agreed on education goals for the
Nation and created the National Education Goals Panel as an
accountability mechanism to monitor and report on the Nation's
progress toward reaching the goals. To date, the goals panel
has issued eight annual reports delineating National and State
progress toward the national education goals.
National Labor Relations Board
Appropriations, 1999.................................... $184,451,000
Budget estimate, 2000................................... 210,193,000
Committee recommendation................................ 210,193,000
The Committee recommends an appropriation of $210,193,000
for the National Labor Relations Board [NLRB], $25,742,000 more
than the fiscal year 1999 comparable level, which includes a
one-time appropriation for year 2000 computer needs, and the
same as the budget request.
While the bulk of this increase is intended to meet built
in costs, such as the mandatory cost of living adjustments, the
Committee recommendation also includes the requested increases
for field operations and the National Board to help reduce
backlogged cases.
The NLRB is a law enforcement agency which adjudicates
disputes under the National Labor Relations Act.
National Mediation Board
Appropriations, 1999.................................... $8,400,000
Budget estimate, 2000................................... 9,100,000
Committee recommendation................................ 9,100,000
The Committee recommends an appropriation of $9,100,000 for
the National Mediation Board, $700,000 more than the fiscal
year 1999 appropriation and the same as the budget request.
The National Mediation Board protects interstate commerce
as it mediates labor-management relations in the railroad and
airline industries under the Railway Labor Act. The Board
mediates collective bargaining disputes, determines the choice
of employee bargaining representatives through elections, and
administers arbitration of employee grievances.
The Committee understands that railroad management and
operating unions have been working on a breakthrough agreement
expected to provide more productivity and job security.
Achievement of this goal could result in significant cost
savings to the economy, industry, and government. In order to
meet this potential, it will be necessary to conduct a broad-
based educational effort to break through 130 years of
different cultures. Therefore, the Committee supports
initiatives associated with alternative dispute resolution
programs and labor-management cooperation activities and
encourages the Board to prioritize such initiatives.
Occupational Safety and Health Review Commission
Appropriations, 1999.................................... $8,100,000
Budget estimate, 2000................................... 8,500,000
Committee recommendation................................ 8,500,000
The Committee recommends an appropriation of $8,500,000 for
the Occupational Safety and Health Review Commission, $400,000
above the fiscal year 1999 appropriation and the same as the
budget request.
The Commission serves as a court to justly and
expeditiously resolve disputes between the Occupational Safety
and Health Administration [OSHA] and employers charged with
violations of health and safety standards enforced by OSHA.
Railroad Retirement Board
dual benefits payments account
Appropriations, 1999.................................... $189,000,000
Budget estimate, 2000................................... 175,000,000
Committee recommendation................................ 175,000,000
The Committee has provided a total of $175,000,000 for dual
benefits, including $10,000,000 in income tax receipts on dual
benefits as authorized by law. The Committee recommendation is
$14,000,000 less than the fiscal year 1999 level and the same
as the budget request.
This appropriation provides for vested dual benefit
payments authorized by the Railroad Retirement Act of 1974, as
amended by the Omnibus Reconciliation Act of 1981. This
separate account, established for the payment of dual benefits,
is funded by general fund appropriations and income tax
receipts of vested dual benefits.
Federal payments to the railroad retirement account
Appropriations, 1999.................................... $150,000
Budget estimate, 2000................................... 150,000
Committee recommendation................................ 150,000
The Committee recommends $150,000 for interest earned on
unnegotiated checks. This is the same as the fiscal year 1999
appropriation and budget request.
limitation on administration
Appropriations, 1999.................................... $90,398,000
Budget estimate, 2000................................... 86,500,000
Committee recommendation................................ 90,000,000
The Committee recommends an appropriation of $90,000,000
for the administration of railroad retirement/survivor benefit
programs. This amount is $398,000 less than the fiscal year
1999 comparable level, which includes a one-time appropriation
for year 2000 computer needs, and $3,500,000 above the budget
request.
The Board administers comprehensive retirement-survivor and
unemployment-sickness insurance benefit programs for the
Nation's railroad workers and their families. This account
limits the amount of funds in the railroad retirement and
railroad unemployment insurance trust funds which may be used
by the Board for administrative expenses.
limitation on the office of the inspector general
Appropriations, 1999.................................... $5,600,000
Budget estimate, 2000................................... 5,400,000
Committee recommendation................................ 5,400,000
The Committee recommends $5,400,000 for the Office of the
Inspector General, $200,000 below the 1999 appropriation and
the same as the budget request.
Social Security Administration
PAYMENTS TO SOCIAL SECURITY TRUST FUNDS
Appropriations, 1999.................................... $19,689,000
Budget estimate, 2000................................... 20,764,000
Committee recommendation................................ 20,764,000
The Committee recommends an appropriation of $20,764,000
for payments to Social Security trust funds, the same as the
administration request. This amount reimburses the old age and
survivors and disability insurance trust funds for special
payments to certain uninsured persons, costs incurred
administering pension reform activities, and the value of the
interest for benefit checks issued but not negotiated. This
appropriation restores the trust funds to the same financial
position they would have been in had they not borne these
costs, properly charged to the general funds.
SPECIAL BENEFITS FOR DISABLED COAL MINERS
Appropriations, 1999.................................... $386,803,000
Budget estimate, 2000................................... 383,638,000
Committee recommendation................................ 383,638,000
The Committee recommends an appropriation of $383,638,000
for special benefits for disabled coal miners. This is in
addition to the $141,000,000 appropriated last year as an
advance for the first quarter of fiscal year 2000. The
recommendation is the same as the administration request. These
funds are used to provide monthly benefits to coal miners
disabled by black lung disease and to their widows and certain
other dependents, as well as to pay related administrative
costs.
The Social Security Administration holds primary
responsibility for claims filed before July 1973, with the
Department of Labor responsible for claims filed after that. By
law, increases in black lung benefit payments are tied directly
to Federal pay increases. The year-to-year decrease in this
account reflects a declining beneficiary population.
The Committee has received the report of the Inspectors
General of the Department of Labor (DOL) and the Social
Security Administration (SSA) 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 those results in their subsequent appropriation
requests.
The Committee recommends an advance appropriation of
$124,000,000 for the first quarter of fiscal year 2001, the
same as the administration request. These funds will ensure
uninterrupted benefit payments to coal miners, their widows,
and dependents.
SUPPLEMENTAL SECURITY INCOME
Appropriations, 1999.................................... $22,047,000,000
Budget estimate, 2000................................... 21,763,000,000
Committee recommendation, 2000.......................... 21,753,085,000
The Committee recommends an appropriation of
$21,753,085,000 for supplemental security income. This is in
addition to the $9,550,000,000 appropriated last year as an
advance for the first quarter of fiscal year 2000 and includes
funds for continuing disability reviews. The recommendation is
$9,915,000 less than the administration's request and
$281,915,000 less than the fiscal year 1999 level. The
Committee also recommends an advance appropriation of
$9,890,000,000 for the first quarter of fiscal year 2001 to
ensure uninterrupted benefits payments.
These funds are used to pay benefits under the SSI Program,
which was established to ensure a Federal minimum monthly
benefit for aged, blind, and disabled individuals, enabling
them to meet basic needs. It is estimated that approximately
6.4 million persons will receive SSI benefits each month during
fiscal year 2000. In many cases, SSI benefits supplement income
from other sources, including Social Security benefits. The
funds are also used to reimburse the Social Security trust
funds for the administrative costs for the program with a final
settlement by the end of the subsequent fiscal year as required
by law, to reimburse vocational rehabilitation agencies for
costs incurred in successfully rehabilitating SSI recipients
and for research and demonstration projects.
Beneficiary services
The Committee recommendation includes $64,000,000 for
beneficiary services, which is the same as the administration
request and $3,000,000 above the fiscal year 1999 level. This
amount is available for reimbursement of State vocational
rehabilitation agencies and alternate public or private
providers. In 1994 SSA published a regulation permitting direct
reimbursement of alternate public and private providers to
provide vocational rehabilitation services. Vocational
rehabilitation services are now more readily available to a
larger number of people with disabilities, since the regulation
allows SSA to use an alternate public or private sector
provider, if a State vocational rehabilitation agency has not
accepted an SSA-referred person for services or extended
evaluation.
Research and demonstration projects
The Committee recommendation includes $25,085,000 for
research and demonstration projects conducted under sections
1110 and 1115 of the Social Security Act. This is $11,915,000
below the fiscal year 1999 level and $1,085,000 above the
administration request.
This amount will support SSA's efforts to strengthen its
policy evaluation capability and focus on research of: program
solvency issues, the impact of demographic changes on future
workloads and effective return-to-work strategies for disabled
beneficiaries.
The Committee recommendation includes $1,085,000 for policy
research conducted by the President's Task Force on Employment
for Persons with Disabilities. The Task Force will consult with
the Social Security Administration in the design and
implementation of this policy research.
The Committee is pleased that the Social Security
Administration, in coordination with the Health Care Financing
Administration and appropriate State agencies, has undertaken a
demonstration program designed to identify potential Medicare
buy-in eligibles, including widowed spouses who may have
recently become eligible due to the recalculation of their
Social Security benefits based on their spouses' death. The
Committee encourages the Administration to incorporate findings
from this effort when considering any changes required to
protect this vulnerable population and ensure that they receive
the benefits to which they are entitled.
The Committee is aware that minority seniors, and in
particular Asian, Pacific Islander, and American Indian
seniors, face additional challenges to receiving the Social
Security and Supplemental Security Income benefits to which
they are entitled because of linguistic, cultural and other
barriers. The Committee also recognizes that significant
actions have been undertaken by the Social Security
Administration (SSA) to address this issue. However, the
Committee encourages SSA to consider utilizing the talents of
other seniors, especially those having knowledge of and
familiarity with the linguistic and cultural backgrounds of
these populations, to help it further enhance the services that
it provides to all of its customers, just as a similar
demonstration program did at the Environmental Protection
Agency.
The Committee believes that the public should be educated
about alternatives to the representative payee process for
beneficiaries facing difficulty managing their benefits. This
will help them to continue to handle their benefit checks in
accordance with their wishes prior to the time when the
appointment of a representative payee may be necessary. SSA
should implement this education effort as soon as feasible.
Administration
The Committee recommendation includes $2,192,000,000 for
payment to the Social Security trust funds for the SSI
Program's share of SSA's base administrative expenses. This is
$78,000,000 above the fiscal year 1999 level and $11,000,000
less than the administration request.
Continuing disability reviews
The recommendation includes $200,000,000 for payments to
the Social Security trust fund to process continuing reviews
and redeterminations of the disability and nondisability
eligibility factors of entitlement for individuals receiving
supplemental security income on the basis of their disability.
LIMITATION ON ADMINISTRATIVE EXPENSES
Appropriations, 1999.................................... $6,426,000,000
Budget estimate, 2000................................... 6,706,000,000
Committee recommendation, 2000.......................... 6,673,871,000
The Committee recommends a program funding level of
$6,673,871,000 for the limitation on administrative expenses,
which is $32,129,000 less than the administration request and
$247,871,000 higher than the fiscal year 1999 level.
This account provides resources from the Social Security
trust funds to administer the Social Security retirement and
survivors and disability insurance programs, and certain Social
Security health insurance functions. As authorized by law, it
also provides resources from the trust funds for certain
nontrust fund administrative costs, which are reimbursed from
the general funds. These include administration of the
supplemental security income program for the aged, blind and
disabled; work associated with the Pension Reform Act of 1984;
and the portion of the annual wage reporting work done by the
Social Security Administration for the benefit of the Internal
Revenue Service. The dollars provided also support automated
data processing activities and fund the State disability
determination services which make initial and continuing
disability determinations on behalf of the Social Security
Administration. Additionally, the limitation provides funding
for computer support, and other administrative costs. In 2000
about 50 million people will receive a Social Security or
supplemental security income checks each month. Cash payments
are expected to be more than $430,000,000,000 during fiscal
year 2000.
The limitation includes $6,188,871,000 for routine
operating expenses of the agency, which is $13,129,000 less
than the amount requested by the President and $192,871,000
over the 1999 comparable amount. These funds, as well as those
derived from an increase in the user fees which are discussed
below, cover the mandatory costs of maintaining equipment and
facilities, as well as staffing.
The Committee recognizes the significant problems facing
the Social Security Appeals Council, due to their overwhelming
workload. Although the amount of appeals processed by the
Council has almost doubled in the past four years, the number
of pending cases has doubled as well. Since improvements have
been made to other aspects of the hearings process of the
Social Security Administration, the Committee understands that
more resources could be directed towards the appeals council
workload. By doing this, the Committee believes that many of
the cases still pending will be processed in a more timely
manner.
Social Security Advisory Board
The Committee has included $1,800,000 within the limitation
on administrative expenses account for the Social Security
Advisory Board for fiscal year 2000, the same level as the
administration request and $200,000 more than the fiscal year
1999 level.
User fees
In addition to other amounts provided, the Committee
recommends $80,000,000 for administrative activities funded
from user fees that were authorized in fiscal year 1998. This
is the same as the administration's request and an increase of
$5,000,000 over the fiscal year 1999 level.
The Committee recommendation does not include $19,000,000
for the claimant representative payment fee requested by the
Administration. This proposal requires enactment of authorizing
legislation.
Continuing disability reviews
The Committee has provided an additional $405,000,000 to
the limitation on administrative expenses account for
continuing disability reviews of individuals receiving Social
Security disability benefits and continuing disability reviews
and redeterminations of the disability and nondisability
eligibility factors of entitlement for individuals receiving
supplemental security income on the basis of disability.
OFFICE OF THE INSPECTOR GENERAL
Appropriations, 1999.................................... $56,000,000
Budget estimate, 2000................................... 66,000,000
Committee recommendation, 2000.......................... 66,000,000
The Committee recommends $66,000,000 for activities for the
Office of the Inspector General, $10,000,000 more than fiscal
year 1999 and the same as the administration request. This
includes a general fund appropriation of $15,000,000 together
with an obligation limitation of $51,000,000 from the Federal
old-age and survivors insurance trust fund and the Federal
disability insurance trust fund.
U.S. Institute of Peace
Appropriations, 1999.................................... $12,160,000
Budget estimate, 2000................................... 13,000,000
Committee recommendation................................ 13,000,000
The Committee recommends an appropriation of $13,000,000
for the U.S. Institute of Peace, $840,000 more than the fiscal
year 1999 appropriation and the budget request.
The Institute was established by the U.S. Institute of
Peace Act (Public Law 98-525) in 1984. The Institute is an
independent, nonprofit, national organization whose primary
mission is to promote, through scholarship and education,
international peace, and the resolution of conflicts without
recourse to violence.
TITLE V--GENERAL PROVISIONS
The Committee recommendation retains provisions which:
authorize transfers of unexpended balances (sec. 501); limit
funding to 1 year availability unless otherwise specified (sec.
502); limit lobbying and related activities (sec. 503); limit
official representation expenses (sec. 504); prohibit funding
of any program to carry out distribution of sterile needles for
the hypodermic injection of any illegal drug unless the
Secretary of HHS determines such programs are effective in
preventing the spread of HIV and do not encourage the use of
illegal drugs (sec. 505); state the sense of Congress about
purchase of American-made equipment and products (sec. 506);
clarify Federal funding as a component of State and local grant
funds (sec. 507); and limit use of funds for abortion (sec. 508
and sec. 509).
The Committee recommendation includes language on human
embryo research (sec. 510).
