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                                                       Calendar No. 699
108th Congress                                                   Report
                                 SENATE
 2d Session                                                     108-345

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



 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATION BILL, 2005
                                _______
                                

               September 15, 2004.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                    [To accompany S. 2810]

    The Committee on Appropriations, to which was referred the 
bill (H.R. 0000) making appropriations for the Departments of 
Labor, Health and Human Services, and Education and related 
agencies for the fiscal year ending September 30, 2005, and for 
other purposes, reports the same to the Senate with amendments 
and recommends that the bill as amended do pass. deg.
    The Committee on Appropriations reports the bill (S. 2810) 
making appropriations for Departments of Labor, Health and 
Human Services, and Education and related agencies for the 
fiscal year ending September 30, 2005, and for other purposes, 
reports favorably thereon and recommends that the bill do pass.



Amount of budget authority

Total bill as reported to Senate........................$494,272,611,000
Amount of adjusted appropriations, 2004................. 479,592,665,000
Budget estimates, 2005.................................. 490,903,284,000
The bill as reported to the Senate:
    Over the adjusted appropriations for 2004........... +14,679,946,000
    Over the budget estimates for 2005..................  +3,369,327,000


                            C O N T E N T S

                              ----------                              
                                                                   Page
Summary of Budget Estimates and Committee Recommendations........     4
Overview and Bill Highlights.....................................     4
Highlights of the Bill...........................................     4
Title I--Department of Labor:
    Employment and Training Administration.......................    12