The Committee recommendation retains the limitation on use
of funds for promotion of legalization of controlled substances
included last year (sec. 511).
The Committee recommendation retains the bill language
limitation on use of funds to enter into or review contracts
with entities subject to the requirement in section 4212(d) of
title 38, United States Code, if the report required by that
section has not been submitted (sec. 512).
The Committee bill includes language regarding the
individual health identifier (sec. 513).
The Committee recommendation includes a provision (sec.
514) which amends the 1997 appropriation's legislation
regarding retirement benefits.
BUDGETARY IMPACT OF BILL
PREPARED IN CONSULTATION WITH THE CONGRESSIONAL BUDGET OFFICE PURSUANT TO SEC. 308(a), PUBLIC LAW 93-344, AS
AMENDED
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
Budget authority Outlays
---------------------------------------------------
Committee Amount of Committee Amount of
allocation bill allocation bill
----------------------------------------------------------------------------------------------------------------
Comparison of amounts in the bill with Committee allocations
to its subcommittees of amounts in the First Concurrent
Resolution for 2000: Subcommittee on Labor, Health and
Human Services, Education, and Related Agencies:
General purpose discretionary........................... 84,018 84,018 84,222 \1\ 84,222
Violent crime reduction fund............................ 156 156 155 155
Mandatory............................................... 233,459 233,459 233,644 233,644
Projections of outlays associated with the recommendation:
2000.................................................... ........... ........... ........... \2\ 213,167
2001.................................................... ........... ........... ........... 89,371
2002.................................................... ........... ........... ........... 10,889
2003.................................................... ........... ........... ........... 6,018
2004 and future year.................................... ........... ........... ........... 685
Financial assistance to State and local governments for 2000 NA 125,410 NA 25,061
in bill....................................................
----------------------------------------------------------------------------------------------------------------
\1\ Includes outlays from prior-year budget authority.
\2\ Excludes outlays from prior-year budget authority.
NA: Not applicable.
Note.--Consistent with the funding recommended in the bill for continuing disability reviews and adoption
assistance, and in accordance with section 314 of the Congressional Budget Act of 1974, the Committee
anticipates that the Budget Committee will file a revised section 302(a) allocation for the Committee on
Appropriations reflecting an upward adjustment of $425,000,000 in budget authority and $364,000,000 in
outlays.
COMPLIANCE WITH PARAGRAPH 7, RULE XVI, OF THE STANDING RULES OF THE
SENATE
Paragraph 7 of rule XVI requires that Committee report on
general appropriations bills identify each Committee amendment
to the House bill ``which proposes an item of appropriation
which is not made to carry out the provisions of an existing
law, a treaty stipulation, or an act or resolution previously
passed by the Senate during that session.''
The following items are identified pursuant to this
requirement:
Community service employment for older Americans,
$440,200,000;
Homeless Veterans, $10,000,000;
National Skills Standards Board, $7,000,000;
School-to-Work (Labor and Education), $110,000,000;
Family Planning, $22,432,000;
Preventive Health and Health Services Block Grant,
$115,914,000;
Sexually transmitted diseases, $115,711,000;
Injury Prevention and Control (Traumatic Brain Injury
Research), $63,994,000;
Substance Abuse and Mental Health Services
Administration (except Program Management),
$2,691,800,000;
Runaway and Homeless Youth; Homeless Youth
Transitional Living, $63,602,000;
Developmental Disabilities, $125,732,000;
Administration on Aging, $927,055,000;
Adolescent Family Life, $19,700,000;
Teacher assistance initiative, $1,200,000,000;
State grants for incarcerated youth offenders,
$19,000,000.
COMPLIANCE WITH PARAGRAPH 7(C), RULE XXVI OF THE STANDING RULES OF THE
SENATE
Pursuant to paragraph 7(c) of rule XXVI, the bill S. 1650
was ordered reported from the Committee, subject to amendment
and subject to the section 302(b) allocation, by recorded vote
of 26-0, with two abstentions, a quorum being present.
The vote was as follows:
Yeas Nays
Chairman Stevens
Mr. Cochran
Mr. Specter
Mr. Domenici
Mr. Bond
Mr. Gorton
Mr. McConnell
Mr. Burns
Mr. Shelby
Mr. Gregg
Mr. Bennett
Mr. Campbell
Mr. Craig
Mrs. Hutchison
Mr. Kyl
Mr. Byrd
Mr. Inouye
Mr. Hollings
Mr. Leahy
Mr. Lautenberg
Mr. Harkin
Ms. Mikulski
Mr. Kohl
Mr. Dorgan
Mrs. Feinstein
Mr. Durbin
Mr. Reid and Mrs. Murray abstained.
COMPLIANCE WITH PARAGRAPH 12, RULE XXVI OF THE STANDING RULES OF THE
SENATE
Paragraph 12 of rule XXVI requires that Committee reports
on a bill or a joint resolution repealing or amending any
statute include ``(a) the text of the statute or part thereof
which is proposed to be repealed; and (b) a comparative print
of that part of the bill or joint resolution making the
amendment and of the statute or part thereof proposed to be
amended, showing by stricken through type and italics, parallel
columns, or other appropriate typographical devices the
omissions and insertions which would be made by the bill or
joint resolution if enacted in the form recommended by the
committee.''
In compliance with this rule, the following changes in
existing law proposed to be made by the bill are shown as
follows: existing law to be omitted is enclosed in black
brackets; new matter is printed in italic; and existing law in
which no change is proposed is shown in roman.
TITLE 8--ALIENS AND NATIONALITY
* * * * * * *
CHAPTER 12--IMMIGRATION AND NATIONALITY
* * * * * * *
SUBCHAPTER II--IMMIGRATION
Part I--Selection System
* * * * * * *
Sec. 1157. Annual admission of refugees and admission of emergency
situation refugees
* * * * * * *
Establishing Categories of Aliens for Purposes of Refugee
Determinations
* * * * * * *
``(a) * * *
* * * * * * *
``(b) Establishment of Categories.--
``(1) * * *
``(3) Within the number of admissions of refugees
allocated for for [sic] each of fiscal years [1997,
1998, and 1999] 1997, 1998, 1999, and 2000 for refugees
who are nationals of the Soviet Union under section
207(a)(3) of the Immigration and Nationality Act [8
U.S.C. 1157(a)(3)] and within the number of such
admissions allocated for each of fiscal years 1993,
1994, 1995, and 1996 for refugees who are nationals of
the independent states of the former Soviet Union,
Estonia, Latvia, and Lithuania under such section,
notwithstanding any other provision of law, the
President shall allocate one thousand of such
admissions for such fiscal year to refugees who are
within the category of aliens described in paragraph
(2)(B).
* * * * * * *
``(e) Period of Application.--
``(1) Subsections (a) and (b) shall take effect on
the date of the enactment of this Act [Nov. 21, 1989]
and shall only apply to applications for refugee status
submitted before [October 1, 1996] October 1, 2000.
``(2) Subsection (c) shall apply to decisions made
after the date of the enactment of this Act and before
[October 1, 1996] October 1, 2000.
``(3) Subsection (d) shall take effect on the date
of the enactment of this Act and shall only apply to
reapplications for refugee status submitted before
[October 1, 1996] October 1, 2000.''
* * * * * * *
Sec. 1255. Adjustment of status of nonimmigrant to that of person
admitted for permanent residence
* * * * * * *
Adjustment of Status for Certain Soviet and Indochinese Parolees
``(a) * * *
* * * * * * *
``(b) Aliens Eligible for Adjustment of Status.--The
benefits provided in subsection (a) shall only apply to an
alien who--
``(1) was a national of an independent state of the
former Soviet Union, Estonia, Latvia, Lithuania,
Vietnam, Laos, or Cambodia, and
``(2) was inspected and granted parole into the
United States during the period beginning on August 15,
1988, and ending on [September 30, 1999] September 30,
2000, after being denied refugee status.
* * * * * * *
TITLE 20--EDUCATION
* * * * * * *
CHAPTER 31--GENERAL PROVISIONS CONCERNING EDUCATION
* * * * * * *
SUBCHAPTER III--GENERAL REQUIREMENTS AND CONDITIONS CONCERNING
OPERATION AND ADMINISTRATION OF EDUCATION PROGRAMS: GENERAL AUTHORITY
OF SECRETARY
* * * * * * *
Part 2--Administration: Requirements and Limitations
* * * * * * *
Sec. 1231g. Applications
(a) * * *
* * * * * * *
(c) * * *
* * * * * * *
SEC. 447. PROHIBITION ON FEDERALLY SPONSORED TESTING.
(a) General Prohibition.--Notwithstanding any other
provision of Federal law and except as provided in subsection
(b), no funds provided to the Department of Education or to an
applicable program, may be used to pilot test, field test,
implement, administer or distribute in any way any federally
sponsored national test in reading, mathematics, or any other
subject that is not specifically and explicitly provided for in
authorizing legislation enacted into law.
(b) Exceptions.--Subsection (a) shall not apply to the
Third International Mathematics and Science Study or other
international comparative assessments developed under the
authority of section 404(a)(6) of the National Education
Statistics Act of 1994 (20 U.S.C. 9003(a)(6) et seq.) and
administered to only a representative sample of pupils in the
United States and in foreign nations.
* * * * * * *
Public Health Service Act
TITLE XIX--BLOCK GRANTS
* * * * * * *
SEC. 1918. DETERMINATION OF AMOUNT OF ALLOTMENT.
(a) * * *
* * * * * * *
[(b) Minimum Allotments for States.--For each of the fiscal
years 1993 and 1994, the amount of the allotment required in
section 1911 for a State for the fiscal year involved shall be
the greater of--
[(1) the amount determined under subsection (a) for
the State for the fiscal year; and
[(2) an amount equal to 20.6 percent of the amount
received by the State from allotments made pursuant to
this part for fiscal year 1992 (including reallotments
under section 205(a) of the ADAMHA Reorganization
Act).]
(b) Minimum Allotments for States.--
(1) In general.--With respect to fiscal year 2000,
the amount of the allotment of a State under section
1911 shall not be less than the amount the State
received under section 1911 for fiscal year 1998.
* * * * * * *
SEC. 1933. DETERMINATION OF AMOUNT OF ALLOTMENT.
(a) * * *
* * * * * * *
[(b) Minimum Allotments for States.--For each of the fiscal
years 1993 and 1994, the amount of the allotment required in
section 1921 for a State for the fiscal year involved shall be
the greater of--
[(1) the amount determined under subsection (a) for
the State for the fiscal year; and
[(2) an amount equal to 79.4 percent of the amount
received by the State from allotments made pursuant to
this part for fiscal year 1992 (including reallotments
under section 205(a) of the ADAMHA Reorganization
Act).]
(b) Minimum Allotments for States.--
(1) In general.--With respect to fiscal year 2000,
the amount of the allotment of a State under section
1921 shall not be less than the amount the State
received under section 1921 for fiscal year 1999
increased by 30.65 percent of the percentage by which
the amount allotted to the States for fiscal year 2000
exceeds the amount allotted to the States for fiscal
year 1999.
(2) Limitation.--
(A) In general.--Except as provided
in subparagraph (B), a State shall not
receive an allotment under section 1921
for fiscal year 2000 in an amount that
is less than an amount equal to 0.375
percent of the amount appropriated
under section 1935(a) for such fiscal
year.
(B) Exception.--In applying
subparagraph (A), the Secretary shall
ensure that no State receives an
increase in its allotment under section
1921 for fiscal year 2000 (as compared
to the amount allotted to the State in
the fiscal year 1999) that is in excess
of an amount equal to 300 percent of
the percentage by which the amount
appropriated under section 1935(a) for
fiscal year 2000 exceeds the amount
appropriated for fiscal year 1999.
* * * * * * *
Departments of Labor, Health and Human Services, and Education, and
Related Agencies Appropriations Act, 1997, Public Law 104-208
* * * * * * *
TITLE V--GENERAL PROVISIONS
* * * * * * *
Sec. 520. Voluntary Separation Incentives for Employees
of Certain Federal Agencies.--(a) * * *
* * * * * * *
(c) * * *
(1) * * *
(2) * * *
(A) * * *
* * * * * * *
(D) may not be made except in the case of
any qualifying employee who voluntarily
separates (whether by retirement or
resignation) before [December 31, 1997]
December 31, 1999;
COMPARATIVE STATEMENT OF NEW BUDGET (OBLIGATIONAL) AUTHORITY FOR FISCAL YEAR 1999 AND BUDGET ESTIMATES AND AMOUNTS RECOMMENDED IN THE BILL FOR FISCAL
YEAR 2000
[In thousands of dollars]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Senate Committee recommendation
compared with (+ or -)
Item 1999 Budget estimate Committee -----------------------------------
appropriation recommendation 1999
appropriation Budget estimate
--------------------------------------------------------------------------------------------------------------------------------------------------------
TITLE I--DEPARTMENT OF LABOR
EMPLOYMENT AND TRAINING ADMINISTRATION
TRAINING AND EMPLOYMENT SERVICES
Grants to States:
Adult Training............................................ 955,000 955,000 238,000 -717,000 -717,000
Fiscal year 2001 advance.............................. ................ ................ 712,000 +712,000 +712,000
-----------------------------------------------------------------------------------------
Subtotal, Adult Training program level.............. 955,000 955,000 950,000 -5,000 -5,000
Youth Training............................................ 1,000,965 1,000,965 1,000,965 ................ ................
Dislocated Worker Assistance.............................. 1,400,510 1,595,510 395,510 -1,005,000 -1,200,000
Fiscal year 2001 advance.............................. ................ ................ 1,200,000 +1,200,000 +1,200,000
-----------------------------------------------------------------------------------------
Subtotal, Dislocated Worker program level........... 1,400,510 1,595,510 1,595,510 +195,000 ................
Federally administered programs:
Native Americans.......................................... 57,815 53,815 60,000 +2,185 +6,185
Migrant and Seasonal Farmworkers \1\...................... 78,517 71,017 75,996 -2,521 +4,979
Job Corps:
Operations............................................ 1,158,642 1,213,533 485,413 -673,229 -728,120
Fiscal year 2001 advance.......................... ................ ................ 728,120 +728,120 +728,120
Construction and Renovation \2\....................... 150,572 133,658 53,463 -97,109 -80,195
Fiscal year 2001 advance.......................... ................ ................ 80,195 +80,195 +80,195
-----------------------------------------------------------------------------------------
Subtotal, Job Corps............................. 1,309,214 1,347,191 1,347,191 +37,977 ................
Subtotal, Job Corps program level............... 1,309,214 1,347,191 1,347,191 +37,977 ................
Veterans' employment...................................... 7,300 7,300 7,300 ................ ................
National activities:
Pilots and Demonstrations............................. 67,500 35,000 98,500 +31,000 +63,500
Research, Demos, evaluation........................... 9,098 12,000 9,098 ................ -2,902
Right Track Partnership............................... ................ 75,000 ................ ................ -75,000
Youth Opportunity Grants.............................. 250,000 250,000 250,000 ................ ................
Other................................................. ................ 5,000 5,000 +5,000 ................
-----------------------------------------------------------------------------------------
Subtotal, National activities....................... 326,598 377,000 362,598 +36,000 -14,402
=========================================================================================
Subtotal, Federal activities........................ 1,779,444 1,856,323 1,853,085 +73,641 -3,238
=========================================================================================
Total, Job Training Partnership Act................. 5,135,919 5,407,798 5,399,560 +263,641 -8,238
Women in Apprenticeship................................... 1,000 ................ 1,000 ................ +1,000
Skills Standards.......................................... 7,000 7,000 7,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, National activities, TES...................... 334,598 384,000 370,598 +36,000 -13,402
School-to-Work \1\........................................ 125,000 55,000 55,000 -70,000 ................
Homeless Veterans......................................... 3,000 5,000 10,000 +7,000 +5,000
=========================================================================================
Total, Training and Employment Services................. 5,271,919 5,474,798 5,472,560 +200,641 -2,238
Current Year...................................... (5,271,919) (5,474,798) (2,752,245) (-2,519,674) (-2,722,553)
Advance year...................................... ................ ................ (2,720,315) (+2,720,315) (+2,720,315)
Welfare-to-work rescission................................ -137,000 ................ ................ +137,000 ................
COMMUNITY SERV. EMPLOYMENT OLDER AMERICANS.................... 440,200 440,200 440,200 ................ ................
FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES
Trade Adjustment.............................................. 312,300 306,400 349,000 +36,700 +42,600
NAFTA Activities.............................................. 48,400 8,000 66,150 +17,750 +58,150
-----------------------------------------------------------------------------------------
Total................................................... 360,700 314,400 415,150 +54,450 +100,750
STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS
Unemployment Compensation (Trust Funds):
State Operations.......................................... 2,122,631 2,206,125 2,154,625 +31,994 -51,500
National Activities....................................... 10,000 57,000 10,000 ................ -47,000
Year 2000 Computer conversion Advance from prior year..... (40,000) ................ ................ (-40,000) ................
Contingency............................................... 161,884 196,333 151,333 -10,551 -45,000
-----------------------------------------------------------------------------------------
Subtotal, Unemployment Comp (trust funds)............... (2,294,515) (2,459,458) (2,315,958) (+21,443) (-143,500)
Employment Service:
Allotments to States:
Federal Funds......................................... 23,452 23,452 23,452 ................ ................
Trust Funds........................................... 738,283 738,283 738,283 ................ ................
-----------------------------------------------------------------------------------------
Subtotal............................................ 761,735 761,735 761,735 ................ ................
Reemployment Service Grants............................... ................ 53,000 40,000 +40,000 -13,000
National Activities:
Federal Funds......................................... ................ 10,000 ................ ................ -10,000
Trust Funds........................................... 59,880 23,580 66,880 +7,000 +43,300
=========================================================================================
Subtotal, Employment Service........................ 821,615 848,315 868,615 +47,000 +20,300
Federal funds................................... 23,452 33,452 23,452 ................ -10,000
Trust funds..................................... 798,163 814,863 845,163 +47,000 +30,300
One Stop Career Centers:
Federal Funds............................................. 138,645 149,000 146,500 +7,855 -2,500
Trust Funds............................................... 7,855 ................ ................ -7,855 ................
-----------------------------------------------------------------------------------------
Total, One stop centers................................. 146,500 149,000 146,500 ................ -2,500
Work Incentives Grants........................................ ................ 50,000 27,000 +27,000 -23,000
=========================================================================================
Total, State Unemployment............................... 3,262,630 3,506,773 3,358,073 +95,443 -148,700
Federal Funds....................................... 162,097 232,452 196,952 +34,855 -35,500
Trust Funds......................................... 3,100,533 3,274,321 3,161,121 +60,588 -113,200
Advances to the UI and Other Trust Funds \4\.................. 357,000 356,000 356,000 -1,000 ................
PROGRAM ADMINISTRATION
Adult Employment and Training................................. 29,353 30,673 30,673 +1,320 ................
Trust Funds............................................... 2,395 2,475 2,475 +80 ................
Youth Employment and Training................................. 32,971 34,867 34,867 +1,896 ................
Employment Security........................................... 5,961 5,065 5,065 -896 ................
Trust Funds \5\........................................... 39,956 33,958 42,248 +2,292 +8,290
Apprenticeship Services....................................... 17,635 19,580 19,580 +1,945 ................
Executive Direction........................................... 8,907 6,445 6,445 -2,462 ................
Trust Funds............................................... 1,365 1,409 1,409 +44 ................
Welfare to Work............................................... 6,160 6,578 6,578 +418 ................
-----------------------------------------------------------------------------------------
Subtotal, Program Administration........................ 144,703 141,050 149,340 +4,637 +8,290
Federal funds....................................... 100,987 103,208 103,208 +2,221 ................
Trust funds......................................... 43,716 37,842 46,132 +2,416 +8,290
=========================================================================================
Subtotal, Employment and Training Administration........ 9,700,152 10,233,221 10,191,323 +491,171 -41,898
Federal funds....................................... 6,555,903 6,921,058 4,263,755 -2,292,148 -2,657,303
Trust funds......................................... 3,144,249 3,312,163 3,207,253 +63,004 -104,910
PENSION AND WELFARE BENEFITS ADMINISTRATION
SALARIES AND EXPENSES
Enforcement and Compliance.................................... 71,106 79,355 77,355 +6,249 -2,000
Policy, Regulation and Public Service......................... 15,216 18,636 18,636 +3,420 ................
Program Oversight............................................. 4,248 3,840 3,840 -408 ................
-----------------------------------------------------------------------------------------
Subtotal, PWBA.......................................... 90,570 101,831 99,831 +9,261 -2,000
PENSION BENEFIT GUARANTY CORPORATION
Program Administration subject to limitation (TF)............. 10,958 11,352 11,352 +394 ................
Termination services not subj to limitation (NA).............. (148,974) (153,599) (153,599) (+4,625) ................
-----------------------------------------------------------------------------------------
Subtotal, PBGC new BA................................... 10,958 11,352 11,352 +394 ................
Subtotal, PBGC (Program level).......................... (159,932) (164,951) (164,951) (+5,019) ................
EMPLOYMENT STANDARDS ADMINISTRATION
SALARIES AND EXPENSES
Enforcement of Wage and Hour Standards........................ 129,581 176,042 142,342 +12,761 -33,700
Office of Labor-Management Standards.......................... 28,148 29,308 29,308 +1,160 ................
Federal Contractor EEO Standards Enforcement.................. 65,461 76,417 76,417 +10,956 ................
Federal Programs for Workers' Compensation.................... 76,759 80,369 80,369 +3,610 ................
Trust Funds............................................... 1,924 1,740 1,740 -184 ................
Program Direction and Support................................. 13,231 12,611 12,611 -620 ................
-----------------------------------------------------------------------------------------
Subtotal, ESA salaries and expenses..................... 315,104 376,487 342,787 +27,683 -33,700
Federal funds....................................... 313,180 374,747 341,047 +27,867 -33,700
Trust funds......................................... 1,924 1,740 1,740 -184 ................
SPECIAL BENEFITS
Federal employees compensation benefits....................... 175,000 75,000 75,000 -100,000 ................
Longshore and harbor workers' benefits........................ 4,000 4,000 4,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Special Benefits.............................. 179,000 79,000 79,000 -100,000 ................
BLACK LUNG DISABILITY TRUST FUND
Benefit payments and interest on advances..................... 969,725 963,506 963,506 -6,219 ................
Employment Standards Adm. S&E.................................; 30,191 28,676 28,676 -1,515 ................
Departmental Management S&E...................................; 20,422 21,144 21,144 +722 ................
Departmental Management, Inspector General.................... 306 318 318 +12 ................
-----------------------------------------------------------------------------------------
Subtotal, Black Lung Disability Trust Fund, apprn....... 1,020,644 1,013,644 1,013,644 -7,000 ................
Treasury Adm. Costs........................................... 356 356 356 ................ ................
-----------------------------------------------------------------------------------------
Total, Black Lung Disability Trust Fund................. 1,021,000 1,014,000 1,014,000 -7,000 ................
=========================================================================================
Total, Employment Standards Administration.............. 1,515,104 1,469,487 1,435,787 -79,317 -33,700
Federal funds....................................... 1,513,180 1,467,747 1,434,047 -79,133 -33,700
Trust funds......................................... 1,924 1,740 1,740 -184 ................
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION
SALARIES AND EXPENSES
Safety and Health Standards................................... 12,323 13,126 13,126 +803 ................
Federal Enforcement........................................... 133,896 142,232 142,232 +8,336 ................
State Programs................................................ 80,084 83,501 83,501 +3,417 ................
Technical Support............................................. 18,203 17,806 17,806 -397 ................
Compliance Assistance:
Federal Assistance........................................ 45,670 57,812 57,812 +12,142 ................
State Consultation Grants................................. 40,943 40,943 40,943 ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 86,613 98,755 98,755 +12,142 ................
Safety and Health Statistics.................................. 15,172 23,677 23,677 +8,505 ................
Executive Direction and Administration........................ 8,084 9,045 9,045 +961 ................
-----------------------------------------------------------------------------------------
Total, OSHA............................................. 354,375 388,142 388,142 +33,767 ................
MINE SAFETY AND HEALTH ADMINISTRATION
SALARIES AND EXPENSES
Coal Enforcement.............................................. 105,489 111,008 111,008 +5,519 ................
Metal/Non-Metal Enforcement................................... 43,886 50,293 50,293 +6,407 ................
Standards Development......................................... 1,509 1,671 1,671 +162 ................
Assessments................................................... 3,896 4,128 4,128 +232 ................
Educational Policy and Development............................ 20,864 24,684 27,184 +6,320 +2,500
Technical Support............................................. 25,312 25,840 25,840 +528 ................
Program Administration........................................ 14,957 10,749 10,749 -4,208 ................
-----------------------------------------------------------------------------------------
Total, Mine Safety and Health Administration............ 215,913 228,373 230,873 +14,960 +2,500
BUREAU OF LABOR STATISTICS
SALARIES AND EXPENSES
Employment and Unemployment Statistics........................ 115,828 118,084 117,084 +1,256 -1,000
Labor Market Information (Trust Funds)........................ 54,146 55,663 55,663 +1,517 ................
Prices and Cost of Living..................................... 120,179 131,032 126,032 +5,853 -5,000
Compensation and Working Conditions........................... 61,029 69,383 65,383 +4,354 -4,000
Productivity and Technology................................... 7,526 8,988 8,288 +762 -700
Economic Growth and Employment Projections.................... 4,905 5,058 5,058 +153 ................
Executive Direction and Staff Services........................ 24,098 25,725 24,950 +852 -775
Consumer Price Index Revision \4\............................. 11,159 6,986 6,986 -4,173 ................
-----------------------------------------------------------------------------------------
Total, Bureau of Labor Statistics....................... 398,870 420,919 409,444 +10,574 -11,475
Federal Funds....................................... 344,724 365,256 353,781 +9,057 -11,475
Trust Funds......................................... 54,146 55,663 55,663 +1,517 ................
DEPARTMENTAL MANAGEMENT
SALARIES AND EXPENSES
Executive Direction........................................... 20,193 34,575 26,575 +6,382 -8,000
Legal Services................................................ 66,519 70,041 70,041 +3,522 ................
Trust Funds............................................... 299 310 310 +11 ................
International Labor Affairs................................... 40,385 76,165 76,165 +35,780 ................
Administration and Management................................. 20,774 23,287 22,029 +1,255 -1,258
Adjudication.................................................. 21,842 23,689 23,689 +1,847 ................
Promoting Employment of People with Disabilities.............. 6,750 7,250 7,250 +500 ................
Women's Bureau................................................ 7,802 8,369 8,369 +567 ................
Civil Rights Activities....................................... 4,929 5,684 5,684 +755 ................
Chief Financial Officer....................................... 5,538 5,799 5,799 +261 ................
Task Force/Employment people w/disabilities................... 1,400 2,485 1,400 ................ -1,085
Year 2000 Computer Conversion (Emergency Funding)............. 4,667 ................ ................ -4,667 ................
-----------------------------------------------------------------------------------------
Total, Salaries and expenses............................ 201,098 257,654 247,311 +46,213 -10,343
Federal funds....................................... 200,799 257,344 247,001 +46,202 -10,343
Trust funds......................................... 299 310 310 +11 ................
VETERANS EMPLOYMENT AND TRAINING
State Administration:
Disabled Veterans Outreach Program........................ 80,040 80,215 80,215 +175 ................
Local Veterans Employment Program......................... 77,078 77,253 77,253 +175 ................
-----------------------------------------------------------------------------------------
Subtotal, State Administration.......................... 157,118 157,468 157,468 +350 ................
Federal Administration........................................ 25,601 28,145 28,145 +2,544 ................
-----------------------------------------------------------------------------------------
Total, Veterans Employment and Training (TF)............ 182,719 185,613 185,613 +2,894 ................
OFFICE OF THE INSPECTOR GENERAL
Program Activities............................................ 39,377 43,927 42,346 +2,969 -1,581
Trust Funds............................................... 3,648 5,010 3,830 +182 -1,180
Executive Direction and Management............................ 5,475 6,241 5,749 +274 -492
-----------------------------------------------------------------------------------------
Total, Office of the Inspector General.................. 48,500 55,178 51,925 +3,425 -3,253
Federal funds....................................... 44,852 50,168 48,095 +3,243 -2,073
Trust funds......................................... 3,648 5,010 3,830 +182 -1,180
=========================================================================================
Total, Departmental Management.......................... 432,317 498,445 484,849 +52,532 -13,596
Federal funds....................................... 245,651 307,512 295,096 +49,445 -12,416
Trust funds......................................... 186,666 190,933 189,753 +3,087 -1,180
=========================================================================================
Total, Labor Department................................. 12,718,259 13,351,770 13,251,601 +533,342 -100,169
Federal funds....................................... 9,320,316 9,779,919 7,065,525 -2,254,791 -2,714,394
Current Year.................................... (9,320,316) (9,779,919) (7,065,525) (-2,254,791) (-2,714,394)
Advance year.................................... ................ ................ (2,720,315) (+2,720,315) (+2,720,315)
Trust funds......................................... 3,397,943 3,571,851 3,465,761 +67,818 -106,090
TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES
HEALTH RESOURCES AND SERVICES ADMINISTRATION
HEALTH RESOURCES AND SERVICES
Consolidated health centers................................... 924,706 945,000 1,024,000 +99,294 +79,000
National Health Service Corps:
Field placements.......................................... 37,232 36,997 36,997 -235 ................
Recruitment............................................... 78,141 78,166 78,166 +25 ................
-----------------------------------------------------------------------------------------
Subtotal, National Health Service Corps................. 115,373 115,163 115,163 -210 ................
Health Professions
Training for Diversity:
Centers of excellence..................................... 25,634 33,142 ................ -25,634 -33,142
Health careers opportunity program........................ 27,790 35,299 ................ -27,790 -35,299
Faculty loan repayment.................................... 1,100 1,100 ................ -1,100 -1,100
Scholarships for disadvantaged students................... 38,087 38,966 ................ -38,087 -38,966
-----------------------------------------------------------------------------------------
Subtotal................................................ 92,611 108,507 ................ -92,611 -108,507
Training in Primary Care Dentistry:
Family medicine training/departments...................... 50,509 ................ ................ -50,509 ................
General internal medicine and pediatrics.................. 18,125 ................ ................ -18,125 ................
Physician assistants...................................... 6,800 ................ ................ -6,800 ................
General dentistry residencies............................. 4,500 ................ ................ -4,500 ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 79,934 ................ ................ -79,934 ................
Interdisciplinary Community-Based Linkages:
Area health education centers............................. 28,578 28,587 ................ -28,578 -28,587
Health education and training centers..................... 3,764 3,765 ................ -3,764 -3,765
Allied health special projects............................ 7,093 ................ ................ -7,093 ................
Geriatric education centers and training.................. 9,697 ................ ................ -9,697 ................
Rural interdisciplinary traineeships...................... 4,544 4,545 ................ -4,544 -4,545
-----------------------------------------------------------------------------------------
Subtotal................................................ 53,676 36,897 ................ -53,676 -36,897
Health Professions Workforce Info and analysis:
Health Professions data systems........................... 246 ................ ................ -246 ................
Research on Health Professions Issues..................... 468 ................ ................ -468 ................
Consolidated HP Workforce Info and Analysis............... ................ 714 ................ ................ -714
-----------------------------------------------------------------------------------------
Subtotal................................................ 714 714 ................ -714 -714
Public Health Workforce Development:
Public health and preventive medicine..................... 8,291 ................ ................ -8,291 ................
Health administration traineeships/projects............... 1,135 ................ ................ -1,135 ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 9,426 ................ ................ -9,426 ................
Pediatric Graduate Medical Education.......................... ................ 40,000 ................ ................ -40,000
Nursing Workforce Development:
Advanced Nurse Education.................................. 12,926 ................ ................ -12,926 ................
Nurse practitioners/nurse midwives........................ 18,259 ................ ................ -18,259 ................
Professional nurse traineeships........................... 16,528 ................ ................ -16,528 ................
Nurse anesthetists........................................ 2,868 ................ ................ -2,868 ................
Consolidated Nursing Workforce Develop.................... ................ 50,598 ................ ................ -50,598
-----------------------------------------------------------------------------------------
Subtotal................................................ 50,581 50,598 ................ -50,581 -50,598
Special projects.............................................. 10,965 10,968 ................ -10,965 -10,968
Nurse disadvantaged assistance................................ 4,009 4,010 ................ -4,009 -4,010
Consolidated health professions............................... ................ ................ 226,916 +226,916 +226,916
-----------------------------------------------------------------------------------------
Subtotal, Health professions............................ 301,916 251,694 226,916 -75,000 -24,778
Other HRSA Programs:
Hansen's Disease Services................................. 21,663 17,282 17,282 -4,381 ................
Maternal and Child Health Block Grant..................... 694,777 695,000 695,000 +223 ................
Healthy Start............................................. 104,967 105,000 110,000 +5,033 +5,000
Universal Newborn Hearing................................. ................ 4,000 4,000 +4,000 ................
Organ Transplantation..................................... 9,997 10,000 10,000 +3 ................
Health Teaching Facilities Interest Subsidies............. 150 150 150 ................ ................
Bone Marrow Program....................................... 17,994 18,000 18,000 +6 ................
Rural outreach grants..................................... 31,384 31,396 31,396 +12 ................
Critical care programs:
Emergency medical services for children............... 14,995 15,000 17,000 +2,005 +2,000
Traumatic brain injury program........................ 5,000 5,000 5,000 ................ ................
Trauma care........................................... ................ 1,000 1,000 +1,000 ................
Poison control........................................ ................ 1,500 3,000 +3,000 +1,500
-----------------------------------------------------------------------------------------
Subtotal............................................ 19,995 22,500 26,000 +6,005 +3,500
Black lung clinics........................................ 4,998 5,000 6,000 +1,002 +1,000
Nursing loan repayment.................................... 2,278 2,279 2,279 +1 ................
Payment to Hawaii, treatment of Hansen's.................. 2,044 2,045 2,045 +1 ................
=========================================================================================
Subtotal, Other HRSA programs........................... 910,247 912,652 922,152 +11,905 +9,500
Ryan White AIDS Programs:
Emergency Assistance...................................... 505,039 521,200 541,200 +36,161 +20,000
Comprehensive Care Programs............................... 737,765 783,000 843,000 +105,235 +60,000
AIDS Drug Assistance Program (ADAP) (NA).............. (461,000) (496,000) (536,000) (+75,000) (+40,000)
Early Intervention Program................................ 94,270 130,300 140,300 +46,030 +10,000
Pediatric Demonstrations.................................. 45,985 48,000 53,000 +7,015 +5,000
AIDS Dental Services...................................... 7,798 8,000 9,000 +1,202 +1,000
Education and Training Centers............................ 19,994 20,000 24,000 +4,006 +4,000
-----------------------------------------------------------------------------------------
Subtotal, Ryan White AIDS programs...................... 1,410,851 1,510,500 1,610,500 +199,649 +100,000
Ricky Ray Hemophilia program.................................. ................ ................ 50,000 +50,000 +50,000
Family Planning............................................... 214,932 239,952 222,432 +7,500 -17,520
Rural Health Research......................................... 6,081 6,085 6,085 +4 ................
Health Care and Other Facilities.............................. 65,324 ................ 10,000 -55,324 +10,000
Buildings and Facilities...................................... 250 250 250 ................ ................
Rural Hospital Flexibility Grants............................. 24,992 25,000 25,000 +8 ................
National Practitioner Data Bank............................... 12,000 16,000 16,000 +4,000 ................
User Fees................................................. -12,000 -16,000 -16,000 -4,000 ................
Office for the Advancement of Telehealth...................... 13,124 13,124 20,000 +6,876 +6,876
Program Management............................................ 128,962 121,663 133,000 +4,038 +11,337
-----------------------------------------------------------------------------------------
Total, Health resources and services.................... 4,116,758 4,141,083 4,365,498 +248,740 +224,415
MEDICAL FACILITIES GUARANTEE AND LOAN FUND: Interest subsidy 1,000 1,000 1,000 ................ ................
program......................................................
HEALTH EDUCATION ASSISTANCE LOANS PROGRAM (HEAL):
Liquidating account....................................... (37,000) (31,500) (31,500) (-5,500) ................
Program management........................................ 3,687 3,688 3,688 +1 ................
VACCINE INJURY COMPENSATION PROGRAM TRUST FUND:
Post-fiscal year 1988 claims.............................. 60,000 60,000 60,000 ................ ................
HRSA administration....................................... 3,000 3,000 3,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Vaccine injury compensation trust fund........ 63,000 63,000 63,000 ................ ................
VACCINE INJURY COMPENSATION: Pre-fiscal year 1989 claims 100,000 ................ ................ -100,000 ................
(appropriation)..........................................
-----------------------------------------------------------------------------------------
Total, Vaccine inquiry.................................. 163,000 63,000 63,000 -100,000 ................
=========================================================================================
Total, Health Resources and Services Administration..... 4,284,445 4,208,771 4,433,186 +148,741 +224,415
CENTERS FOR DISEASE CONTROL AND PREVENTION
DISEASE CONTROL, RESEARCH AND TRAINING
Preventive Health Services Block Grant:
Program................................................... 147,753 115,914 115,914 -31,839 ................
Salaries and Expenses..................................... 2,247 4,086 2,247 ................ -1,839
-----------------------------------------------------------------------------------------
Subtotal, Preventive Health Services Block Grant........ 150,000 120,000 118,161 -31,839 -1,839
Prevention Centers:
Program................................................... 13,000 13,000 15,000 +2,000 +2,000
Salaries and Expenses..................................... 500 500 500 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Prevention Centers............................ 13,500 13,500 15,500 +2,000 +2,000
CDC/HCFA vaccine program:
Childhood immunization:
Program............................................... 400,568 463,364 463,364 +62,796 ................
Salaries and Expenses................................. 48,909 62,803 48,909 ................ -13,894
-----------------------------------------------------------------------------------------
Subtotal, Childhood immunization \6\................ 449,477 526,167 512,273 +62,796 -13,894
HCFA vaccine purchase (NA)................................ 566,278 545,043 545,043 -21,235 ................
-----------------------------------------------------------------------------------------
Subtotal, CDC/HCFA vaccine program level................ 1,015,755 1,071,210 1,057,316 +41,561 -13,894
Communicable Diseases:
AIDS:
Program............................................... 534,964 540,240 540,240 +5,276 ................
Salaries and Expenses................................. 122,036 126,156 122,036 ................ -4,120
-----------------------------------------------------------------------------------------
Subtotal, HIV/AIDS.................................. 657,000 666,396 662,276 +5,276 -4,120
Tuberculosis:
Program............................................... 114,777 112,147 120,000 +5,223 +7,853
Salaries and Expenses................................. 5,185 7,815 5,185 ................ -2,630
-----------------------------------------------------------------------------------------
Subtotal, Tuberculosis.............................. 119,962 119,962 125,185 +5,223 +5,223
Sexually Transmitted Diseases:
Program............................................... 110,656 115,711 115,711 +5,055 ................
Salaries and Expenses................................. 13,097 14,938 13,097 ................ -1,841
-----------------------------------------------------------------------------------------
Subtotal, Sexually Transmitted Diseases............. 123,753 130,649 128,808 +5,055 -1,841
Chronic Diseases:
Chronic and Environmental Disease Prevention:
Program............................................... 241,378 250,364 260,364 +18,986 +10,000
Salaries and Expenses................................. 58,011 75,579 58,011 ................ -17,568
-----------------------------------------------------------------------------------------
Subtotal, Chronic and Environ'l Disease \7\......... 299,389 325,943 318,375 +18,986 -7,568
Breast and Cervical Cancer Screening:
Program............................................... 149,091 147,071 157,071 +7,980 +10,000
Salaries and Expenses................................. 9,980 12,000 9,980 ................ -2,020
-----------------------------------------------------------------------------------------
Subtotal, Breast and Cervical Cancer Screening...... 159,071 159,071 167,051 +7,980 +7,980
Infectious Diseases:
Program................................................... 70,300 98,274 98,274 +27,974 ................
Salaries and Expenses..................................... 67,336 83,652 67,336 ................ -16,316
-----------------------------------------------------------------------------------------
Subtotal, Infectious diseases........................... 137,636 181,926 165,610 +27,974 -16,316
Lead Poisoning Prevention:
Program................................................... 31,457 30,457 30,457 -1,000 ................
Salaries and Expenses..................................... 6,748 7,748 6,748 ................ -1,000
-----------------------------------------------------------------------------------------
Subtotal, Lead Poisoning Prevention..................... 38,205 38,205 37,205 -1,000 -1,000
Injury Control:
Program................................................... 38,756 49,494 63,994 +25,238 +14,500
Salaries and Expenses..................................... 18,825 21,004 18,825 ................ -2,179
-----------------------------------------------------------------------------------------
Subtotal, Injury Control................................ 57,581 70,498 82,819 +25,238 +12,321
Occupational Safety and Health (NIOSH): \8\
Program................................................... 78,744 87,415 93,744 +15,000 +6,329
Salaries and Expenses..................................... 121,256 124,434 121,256 ................ -3,178
-----------------------------------------------------------------------------------------
Subtotal, Occupational Safety and Health................ 200,000 211,849 215,000 +15,000 +3,151
Epidemic Services:
Program................................................... 30,432 25,865 25,865 -4,567 ................
Salaries and Expenses..................................... 55,484 59,183 55,484 ................ -3,699
-----------------------------------------------------------------------------------------
Subtotal, Epidemic Services............................. 85,916 85,048 81,349 -4,567 -3,699
Office of the Director:
Budget Authority.......................................... 30,440 30,322 32,322 +1,882 +2,000
1 percent Set Aside....................................... (696) ................ ................ (-696) ................
-----------------------------------------------------------------------------------------
Office of the Director, program level................... (31,136) (30,322) (32,322) (+1,186) (+2,000)
National Center for Health Statistics:
Program Operations: Budget Authority...................... 9,522 ................ ................ -9,522 ................
Salaries and expenses:
Budget Authority...................................... 17,249 ................ ................ -17,249 ................
1 percent evaluation funds (NA)....................... (67,793) (109,573) (109,573) (+41,780) ................
-----------------------------------------------------------------------------------------
Subtotal, Health Statistics program level........... (94,564) (109,573) (109,573) (+15,009) ................
Buildings and Facilities...................................... 17,800 39,800 39,800 +22,000 ................
Prevention research:
Program................................................... 11,995 12,000 12,000 +5 ................
Salaries and Expenses..................................... 3,000 3,000 3,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Prevention research........................... 14,995 15,000 15,000 +5 ................
Health disparities demonstration:
Program................................................... 9,397 31,697 31,697 +22,300 ................
Salaries and Expenses..................................... 600 3,303 3,303 +2,703 ................
-----------------------------------------------------------------------------------------
Subtotal, Health disparities demonstration.............. 9,997 35,000 35,000 +25,003 ................
Bioterrorism Emergency........................................ 123,600 ................ ................ -123,600 ................
Reimbursement to Calvin County, MI (hep A outbreak)........... 322 ................ ................ -322 ................
Year 2000 Computer Conversion (Emergency Funding)............. 4,900 ................ ................ -4,900 ................
Undistributed................................................. ................ 104 104 +104 ................
=========================================================================================
Subtotal, Centers for Disease Control................... 2,720,315 2,769,440 2,751,838 +31,523 -17,602
Crime Bill Activities:
Crime Trust Fund:
Rape Prevention and Education......................... 44,986 45,000 45,000 +14 ................
Domestic Violence Community Demonstrations............ 5,998 6,000 6,000 +2 ................
-----------------------------------------------------------------------------------------
Subtotal, Crime bill activities..................... 50,984 51,000 51,000 +16 ................
=========================================================================================
Total, Disease Control.............................. 2,771,299 2,820,440 2,802,838 +31,539 -17,602
NATIONAL INSTITUTES OF HEALTH
National Cancer Institute..................................... 2,902,375 2,732,795 3,286,859 +384,484 +554,064
AIDS (NA)................................................. ................ (240,124) ................ ................ (-240,124)
-----------------------------------------------------------------------------------------
Subtotal, NCI........................................... (2,902,375) (2,972,919) (3,286,859) (+384,484) (+313,940)
National Heart, Lung, and Blood Institute..................... 1,782,577 1,759,806 2,001,185 +218,608 +241,379
AIDS (NA)................................................. ................ (66,043) ................ ................ (-66,043)
-----------------------------------------------------------------------------------------
Subtotal, NHLBI......................................... (1,782,577) (1,825,849) (2,001,185) (+218,608) (+175,336)
National Institute of Dental and Craniofacial Research........ 238,318 225,709 267,543 +29,225 +41,834
AIDS (NA)................................................. ................ (18,397) ................ ................ (-18,397)
-----------------------------------------------------------------------------------------
Subtotal, NIDR.......................................... (238,318) (244,106) (267,543) (+29,225) (+23,437)
National Institute of Diabetes and Digestive and Kidney 996,848 1,002,747 1,130,056 +133,208 +127,309
Diseases.....................................................
AIDS (NA)................................................. ................ (18,322) ................ ................ (-18,322)
-----------------------------------------------------------------------------------------
Subtotal, NIDDK......................................... (996,848) (1,021,069) (1,130,056) (+133,208) (+108,987)
National Institute of Neurological Disorders and Stroke....... 899,119 890,816 1,019,271 +120,152 +128,455
AIDS (NA)................................................. ................ (30,154) ................ ................ (-30,154)
-----------------------------------------------------------------------------------------
Subtotal, NINDS......................................... (899,119) (920,970) (1,019,271) (+120,152) (+98,301)
National Institute of Allergy and Infectious Diseases......... 1,576,104 789,156 1,786,718 +210,614 +997,562
AIDS (NA)................................................. ................ (825,294) ................ ................ (-825,294)
-----------------------------------------------------------------------------------------
Subtotal, NIAID......................................... (1,576,104) (1,614,450) (1,786,718) (+210,614) (+172,268)
National Institute of General Medical Sciences................ 1,197,597 1,194,068 1,352,843 +155,246 +158,775
AIDS (NA)................................................. ................ (32,630) ................ ................ (-32,630)
-----------------------------------------------------------------------------------------
Subtotal, NIGMS......................................... (1,197,597) (1,226,698) (1,352,843) (+155,246) (+126,145)
National Institute of Child Health and Human Development...... 753,406 694,114 848,044 +94,638 +153,930
AIDS (NA)................................................. ................ (77,599) ................ ................ (-77,599)
-----------------------------------------------------------------------------------------
Subtotal, NICHD......................................... (753,406) (771,713) (848,044) (+94,638) (+76,331)
National Eye Institute........................................ 396,896 395,935 445,172 +48,276 +49,237
AIDS (NA)................................................. ................ (10,604) ................ ................ (-10,604)
-----------------------------------------------------------------------------------------
Subtotal, NEI........................................... (396,896) (406,539) (445,172) (+48,276) (+38,633)
National Institute of Environmental Health Sciences........... 388,477 390,718 436,113 +47,636 +45,395
AIDS (NA)................................................. ................ (7,194) ................ ................ (-7,194)
-----------------------------------------------------------------------------------------
Subtotal, NIEHS......................................... (388,477) (397,912) (436,113) (+47,636) (+38,201)
National Institute on Aging................................... 600,136 612,599 680,332 +80,196 +67,733
AIDS (NA)................................................. ................ (2,118) ................ ................ (-2,118)
-----------------------------------------------------------------------------------------
Subtotal, NIA........................................... (600,136) (614,717) (680,332) (+80,196) (+65,615)
National Institute of Arthritis and Musculoskeletal and Skin 307,284 309,953 350,429 +43,145 +40,476
Diseases.....................................................
AIDS (NA)................................................. ................ (4,797) ................ ................ (-4,797)
-----------------------------------------------------------------------------------------
Subtotal, NIAMS......................................... (307,284) (314,750) (350,429) (+43,145) (+35,679)
National Institute on Deafness and Other Communication 231,547 235,297 261,962 +30,415 +26,665
Disorders....................................................
AIDS (NA)................................................. ................ (1,874) ................ ................ (-1,874)
-----------------------------------------------------------------------------------------
Subtotal, NIDCD......................................... (231,547) (237,171) (261,962) (+30,415) (+24,791)
National Institute of Nursing Research........................ 70,031 65,335 90,000 +19,969 +24,665
AIDS (NA)................................................. ................ (6,395) ................ ................ (-6,395)
-----------------------------------------------------------------------------------------
Subtotal, NINR.......................................... (70,031) (71,730) (90,000) (+19,969) (+18,270)
National Institute on Alcohol Abuse and Alcoholism............ 259,202 248,916 291,247 +32,045 +42,331
AIDS (NA)................................................. ................ (16,581) ................ ................ (-16,581)
-----------------------------------------------------------------------------------------
Subtotal, NIAAA......................................... (259,202) (265,497) (291,247) (+32,045) (+25,750)
National Institute on Drug Abuse.............................. 607,979 429,246 682,536 +74,557 +253,290
AIDS (NA)................................................. ................ (193,505) ................ ................ (-193,505)
-----------------------------------------------------------------------------------------
Subtotal, NIDA.......................................... (607,979) (622,751) (682,536) (+74,557) (+59,785)
National Institute of Mental Health........................... 855,210 758,892 969,494 +114,284 +210,602
AIDS (NA)................................................. ................ (117,101) ................ ................ (-117,101)
-----------------------------------------------------------------------------------------
Subtotal, NIMH.......................................... (855,210) (875,993) (969,494) (+114,284) (+93,501)
National Human Genome Research Institute...................... 269,086 271,536 337,322 +68,236 +65,786
AIDS (NA)................................................. ................ (4,086) ................ ................ (-4,086)
-----------------------------------------------------------------------------------------
Subtotal, NHGRI......................................... (269,086) (275,622) (337,322) (+68,236) (+61,700)
National Center for Research Resources........................ 554,643 469,684 625,988 +71,345 +156,304
Fiscal year 2001 advance.................................. ................ ................ 30,000 +30,000 +30,000
-----------------------------------------------------------------------------------------
Subtotal, program level................................. 554,643 469,684 655,988 +101,345 +186,304
AIDS (NA)................................................. ................ (98,435) ................ ................ (-98,435)
-----------------------------------------------------------------------------------------
Subtotal, NCRR.......................................... (554,643) (568,119) (655,988) (+101,345) (+87,869)
National Center for Complementary and Alternative Medicine.... 50,000 50,168 56,214 +6,214 +6,046
John E. Fogarty International Center.......................... 35,415 23,498 43,723 +8,308 +20,225
AIDS (NA)................................................. ................ (12,776) ................ ................ (-12,776)
-----------------------------------------------------------------------------------------
Subtotal, FIC........................................... (35,415) (36,274) (43,723) (+8,308) (+7,449)
National Library of Medicine.................................. 181,309 181,443 210,183 +28,874 +28,740
AIDS (NA)................................................. ................ (4,211) ................ ................ (-4,211)
-----------------------------------------------------------------------------------------
Subtotal, NLM........................................... (181,309) (185,654) (210,183) (+28,874) (+24,529)
Office of the Director........................................ 256,462 218,153 299,504 +43,042 +81,351
AIDS (NA)................................................. ................ (44,556) ................ ................ (-44,556)
-----------------------------------------------------------------------------------------
Subtotal, OD............................................ (256,462) (262,709) (299,504) (+43,042) (+36,795)
Buildings and facilities:
Current year.............................................. 197,456 108,376 100,732 -96,724 -7,644
Advance for subsequent year............................... 40,000 ................ ................ -40,000 ................
Advance from prior year................................... ................ (40,000) (40,000) (+40,000) ................
Office of AIDS Research....................................... ................ 1,833,826 ................ ................ -1,833,826
Year 2000 Computer Conversion (Emergency Funding)............. 5,993 ................ ................ -5,993 ................
Undistributed................................................. ................ ................ ................ ................ ................
=========================================================================================
Total N.I.H.:
Current Year....................................... 15,613,470 15,892,786 17,573,470 +1,960,000 +1,680,684
Advance from prior year............................. ................ 40,000 40,000 +40,000 ................
-----------------------------------------------------------------------------------------
Total N.I.H. funding available.................... 15,613,470 15,932,786 17,613,470 +2,000,000 +1,680,684
SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION
Mental Health:
Knowledge development and application..................... 97,932 97,964 137,932 +40,000 +39,968
Mental Health Performance Partnership..................... 288,723 358,816 310,000 +21,277 -48,816
Children's Mental Health.................................. 77,974 78,000 78,000 +26 ................
Grants to States for the Homeless (PATH).................. 25,991 31,000 31,000 +5,009 ................
Protection and Advocacy................................... 22,949 22,957 25,000 +2,051 +2,043
-----------------------------------------------------------------------------------------
Subtotal, mental health................................. 513,569 588,737 581,932 +68,363 -6,805
Substance Abuse Treatment:
Knowledge Development and Application..................... 116,636 116,636 116,636 ................ ................
Targeted capacity expansion............................... 55,174 110,232 110,232 +55,058 ................
Substance Abuse Performance Partnership................... 1,584,492 1,615,000 1,615,000 +30,508 ................
Subs. Abuse Partnership Fiscal year 2001 advance...... ................ 100,000 100,000 +100,000 ................
-----------------------------------------------------------------------------------------
Subtotal, Sub Abuse Treatment, current year......... 1,756,302 1,841,868 1,841,868 +85,566 ................
Subtotal, Sub Abuse Treatment, program level........ 1,756,302 1,941,868 1,941,868 +185,566 ................
Substance Abuse Prevention:
Knowledge Development and Application..................... 78,717 52,717 82,717 +4,000 +30,000
Targeted capacity expansion............................... 78,230 78,283 78,283 +53 ................
High Risk Youth Grants.................................... 6,997 7,000 7,000 +3 ................
-----------------------------------------------------------------------------------------
Subtotal, Substance abuse prevention.................... 163,944 138,000 168,000 +4,056 +30,000
Program Management and Buildings and Facilities............... 53,498 57,900 58,900 +5,402 +1,000
=========================================================================================
Total, Substance Abuse and Mental Health................ 2,487,313 2,726,505 2,750,700 +263,387 +24,195
Current Year........................................ (2,487,313) (2,626,505) (2,650,700) (+163,387) (+24,195)
Advance Year........................................ ................ (100,000) (100,000) (+100,000) ................
RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS
Retirement payments........................................... 159,251 172,045 172,045 +12,794 ................
Survivors benefits............................................ 11,531 11,906 11,906 +375 ................
Dependents' medical care...................................... 28,541 29,626 29,626 +1,085 ................
Military services credits..................................... 2,312 1,328 1,328 -984 ................
-----------------------------------------------------------------------------------------
Total, Retirement pay and medical benefits.............. 201,635 214,905 214,905 +13,270 ................
AGENCY FOR HEALTH CARE POLICY AND RESEARCH
Research on Health Care Systems Cost and Access:
Federal Funds............................................. 98,035 24,326 17,163 -80,872 -7,163
1 percent evaluation funding (NA)......................... (42,847) (143,588) (155,751) (+112,904) (+12,163)
-----------------------------------------------------------------------------------------
Subtotal................................................ (140,882) (167,914) (172,914) (+32,032) (+5,000)
Health insurance and expenditure surveys: 1 percent evaluation (27,800) (36,000) (36,000) (+8,200) ................
funding (NA).................................................
Program Support............................................... 4,136 2,341 2,341 -1,795 ................
=========================================================================================
Total, AHCPR............................................ (172,818) (206,255) (211,255) (+38,437) (+5,000)
Federal Funds....................................... 102,171 26,667 19,504 -82,667 -7,163
1 percent evaluation funding (non-add).............. (70,647) (179,588) (191,751) (+121,104) (+12,163)
=========================================================================================
Total, Public Health Service............................ 25,500,333 25,890,074 27,824,603 +2,324,270 +1,934,529
Current Year........................................ (25,460,333) (25,790,074) (27,694,603) (+2,234,270) (+1,904,529)
Advance Year........................................ (40,000) (100,000) (130,000) (+90,000) (+30,000)
HEALTH CARE FINANCING ADMINISTRATION
GRANTS TO STATES FOR MEDICAID
Medicaid current law benefits................................. 102,265,000 108,257,500 108,257,500 +5,992,500 ................
State and local administration................................ 5,740,376 6,018,455 6,018,455 +278,079 ................
Vaccines for Children......................................... 528,240 545,043 545,043 +16,803 ................
-----------------------------------------------------------------------------------------
Subtotal, Medicaid program level, current year.. 114,820,998 114,820,998 +6,287,382 ................
108,533,616............................................
Carryover balance................................... -6,012,383 ................ ................ +6,012,383 ................
Less funds advanced in prior year................... -27,800,689 -28,733,605 -28,733,605 -932,916 ................
=========================================================================================
Total, request, current year............................ 74,720,544 86,087,393 86,087,393 +11,366,849 ................
New advance 1st quarter, fiscal year 2001........... 28,733,605 30,589,003 30,589,003 +1,855,398 ................
=========================================================================================
PAYMENTS TO HEALTH CARE TRUST FUNDS
Supplemental medical insurance................................ 61,879,000 68,690,000 68,690,000 +6,811,000 ................
Hospital insurance for the uninsured.......................... 555,000 349,000 349,000 -206,000 ................
Federal uninsured payment..................................... 97,000 121,000 121,000 +24,000 ................
Program management............................................ 292,000 129,100 129,100 -162,900 ................
-----------------------------------------------------------------------------------------
Total, Payments to Trust Funds, current law............. 62,823,000 69,289,100 69,289,100 +6,466,100 ................
PROGRAM MANAGEMENT
Research, demonstration, and evaluation:
Regular Program........................................... 50,000 55,000 65,000 +15,000 +10,000
Medicare Contractors.......................................... 1,265,081 1,367,053 1,244,000 -21,081 -123,053
User Fee legislative proposal............................. ................ -92,750 ................ ................ +92,750
H.R. 3103 funding (NA).................................... (560,000) (630,000) (630,000) (+70,000) ................
-----------------------------------------------------------------------------------------
Subtotal, Medicare Contractors limit'n on new BA........ 1,265,081 1,274,303 1,244,000 -21,081 -30,303
Subtotal, Contractors program level..................... (1,825,081) (1,904,303) (1,874,000) (+48,919) (-30,303)
State Survey and Certification................................ 175,000 269,347 204,347 +29,347 -65,000
User fee legislative proposal................................. ................ -65,000 ................ ................ +65,000
Federal Administration:
Year 2000 Computer Conversion (Emergency Funding)......... (196,954) ................ ................ (-196,954) ................
Federal Administration.................................... 457,784 521,203 480,000 +22,216 -41,203
User Fees................................................. -1,984 -2,026 -2,026 -42 ................
User fee legislative proposal............................. ................ -36,700 ................ ................ +36,700
-----------------------------------------------------------------------------------------
Subtotal, Federal Administration........................ 652,754 482,477 477,974 -174,780 -4,503
=========================================================================================
Total, Program management............................... 2,142,835 2,016,127 1,991,321 -151,514 -24,806
Total, Program Management program level................. (2,702,835) (2,646,127) (2,621,321) (-81,514) (-24,806)
=========================================================================================
Medicare Trust Fund Activity:
Hospital Insurance TF (1)................................. (-6,800,000) ................ ................ (+6,800,000) ................
Supplemental Medical Ins. TF (2).......................... (-300,000) ................ ................ (+300,000) ................
=========================================================================================
Total, Health Care Financing Administration............. 168,419,984 187,981,623 187,956,817 +19,536,833 -24,806
Federal funds....................................... 166,277,149 185,965,496 185,965,496 +19,688,347 ................
Current year.................................... (137,543,544) (155,376,493) (155,376,493) (+17,832,949) ................
New advance, 1st quarter, fiscal year 2001...... (28,733,605) (30,589,003) (30,589,003) (+1,855,398) ................
Trust funds......................................... 2,142,835 2,016,127 1,991,321 -151,514 -24,806
=========================================================================================
ADMINISTRATION FOR CHILDREN AND FAMILIES
PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY
SUPPORT PROGRAMS
Aid to Families with Dependent Children (AFDC)................ 35,000 ................ ................ -35,000 ................
Quality control liabilities................................... -25,000 ................ ................ +25,000 ................
Payments to territories....................................... 38,000 38,000 38,000 ................ ................
Emergency assistance.......................................... 65,000 ................ ................ -65,000 ................
Repatriation.................................................. 1,000 1,000 1,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Welfare payments.............................. 114,000 39,000 39,000 -75,000 ................
Child Support Enforcement:
State and local administration............................ 2,572,800 2,823,000 2,823,000 +250,200 ................
Federal incentive payments................................ 385,000 354,000 354,000 -31,000 ................
Hold Harmless payments.................................... 41,000 65,000 65,000 +24,000 ................
Access and visitation..................................... 10,000 10,000 10,000 ................ ................
Repeal of hold harmless payments \11\..................... ................ -65,000 ................ ................ +65,000
Change match rate for paternity testing \11\.............. ................ -9,200 ................ ................ +9,200
-----------------------------------------------------------------------------------------
Subtotal, Welfare payments.............................. 3,008,800 3,177,800 3,252,000 +243,200 +74,200
=========================================================================================
Total, Payments, current year program level............. 3,122,800 3,216,800 3,291,000 +168,200 +74,200
Less funds advanced in previous years............... -660,000 -750,000 -750,000 -90,000 ................
-----------------------------------------------------------------------------------------
Total, payments, current request........................ 2,462,800 2,466,800 2,541,000 +78,200 +74,200
New advance, 1st quarter, fiscal year 2001.......... 750,000 650,000 650,000 -100,000 ................
=========================================================================================
LOW INCOME HOME ENERGY ASSISTANCE PROGRAM
Advance from prior year (NA).................................. (1,100,000) (1,100,000) (1,100,000) ................ ................
New Emergency Allocation (NA)................................. (300,000) (300,000) (300,000) ................ ................
Advance funding fiscal year 2001.............................. 1,100,000 1,100,000 1,100,000 ................ ................
REFUGEE AND ENTRANT ASSISTANCE
Transitional and Medical Services............................. 220,628 220,698 220,698 +70 ................
Social Services............................................... 139,946 147,990 147,990 +8,044 ................
Preventive Health............................................. 4,833 4,835 4,835 +2 ................
Targeted Assistance........................................... 49,461 49,477 49,477 +16 ................
Victims of Torture............................................ ................ 7,500 7,500 +7,500 ................
Contingent emergency appropriation............................ 100,000 ................ ................ -100,000 ................
-----------------------------------------------------------------------------------------
Total, Refugee and entrant assistance (BA).............. 514,868 430,500 430,500 -84,368 ................
CHILD CARE AND DEVELOPMENT BLOCK GRANT:
Advance funding from prior year (NA)...................... (1,000,000) (1,182,672) (1,182,672) (+182,672) ................
Advance funding fiscal year 2001.......................... 1,182,672 1,182,672 1,182,672 ................ ................
SOCIAL SERVICES BLOCK GRANT (Title XX)........................ 1,909,000 2,380,000 1,050,000 -859,000 -1,330,000
CHILDREN AND FAMILIES SERVICES PROGRAMS
Programs for Children, Youth, and Families:
Head Start................................................ 4,658,517 5,267,000 3,367,000 -1,291,517 -1,900,000
Fiscal year 2001 appropriation........................ ................ ................ (1,900,000) (+1,900,000) (+1,900,000)
-----------------------------------------------------------------------------------------
Subtotal, Head Start................................ 4,658,517 5,267,000 5,267,000 +608,483 ................
Runaway and Homeless Youth................................ 43,639 43,653 43,653 +14 ................
Runaway Youth--Transitional Living........................ 14,944 19,949 19,949 +5,005 ................
-----------------------------------------------------------------------------------------
Subtotal, runaway....................................... 58,583 63,602 63,602 +5,019 ................
Child Abuse State Grants.................................. 21,019 21,026 21,026 +7 ................
Child Abuse Discretionary Activities...................... 14,149 14,154 22,154 +8,005 +8,000
Abandoned Infants Assistance.............................. 12,247 12,251 12,251 +4 ................
Child Welfare Services.................................... 291,896 291,989 291,989 +93 ................
Child Welfare Training.................................... 6,998 7,000 7,000 +2 ................
Adoption Opportunities.................................... 24,992 27,363 26,000 +1,008 -1,363
Adoption Incentive........................................ 19,994 20,000 20,000 +6 ................
Battered Women's shelters................................. ................ ................ 13,500 +13,500 +13,500
Social Services and Income Maintenance Research............... 36,988 26,000 36,991 +3 +10,991
Community Based Resource Centers.............................. 32,825 32,835 32,835 +10 ................
Developmental disabilities program:
State Councils............................................ 64,782 64,803 66,803 +2,021 +2,000
Protection and Advocacy................................... 26,710 26,718 28,718 +2,008 +2,000
Developmental Disabilities Special Projects............... 10,247 10,250 11,250 +1,003 +1,000
Developmental Disabilities University Affiliated.......... 17,455 17,461 18,961 +1,506 +1,500
-----------------------------------------------------------------------------------------
Subtotal, Developmental disabilities.................... 119,194 119,232 125,732 +6,538 +6,500
Native American Programs...................................... 34,922 34,933 36,922 +2,000 +1,989
Community services:
Grants to States for Community Services................... 499,841 500,000 500,000 +159 ................
Community initiative program:
Economic Development.................................. 30,055 ................ 30,065 +10 +30,065
Rural Community Facilities............................ 3,499 ................ 3,500 +1 +3,500
-----------------------------------------------------------------------------------------
Subtotal, discretionary funds....................... 33,554 ................ 33,565 +11 +33,565
National Youth Sports..................................... 14,995 ................ 15,000 +5 +15,000
Community Food and Nutrition.............................. 4,999 ................ 6,500 +1,501 +6,500
-----------------------------------------------------------------------------------------
Subtotal, Community services............................ 553,389 500,000 555,065 +1,676 +55,065
Program Direction............................................. 144,454 150,568 150,568 +6,114 ................
Year 2000 Computer Conversion (Emergency Funding)............. 24,071 ................ ................ -24,071 ................
=========================================================================================
Total, Children and Families Services Programs.......... 6,054,238 6,587,953 6,682,635 +628,397 +94,682
Current Year........................................ (6,054,238) (6,587,953) (4,782,635) (-1,271,603) (-1,805,318)
Fiscal year 2001 appropriations..................... ................ ................ (1,900,000) (+1,900,000) (+1,900,000)
VIOLENT CRIME REDUCTION PROGRAMS:
Crime Trust Funds:
Runaway Youth Prevention.............................. 14,995 15,000 15,000 +5 ................
Domestic Violence Hotline............................. 1,200 1,200 1,200 ................ ................
Battered Women's Shelters............................. 88,772 102,300 88,800 +28 -13,500
-----------------------------------------------------------------------------------------
Total, Violent crime reduction programs............. 104,967 118,500 105,000 +33 -13,500
Rescission of permanent appropriations........................ -21,000 ................ ................ +21,000 ................
PROMOTING SAFE AND STABLE FAMILIES............................ 275,000 295,000 295,000 +20,000 ................
PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE
Foster Care................................................... 3,982,700 4,537,200 4,537,200 +554,500 ................
Adoption Assistance........................................... 868,800 1,020,100 1,020,100 +151,300 ................
Independent living............................................ 70,000 105,000 105,000 +35,000 ................
Independent living expansion.................................. ................ 5,000 5,000 +5,000 ................
-----------------------------------------------------------------------------------------
Total, Program level: Payments to States................ 4,921,500 5,667,300 5,667,300 +745,800 ................
Less Advances from Prior Year....................... -1,157,500 -1,355,000 -1,355,000 -197,500 ................
=========================================================================================
Total, request, current year............................ 3,764,000 4,312,300 4,312,300 +548,300 ................
New Advance, 1st quarter, fiscal year 2001.......... 1,355,000 1,538,000 1,538,000 +183,000 ................
=========================================================================================
Total, Administration for Children and Families......... 19,451,545 21,061,725 17,987,107 -1,464,438 -3,074,618
Current year........................................ (15,063,873) (16,591,053) (13,516,435) (-1,547,438) (-3,074,618)
Advance year........................................ (4,387,672) (4,470,672) (4,470,672) (+83,000) ................
=========================================================================================
ADMINISTRATION ON AGING
Grants to States:
Supportive Services and Centers........................... 300,192 310,082 310,082 +9,890 ................
Preventive Health......................................... 16,123 16,123 16,123 ................ ................
Title VII................................................. 12,181 12,181 13,181 +1,000 +1,000
Nutrition:
Congregate Meals...................................... 374,258 374,412 374,412 +154 ................
Home Delivered Meals.................................. 112,000 147,000 147,000 +35,000 ................
Frail Elderly In-Home Services................................ 9,763 ................ ................ -9,763 ................
Grants to Indians............................................. 18,457 18,457 18,457 ................ ................
Aging Research, Training and Special Projects................. 18,000 18,000 26,000 +8,000 +8,000
Alzheimer's Initiative........................................ 5,970 5,970 5,970 ................ ................
Program Administration........................................ 15,395 16,830 16,830 +1,435 ................
National Family Caregiver Support \12\........................ ................ 125,000 ................ ................ -125,000
Health Disparities Interventions.............................. ................ 4,000 ................ ................ -4,000
-----------------------------------------------------------------------------------------
Total, Administration on Aging.......................... 882,339 1,048,055 928,055 +45,716 -120,000
OFFICE OF THE SECRETARY
GENERAL DEPARTMENTAL MANAGEMENT:
Federal Funds............................................. 108,291 120,074 115,243 +6,952 -4,831
Trust Funds............................................... 5,851 6,851 6,517 +666 -334
1 percent Evaluation funds (ASPE) (NA).................... (20,552) (20,552) (20,552) ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ (134,694) (147,477) (142,312) (+7,618) (-5,165)
(Nursing Home initiative)................................. (1,000) (9,500) (9,500) (+8,500) ................
Year 2000 Computer Conversion (Emergency Funding)......... 2,419 ................ ................ -2,419 ................
Adolescent Family Life (Title XX)......................... 17,700 9,200 19,700 +2,000 +10,500
Physical Fitness and Sports............................... 1,005 1,097 1,097 +92 ................
Minority health........................................... 36,000 28,000 28,000 -8,000 ................
Office of women's health.................................. 15,495 17,522 15,495 ................ -2,027
Office of Emergency Preparedness.......................... 25,000 9,668 9,668 -15,332 ................
Minority AIDS Emergency Funding........................... 50,000 ................ ................ -50,000 ................
Health Care Access for the Uninsured...................... ................ 25,000 ................ ................ -25,000
U.S. Surgeon general violence initiative.................. ................ ................ 4,000 +4,000 +4,000
-----------------------------------------------------------------------------------------
Total, General Departmental Management.................. 261,761 217,412 199,720 -62,041 -17,692
Federal funds....................................... 255,910 210,561 193,203 -62,707 -17,358
Trust funds......................................... 5,851 6,851 6,517 +666 -334
OFFICE OF THE INSPECTOR GENERAL:
Federal Funds............................................. 34,391 31,500 35,000 +609 +3,500
HIPAA funding (NA)........................................ (100,000) (120,000) (120,000) (+20,000) ................
-----------------------------------------------------------------------------------------
Total, Inspector General program level.................. (134,391) (151,500) (155,000) (+20,609) (+3,500)
OFFICE FOR CIVIL RIGHTS:
Federal Funds............................................. 17,338 18,845 18,845 +1,507 ................
Trust Funds............................................... 3,314 3,314 3,314 ................ ................
-----------------------------------------------------------------------------------------
Total, Office for Civil Rights.......................... 20,652 22,159 22,159 +1,507 ................
Policy Research............................................... 13,996 14,000 15,000 +1,004 +1,000
Public Health and Social Service Fund:
Emergency fund............................................ (223,422) ................ ................ (-223,422) ................
Discretionary............................................. ................ 386,022 475,000 +475,000 +88,978
-----------------------------------------------------------------------------------------
Total................................................... (223,422) (386,022) (475,000) (+251,578) (+88,978)
=========================================================================================
Total, Office of the Secretary.......................... 330,800 671,093 746,879 +416,079 +75,786
Federal funds....................................... 321,635 660,928 737,048 +415,413 +76,120
Trust funds......................................... 9,165 10,165 9,831 +666 -334
=========================================================================================
Total, Department of Health and Human Services.......... 214,585,001 236,652,570 235,443,461 +20,858,460 -1,209,109
Federal Funds....................................... 212,433,001 234,626,278 233,442,309 +21,009,308 -1,183,969
Current year.................................... (179,271,724) (199,466,603) (198,252,634) (+18,980,910) (-1,213,969)
Advance year.................................... (33,161,277) (35,159,675) (35,189,675) (+2,028,398) (+30,000)
Trust funds......................................... 2,152,000 2,026,292 2,001,152 -150,848 -25,140
TITLE III--DEPARTMENT OF EDUCATION
EDUCATION REFORM
Goals 2000: Educate America Act:
State Grants forward funded............................... 459,500 459,500 114,875 -344,625 -344,625
Fiscal year 2001 advance.............................. ................ ................ 344,625 +344,625 +344,625
State Grants current funded............................... 1,500 1,500 1,500 ................ ................
Parental Assistance....................................... 30,000 30,000 33,000 +3,000 +3,000
-----------------------------------------------------------------------------------------
Subtotal, Goals 2000.................................... 491,000 491,000 494,000 +3,000 +3,000
School-to-Work Opportunities.................................. 125,000 55,000 55,000 -70,000 ................
Education Technology:
Technology Literacy Challenge Fund........................ 425,000 450,000 425,000 ................ -25,000
Technology Innovation Challenge Fund...................... 115,100 110,000 115,100 ................ +5,100
Regional Technology in Education Consortia................ 10,000 10,000 10,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal................................................ 550,100 570,000 550,100 ................ -19,900
National Activities:
Technology Leadership Activities...................... 2,000 2,000 2,000 ................ ................
Teacher Training in Technology........................ 75,000 75,000 75,000 ................ ................
Community-Based Technology Centers.................... 10,000 65,000 10,000 ................ -55,000
Middle School Teacher Training........................ ................ 30,000 ................ ................ -30,000
Software Development Initiative....................... ................ 5,000 ................ ................ -5,000
-----------------------------------------------------------------------------------------
Subtotal............................................ 87,000 177,000 87,000 ................ -90,000
Star Schools.......................................... 45,000 45,000 45,000 ................ ................
Ready to Learn Television............................. 11,000 7,000 16,000 +5,000 +9,000
Telcom Demo Project for Mathematics................... 5,000 2,000 8,500 +3,500 +6,500
-----------------------------------------------------------------------------------------
Subtotal, Education technology...................... 698,100 801,000 706,600 +8,500 -94,400
21st Century Community Learning Centers \13\.................. 200,000 600,000 400,000 +200,000 -200,000
=========================================================================================
Total, Education Reform................................. 1,514,100 1,947,000 1,655,600 +141,500 -291,400
Current Year........................................ (1,514,100) (1,947,000) (1,310,975) (-203,125) (-636,025)
Advance year........................................ ................ ................ (344,625) (+344,625) (+344,625)
EDUCATION FOR THE DISADVANTAGED
Grants to Local Education Agencies (LEAs):
Basic Grants:
Advance from prior year............................... (1,448,386) (5,046,366) (5,046,366) (+3,597,980) ................
Forward funded........................................ 1,524,134 1,844,134 1,844,134 +320,000 ................
Current funded........................................ 3,500 3,500 3,500 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Basic grants current year funding......... 1,527,634 1,847,634 1,847,634 +320,000 ................
-----------------------------------------------------------------------------------------
Subtotal, Basic grants total funds available........ (2,976,020) (6,894,000) (6,894,000) (+3,917,980) ................
Basic Grant Fiscal Year 2001 Advance...................... 5,046,366 4,292,366 5,046,366 ................ +754,000
-----------------------------------------------------------------------------------------
Subtotal, Basic grants, program level................... (6,574,000) (6,140,000) (6,894,000) (+320,000) (+754,000)
Concentration Grants--Advance from prior year............. ................ (1,102,020) (1,158,397) (+1,158,397) (+56,377)
Concentration Grants Fiscal Year 2001 Advance............. 1,158,397 1,100,000 1,158,397 ................ +58,397
Targeted Grants Fiscal Year 2001 Advance.................. ................ 756,020 ................ ................ -756,020
-----------------------------------------------------------------------------------------
Subtotal, Grants to LEAs................................ 7,732,397 7,996,020 8,052,397 +320,000 +56,377
Capital Expenses for Private School Children.................. 24,000 ................ 15,000 -9,000 +15,000
Even Start.................................................... 135,000 145,000 145,000 +10,000 ................
State agency programs:
Migrant................................................... 354,689 380,000 354,689 ................ -25,311
Neglected and Delinquent/High Risk Youth.................. 40,311 42,000 42,000 +1,689 ................
Evaluation.................................................... 7,500 8,900 8,900 +1,400 ................
Comprehensive School Reform Demonstration..................... 120,000 150,000 120,000 ................ -30,000
=========================================================================================
Total, ESEA............................................. 8,413,897 8,721,920 8,737,986 +324,089 +16,066
Migrant education:
High School Equivalency Program........................... 9,000 15,000 9,000 ................ -6,000
College Assistance Migrant Program........................ 4,000 7,000 4,000 ................ -3,000
-----------------------------------------------------------------------------------------
Subtotal, migrant education............................. 13,000 22,000 13,000 ................ -9,000
=========================================================================================
Total, Education for the disadvantaged.................. 8,426,897 8,743,920 8,750,986 +324,089 +7,066
Current year........................................ (2,222,134) (2,595,534) (2,546,223) (+324,089) (-49,311)
Advance year........................................ (6,204,763) (6,148,386) (6,204,763) ................ (+56,377)
Subtotal, forward funded................................ (2,198,134) (2,561,134) (2,520,823) (+322,689) (-40,311)
=========================================================================================
IMPACT AID
Basic Support Payments........................................ 704,000 684,000 725,000 +21,000 +41,000
Payments for Children with Disabilities....................... 50,000 40,000 50,000 ................ +10,000
Payments for Heavily Impacted Districts (Sec. f).............. 70,000 ................ 75,000 +5,000 +75,000
-----------------------------------------------------------------------------------------
Subtotal................................................ 824,000 724,000 850,000 +26,000 +126,000
Facilities Maintenance (Sec. 8008)............................ 5,000 5,000 5,000 ................ ................
Construction (Sec. 8007)...................................... 7,000 7,000 7,000 ................ ................
Payments for Federal Property (Sec. 8002)..................... 28,000 ................ 30,000 +2,000 +30,000
=========================================================================================
Total, Impact aid....................................... 864,000 736,000 892,000 +28,000 +156,000
SCHOOL IMPROVEMENT PROGRAMS
Eisenhower Professional Development........................... 335,000 335,000 335,000 ................ ................
Innovative Education (Education Block Grant).................. 375,000 ................ 375,000 ................ +375,000
Teacher Assistance Initiative............................. 1,200,000 1,400,000 300,000 -900,000 -1,100,000
Fiscal year 2001 advance.................................. ................ ................ 900,000 +900,000 +900,000
-----------------------------------------------------------------------------------------
Subtotal, program level................................. 1,200,000 1,400,000 1,200,000 ................ -200,000
Safe and drug-free schools:
State Grants.............................................. 441,000 439,000 111,250 -329,750 -327,750
Fiscal year 2001 advance.............................. ................ ................ 339,750 +339,750 +339,750
National Programs......................................... 90,000 90,000 100,000 +10,000 +10,000
Coordinator Initiative.................................... 35,000 50,000 60,000 +25,000 +10,000
Project SERV.............................................. ................ 12,000 ................ ................ -12,000
-----------------------------------------------------------------------------------------
Subtotal, Safe and drug-free schools.................... 125,000 152,000 160,000 +35,000 +8,000
-----------------------------------------------------------------------------------------
Subtotal, program level................................. 566,000 591,000 611,000 +45,000 +20,000
Inexpensive Book Distribution (RIF)........................... 18,000 18,000 21,500 +3,500 +3,500
Arts in Education............................................. 10,500 10,500 12,500 +2,000 +2,000
Other school improvement programs:
Magnet Schools Assistance................................. 104,000 114,000 112,000 +8,000 -2,000
Education for Homeless Children and Youth................. 28,800 31,700 28,800 ................ -2,900
Women's Educational Equity................................ 3,000 3,000 3,000 ................ ................
Training and Advisory Services (Civil Rights)............. 7,334 7,334 7,334 ................ ................
Ellender Fellowships/Close Up............................. 1,500 ................ 1,500 ................ +1,500
Education for Native Hawaiians............................ 20,000 20,000 23,000 +3,000 +3,000
Alaska Native Education Equity............................ 10,000 10,000 13,000 +3,000 +3,000
Charter Schools........................................... 100,000 130,000 100,000 ................ -30,000
-----------------------------------------------------------------------------------------
Subtotal, other school improvement programs............. 274,634 316,034 288,634 +14,000 -27,400
Comprehensive Regional Assistance Centers..................... 28,000 32,000 28,000 ................ -4,000
Advanced Placement Fees....................................... 4,000 20,000 15,000 +11,000 -5,000
=========================================================================================
Total, School improvement programs...................... 2,811,134 2,722,534 2,886,634 +75,500 +164,100
Current Year........................................ (2,811,134) (2,722,534) (1,646,884) (-1,164,250) (-1,075,650)
Advance year........................................ ................ ................ (1,239,750) (+1,239,750) (+1,239,750)
-----------------------------------------------------------------------------------------
Subtotal, forward funded................................ (2,381,300) (2,205,700) (1,151,550) (-1,229,750) (-1,054,150)
READING EXCELLENCE
Reading Excellence Act........................................ 260,000 286,000 65,000 -195,000 -221,000
Fiscal year 2001 advance.................................. ................ ................ 195,000 +195,000 +195,000
-----------------------------------------------------------------------------------------
Subtotal, program level................................. 260,000 286,000 260,000 ................ -26,000
=========================================================================================
INDIAN EDUCATION
Grants to Local Educational Agencies.......................... 62,000 62,000 62,000 ................ ................
Special Programs for Indian Children.......................... 3,265 13,265 13,265 +10,000 ................
National Activities........................................... 735 1,735 1,735 +1,000 ................
-----------------------------------------------------------------------------------------
Total, Indian Education................................. 66,000 77,000 77,000 +11,000 ................
BILINGUAL AND IMMIGRANT EDUCATION
Bilingual education:
Instructional Services.................................... 160,000 170,000 165,000 +5,000 -5,000
Support Services.......................................... 14,000 14,000 14,000 ................ ................
Professional Development.................................. 50,000 75,000 55,000 +5,000 -20,000
Immigrant Education........................................... 150,000 150,000 150,000 ................ ................
Foreign Language Assistance................................... 6,000 6,000 10,000 +4,000 +4,000
-----------------------------------------------------------------------------------------
Total, Bilingual and Immigrant Education................ 380,000 415,000 394,000 +14,000 -21,000
SPECIAL EDUCATION
State grants:
Grants to States Part B advance funded.................... ................ 1,925,000 2,201,059 +2,201,059 +276,059
Advance from prior year................................... (210,000) ................ ................ (-210,000) ................
Grants to States Part B current year...................... 4,100,700 2,389,000 2,788,626 -1,312,074 +399,626
Preschool Grants.......................................... 373,985 402,435 390,000 +16,015 -12,435
Grants for Infants and Families........................... 370,000 390,000 375,000 +5,000 -15,000
-----------------------------------------------------------------------------------------
Subtotal, State grants program level.................... (5,054,685) (5,106,435) (5,754,685) (+700,000) (+648,250)
IDEA National Programs (Public Law 105-17):
State Program Improvement Grants.......................... 35,200 45,200 35,200 ................ -10,000
Research and Innovation................................... 64,508 64,508 64,508 ................ ................
Technical Assistance and Dissemination.................... 44,556 44,556 44,556 ................ ................
Personnel Preparation..................................... 82,139 82,139 82,139 ................ ................
Parent Information Centers................................ 18,535 22,535 18,535 ................ -4,000
Technology and Media Services............................. 33,023 34,523 34,523 +1,500 ................
Public Telecom Info/Training Dissemination............ 1,500 ................ 1,500 ................ +1,500
Primary Education Intervention............................ ................ 50,000 ................ ................ -50,000
-----------------------------------------------------------------------------------------
Subtotal, IDEA special programs reauthorization......... 279,461 343,461 280,961 +1,500 -62,500
=========================================================================================
Total, Special education................................ 5,124,146 5,449,896 6,035,646 +911,500 +585,750
Current Year........................................ (5,124,146) (3,524,896) (3,834,587) (-1,289,559) (+309,691)
Advance year........................................ ................ (1,925,000) (2,201,059) (+2,201,059) (+276,059)
Subtotal, Forward funded................................ (4,879,885) (3,226,635) (3,588,826) (-1,291,059) (+362,191)
REHABILITATION SERVICES AND DISABILITY RESEARCH \14\
Vocational Rehabilitation State Grants........................ 2,304,411 2,338,977 2,338,977 +34,566 ................
Client Assistance State grants................................ 10,928 10,928 10,928 ................ ................
Training...................................................... 39,629 41,629 39,629 ................ -2,000
Demonstration and training programs........................... 18,942 16,942 18,942 ................ +2,000
Migrant and seasonal farmworkers.............................. 2,350 2,350 2,350 ................ ................
Recreational programs......................................... 2,596 2,596 2,596 ................ ................
Protection and advocacy of individual rights (PAIR)........... 10,894 10,894 10,894 ................ ................
Projects with industry........................................ 22,071 22,071 22,071 ................ ................
Supported employment State grants............................. 38,152 38,152 38,152 ................ ................
Independent living:
State grants.............................................. 22,296 22,296 22,296 ................ ................
Centers................................................... 46,109 50,886 48,000 +1,891 -2,886
Services for older blind individuals...................... 11,169 11,392 15,000 +3,831 +3,608
-----------------------------------------------------------------------------------------
Subtotal, Independent living............................ 79,574 84,574 85,296 +5,722 +722
Program Improvement........................................... 1,900 1,900 1,900 ................ ................
Evaluation.................................................... 1,587 1,587 1,587 ................ ................
Helen Keller National Center for Deaf-Blind Youths and Adults. 8,550 8,550 8,550 ................ ................
National Institute for Disability and Rehabilitation Research 81,000 90,964 81,000 ................ -9,964
(NIDRR)......................................................
Assistive Technology.......................................... 30,000 45,000 30,000 ................ -15,000
-----------------------------------------------------------------------------------------
Subtotal, discretionary programs........................ 348,173 378,137 353,895 +5,722 -24,242
=========================================================================================
Total, Rehabilitation services.......................... 2,652,584 2,717,114 2,692,872 +40,288 -24,242
SPECIAL INSTITUTIONS FOR PERSONS WITH DISABILITIES
AMERICAN PRINTING HOUSE FOR THE BLIND......................... 8,661 8,973 10,100 +1,439 +1,127
NATIONAL TECHNICAL INSTITUTE FOR THE DEAF..................... 45,500 ................ ................ -45,500 ................
Operations................................................ ................ 45,274 45,500 +45,500 +226
Construction.............................................. ................ 2,651 2,651 +2,651 ................
-----------------------------------------------------------------------------------------
Total................................................... 45,500 47,925 48,151 +2,651 +226
GALLAUDET UNIVERSITY.......................................... 83,480 ................ ................ -83,480 ................
Operations................................................ ................ 82,620 83,000 +83,000 +380
Construction.............................................. ................ 2,500 2,500 +2,500 ................
-----------------------------------------------------------------------------------------
Total................................................... 83,480 85,120 85,500 +2,020 +380
=========================================================================================
Total, Special Inst for Persons with Disabilities....... 137,641 142,018 143,751 +6,110 +1,733
VOCATIONAL AND ADULT EDUCATION
Vocational education:
Basic State Grants........................................ 1,030,650 1,030,650 1,030,650 ................ ................
Tech-Prep Education....................................... 106,000 111,000 106,000 ................ -5,000
Tribally Controlled Postsecondary Vocational Institutions. 4,100 4,100 4,600 +500 +500
National Programs......................................... 13,497 17,500 19,500 +6,003 +2,000
NOICC..................................................... 9,000 ................ 9,000 ................ +9,000
-----------------------------------------------------------------------------------------
Subtotal, Vocational education.......................... 1,163,247 1,163,250 1,169,750 +6,503 +6,500
Adult education:
State Grants.............................................. 365,000 468,000 468,000 +103,000 ................
National programs:
National Leadership Activities........................ 14,000 101,000 14,000 ................ -87,000
National Institute for Literacy....................... 6,000 6,000 6,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, National programs......................... 20,000 107,000 20,000 ................ -87,000
=========================================================================================
Subtotal, adult education........................... 385,000 575,000 488,000 +103,000 -87,000
State Grants for Incarcerated Youth Offenders................. 16,723 12,000 19,000 +2,277 +7,000
=========================================================================================
Total, Vocational and adult education................... 1,564,970 1,750,250 1,676,750 +111,780 -73,500
STUDENT FINANCIAL ASSISTANCE
Pell Grants--maximum grant (NA)............................... (3,125) (3,250) (3,325) (+200) (+75)
Pell Grants--Regular Program.................................. 7,704,000 7,463,000 6,601,600 -1,102,400 -861,400
Fiscal year 2001 advance.................................. ................ ................ 1,176,400 +1,176,400 +1,176,400
-----------------------------------------------------------------------------------------
Subtotal, program level................................. 7,704,000 7,463,000 7,778,000 +74,000 +315,000
Federal Supplemental Educational Opportunity Grants........... 619,000 631,000 631,000 +12,000 ................
Federal Work Study............................................ 870,000 934,000 934,000 +64,000 ................
Federal Perkins loans:
Capital Contributions..................................... 100,000 100,000 100,000 ................ ................
Loan Cancellations........................................ 30,000 30,000 30,000 ................ ................
-----------------------------------------------------------------------------------------
Subtotal, Federal Perkins loans......................... 130,000 130,000 130,000 ................ ................
LEAP program.................................................. 25,000 25,000 25,000 ................ ................
=========================================================================================
Total, Student financial assistance..................... 9,348,000 9,183,000 9,498,000 +150,000 +315,000
Current Year........................................ (9,348,000) (9,183,000) (8,321,600) (-1,026,400) (-861,400)
Advance year........................................ ................ ................ (1,176,400) (+1,176,400) (+1,176,400)
FEDERAL FAMILY EDUCATION LOAN PROGRAM
Federal Administration........................................ 47,276 48,000 48,000 +724 ................
Direct Loan Program Year 2000 Comp Conv (Emergency)........... 531 ................ ................ -531 ................
HIGHER EDUCATION
Aid for institutional development:
Strengthening Institutions................................ 60,250 61,575 60,250 ................ -1,325
Hispanic Serving Institutions............................. 28,000 42,250 42,250 +14,250 ................
Strengthening Historically Black Colleges (HBCUs)......... 136,000 148,750 141,500 +5,500 -7,250
Strengthening historically black graduate insts........... 30,000 32,000 31,000 +1,000 -1,000
Strengthening Alaska / Native Hawaiian Instit............. 3,000 3,000 5,000 +2,000 +2,000
Strengthening Tribal Colleges............................. 3,000 6,000 6,000 +3,000 ................
-----------------------------------------------------------------------------------------
Subtotal, Institutional development..................... 260,250 293,575 286,000 +25,750 -7,575
Program development:
Fund for the Improvement of Postsec. Ed. (FIPSE).......... 50,000 27,500 27,500 -22,500 ................
Minority Science and Engineering Improvement.............. 7,500 8,500 7,500 ................ -1,000
International educ and foreign language studies:
Domestic Programs..................................... 60,000 61,320 61,320 +1,320 ................
Overseas Programs..................................... 6,536 6,680 6,680 +144 ................
Institute for International Public Policy............. 1,000 1,022 1,022 +22 ................
-----------------------------------------------------------------------------------------
Subtotal, International education................... 67,536 69,022 69,022 +1,486 ................
Urban Community Service................................... 4,637 ................ ................ -4,637 ................
=========================================================================================
Subtotal, Program development........................... 129,673 105,022 104,022 -25,651 -1,000
Interest Subsidy Grants....................................... 13,000 12,000 12,000 -1,000 ................
Federal TRIO Programs......................................... 600,000 630,000 630,000 +30,000 ................
GEAR UP....................................................... 120,000 240,000 180,000 +60,000 -60,000
Byrd Honors Scholarships...................................... 39,288 39,859 39,859 +571 ................
Graduate Assistance in Areas of National Need................. 31,000 41,000 51,000 +20,000 +10,000
Learning Anytime Anywhere Partnerships........................ 10,000 20,000 10,000 ................ -10,000
Teacher Quality Enhancement Grants............................ 77,212 115,000 80,000 +2,788 -35,000
Child Care Access Means Parents in School..................... 5,000 5,000 5,000 ................ ................
Demonstration in Disabilities/Higher Education................ 5,000 5,000 5,000 ................ ................
Web Based Education Commission................................ 450 ................ ................ -450 ................
Underground Railroad Program.................................. 1,750 1,750 1,750 ................ ................
Preparing for College......................................... ................ 15,000 ................ ................ -15,000
College Completion Challenge Grants........................... ................ 35,000 ................ ................ -35,000
D.C. Resident Tuition Support................................. ................ 17,000 ................ ................ -17,000
GPRA data/HEA program evaluation.............................. ................ 4,000 ................ ................ -4,000
=========================================================================================
Total, Higher education................................. 1,292,623 1,579,206 1,404,631 +112,008 -174,575
HOWARD UNIVERSITY
Academic Program.............................................. 181,470 185,540 185,540 +4,070 ................
Endowment Program............................................. 3,530 3,530 3,530 ................ ................
Howard University Hospital.................................... 29,489 30,374 30,374 +885 ................
-----------------------------------------------------------------------------------------
Total, Howard University................................ 214,489 219,444 219,444 +4,955 ................
COLLEGE HOUSING AND ACADEMIC FACILITIES LOANS PROGRAM: Federal 698 737 737 +39 ................
Administration...............................................
HISTORICALLY BLACK COLLEGE AND UNIVERSITY CAPITAL FINANCING,
PROGRAM ACCOUNT
Federal Administration........................................ 96 207 207 +111 ................
EDUCATION RESEARCH, STATISTICS, AND IMPROVEMENT
Research and statistics:
Research.................................................. 82,567 133,282 82,567 ................ -50,715
Regional Educational Laboratories......................... 61,000 65,000 65,000 +4,000 ................
Statistics................................................ 68,000 77,500 70,000 +2,000 -7,500
Assessment:
National Assessment................................... 36,000 40,000 36,000 ................ -4,000
National Assessment Governing Board................... 4,000 4,500 4,500 +500 ................
-----------------------------------------------------------------------------------------
Subtotal, Assessment................................ 40,000 44,500 40,500 +500 -4,000
=========================================================================================
Subtotal, Research and statistics................... 251,567 320,282 258,067 +6,500 -62,215
Fund for the Improvement of Education......................... 139,000 139,500 139,500 +500 ................
International Education Exchange.............................. 7,000 7,000 7,000 ................ ................
Civic Education............................................... 7,500 9,500 9,500 +2,000 ................
Eisenhower Professional Dvp. Federal Activities............... 23,300 30,000 23,300 ................ -6,700
Eisenhower Regional Math and Science Ed. Consortia............ 15,000 17,500 15,000 ................ -2,500
Javits Gifted and Talented Education.......................... 6,500 6,500 6,500 ................ ................
National Writing Project...................................... 7,000 10,000 10,000 +3,000 ................
=========================================================================================
Total, ERSI............................................. 456,867 540,282 468,867 +12,000 -71,415
DEPARTMENTAL MANAGEMENT
PROGRAM ADMINISTRATION........................................ 364,521 386,000 378,184 +13,663 -7,816
OFFICE FOR CIVIL RIGHTS....................................... 66,000 73,262 71,200 +5,200 -2,062
OFFICE OF THE INSPECTOR GENERAL............................... 31,242 34,000 34,000 +2,758 ................
-----------------------------------------------------------------------------------------
Total, Departmental management.......................... 461,763 493,262 483,384 +21,621 -9,878
STUDENT LOANS
New Annual Loan Volume (including consolidation):
Federal Family Education Loans (FFEL)..................... (21,932,000) (21,932,000) (21,932,000) ................ ................
Federal Direct Student Loans (FDSL)....................... (12,002,000) (12,002,000) (12,002,000) ................ ................
Total Outstanding Loan Volume:
Federal Family Education Loans (FFEL)..................... (126,602,699) (126,602,699) (126,602,699) ................ ................
Federal Direct Student Loans (FDSL)....................... (45,363,630) (45,363,630) (45,363,630) ................ ................
=========================================================================================
Total, Department of Education.......................... 35,623,815 37,050,870 37,588,509 +1,964,694 +537,639
Current year........................................ (29,419,052) (28,977,484) (26,226,912) (-3,192,140) (-2,750,572)
Advance year........................................ (6,204,763) (8,073,386) (11,361,597) (+5,156,834) (+3,288,211)
TITLE IV--RELATED AGENCIES
ARMED FORCES RETIREMENT HOME
Operations and Maintenance.................................... 55,028 55,599 ................ -55,028 -55,599
Capital Program............................................... 15,717 12,696 ................ -15,717 -12,696
-----------------------------------------------------------------------------------------
Total, AFRH............................................. 70,745 68,295 ................ -70,745 -68,295
CORPORATION FOR NATIONAL AND COMMUNITY SERVICE
Domestic Volunteer Service Programs:
Volunteers in Service to America (VISTA).................. 73,000 81,000 81,000 +8,000 ................
National Senior Volunteer Corps:
Foster Grandparents Program........................... 93,256 95,000 95,000 +1,744 ................
Senior Companion Program.............................. 36,573 39,031 39,031 +2,458 ................
Retired Senior Volunteer Program...................... 43,001 46,001 46,001 +3,000 ................
Senior Demonstration Program.......................... 1,080 5,000 3,100 +2,020 -1,900
-----------------------------------------------------------------------------------------
Subtotal, Senior Volunteers......................... 173,910 185,032 183,132 +9,222 -1,900
Program Administration.................................... 29,929 33,500 29,129 -800 -4,371
=========================================================================================
Total, Domestic Volunteer Service Programs.............. 276,839 299,532 293,261 +16,422 -6,271
Corporation for Public Broadcasting:
Fiscal year 2002 (current request) with fiscal year 2001 340,000 350,000 350,000 +10,000 ................
comparable...............................................
Fiscal year 2001 advance with fiscal year 2000 comparable (300,000) (340,000) (340,000) (+40,000) ................
(NA).....................................................
Fiscal year 2000 advance with fiscal year 1999 comparable (250,000) (300,000) (300,000) (+50,000) ................
(NA).....................................................
Digitalization program.................................... 15,000 20,000 ................ -15,000 -20,000
Satellite replacement supplemental fiscal year 1999 and fiscal 30,700 17,300 ................ -30,700 -17,300
year 2000....................................................
-----------------------------------------------------------------------------------------
Subtotal, fiscal year 2000 appropriation................ 295,700 337,300 300,000 +4,300 -37,300
Federal Mediation and Conciliation Service.................... 34,620 36,834 36,834 +2,214 ................
Federal Mine Safety and Health Review Commission.............. 6,060 6,159 6,159 +99 ................
Office of Library Services: Grants and Administration......... 166,175 154,500 154,500 -11,675 ................
Medicare Payment Advisory Commission (TF)..................... 7,015 7,015 7,015 ................ ................
National Commission on Libraries and Info Science............. 1,000 1,300 1,300 +300 ................
National Council on Disability................................ 2,344 2,400 2,400 +56 ................
National Education Goals Panel................................ 2,100 2,250 2,250 +150 ................
National Labor Relations Board................................ 184,451 210,193 210,193 +25,742 ................
National Mediation Board...................................... 8,400 9,100 9,100 +700 ................
Occupational Safety and Health Review Commission.............. 8,100 8,500 8,500 +400 ................
RAILROAD RETIREMENT BOARD
Dual Benefits Payments Account................................ 189,000 175,000 175,000 -14,000 ................
Less Income Tax Receipts on Dual Benefits..................... -11,000 -10,000 -10,000 +1,000 ................
-----------------------------------------------------------------------------------------
Subtotal, Dual Benefits................................. 178,000 165,000 165,000 -13,000 ................
Federal Payment to the RR Retirement Account.................. 150 150 150 ................ ................
Limitation on administration:
Consolidated Account...................................... 90,398 86,500 90,000 -398 +3,500
Inspector General......................................... 5,600 5,400 5,400 -200 ................
SOCIAL SECURITY ADMINISTRATION
Payments to Social Security Trust Funds....................... 19,689 20,764 20,764 +1,075 ................
SPECIAL BENEFITS FOR DISABLED COAL MINERS
Benefit payments.............................................. 542,183 520,000 520,000 -22,183 ................
Administration................................................ 4,620 4,638 4,638 +18 ................
-----------------------------------------------------------------------------------------
Subtotal, Black Lung, current year program level........ 546,803 524,638 524,638 -22,165 ................
Less funds advanced in prior year................... -160,000 -141,000 -141,000 +19,000 ................
-----------------------------------------------------------------------------------------
Total, Black Lung, current request...................... 386,803 383,638 383,638 -3,165 ................
New advances, 1st quarter fiscal year 2001.......... 141,000 124,000 124,000 -17,000 ................
=========================================================================================
SUPPLEMENTAL SECURITY INCOME
Federal benefit payments...................................... 28,263,000 28,822,000 28,822,000 +559,000 ................
Beneficiary services.......................................... 61,000 64,000 64,000 +3,000 ................
Research and demonstration.................................... 37,000 24,000 25,085 -11,915 +1,085
Administration................................................ 2,114,000 2,203,000 2,192,000 +78,000 -11,000
-----------------------------------------------------------------------------------------
Subtotal, SSI current year program level.................. 30,475,000 31,113,000 31,103,085 +628,085 -9,915
Less funds advanced in prior year..................... -8,680,000 -9,550,000 -9,550,000 -870,000 ................
=========================================================================================
Subtotal, regular SSI current year, Current year.... 21,795,000 21,563,000 21,553,085 -241,915 -9,915
Additional CDR funding \4\...................... 177,000 200,000 200,000 +23,000 ................
User Fee Activities............................. 75,000 ................ ................ -75,000 ................
-----------------------------------------------------------------------------------------
Total, SSI, current request............................. 22,047,000 21,763,000 21,753,085 -293,915 -9,915
New advance, 1st quarter, fiscal year 2001.......... 9,550,000 9,890,000 9,890,000 +340,000 ................
=========================================================================================
LIMITATION ON ADMINISTRATIVE EXPENSES
OASDI Trust Funds............................................. 2,928,400 2,910,200 2,928,400 ................ +18,200
HI/SMI Trust Funds............................................ 952,000 1,087,000 1,066,671 +114,671 -20,329
Social Security Advisory Board................................ 1,600 1,800 1,800 +200 ................
SSI........................................................... 2,114,000 2,203,000 2,192,000 +78,000 -11,000
-----------------------------------------------------------------------------------------
Subtotal, regular LAE................................... 5,996,000 6,202,000 6,188,871 +192,871 -13,129
User Fee Activities........................................... 75,000 80,000 80,000 +5,000 ................
Claimant representative payments.............................. ................ 19,000 ................ ................ -19,000
=========================================================================================
TOTAL, REGULAR LAE...................................... 6,071,000 6,301,000 6,268,871 +197,871 -32,129
Additional CDR funding: \4\
OASDI........................................... 178,000 205,000 205,000 +27,000 ................
SSI............................................. 177,000 200,000 200,000 +23,000 ................
-----------------------------------------------------------------------------------------
Subtotal, CDR funding......................... 355,000 405,000 405,000 +50,000 ................
=========================================================================================
TOTAL, LAE.............................................. 6,426,000 6,706,000 6,673,871 +247,871 -32,129
OFFICE OF INSPECTOR GENERAL
Federal Funds................................................. 12,000 15,000 15,000 +3,000 ................
Trust Funds................................................... 44,000 51,000 51,000 +7,000 ................
-----------------------------------------------------------------------------------------
Total, Office of the Inspector General.................. 56,000 66,000 66,000 +10,000 ................
Adjustment: Trust fund transfers from general revenues........ -2,366,000 -2,403,000 -2,392,000 -26,000 +11,000
=========================================================================================
Total, Social Security Administration................... 36,260,492 36,550,402 36,519,358 +258,866 -31,044
Federal funds....................................... 32,156,492 32,196,402 32,186,487 +29,995 -9,915
Current year.................................... (22,465,492) (22,182,402) (22,172,487) (-293,005) (-9,915)
New advances, 1st quarter fiscal year 2000...... (9,691,000) (10,014,000) (10,014,000) (+323,000) ................
Trust funds......................................... 4,104,000 4,354,000 4,332,871 +228,871 -21,129
United States Institute of Peace.............................. 12,160 13,000 13,000 +840 ................
=========================================================================================
Total, Title IV, Related Agencies....................... 37,700,349 38,013,830 37,874,420 +174,071 -139,410
Federal funds....................................... 33,493,336 33,560,915 33,439,134 -54,202 -121,781
Current year.................................... (23,462,336) (23,196,915) (23,075,134) (-387,202) (-121,781)
Advance year 2001............................... (9,691,000) (10,014,000) (10,014,000) (+323,000) ................
Advance year 2002............................... (340,000) (350,000) (350,000) (+10,000) ................
Trust funds......................................... 4,207,013 4,452,915 4,435,286 +228,273 -17,629
=========================================================================================
SUMMARY
Grand bill total.............................................. 300,627,424 325,069,040 324,157,991 +23,530,567 -911,049
Federal Funds............................................. 290,870,468 315,017,982 314,255,792 +23,385,324 -762,190
Current year.......................................... (241,473,428) (261,420,921) (254,620,205) (+13,146,777) (-6,800,716)
Advance year 2001................................. (49,057,040) (53,247,061) (59,285,587) (+10,228,547) (+6,038,526)
Advance year 2002................................. (340,000) (350,000) (350,000) (+10,000) ................
Trust Funds............................................... 9,756,956 10,051,058 9,902,199 +145,243 -148,859
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Fiscal year 1999 includes $7 million in emergency funding.
\2\ Three year forward funded availability.
\3\ 15 month forward funded availability.
\4\ Two year availability.
\5\ Includes $8.29 million transfer from ESA account in Senate recommendation.
\6\ Includes $28 million for global polio/measles eradication emergency funding in fiscal year 1999.
\7\ Includes $5 million for Environmental Health Lab emergency funding in fiscal year 1999.
\8\ Includes Mine Safety and Health.
\9\ Intermediate estimates: Page 40 of the 1998 Annual Report of the Board of Trustees of the Federal Hospital Insurance Trust Fund.
\10\ Intermediate estimates: Page 39 of the 1998 Annual Report of the Board of Trustees of the Federal Supplementary Medical Insurance Trust Fund.
\11\ Requires new legislation.
\12\ Requires new authorizing legislation.
\13\ The Administration proposes transferring this from the Education, Research, Statistics and Improvement Account.
\14\ Public Law 105-220 reclassified all Voc Rehab programs except State Grants as discretionary funding.
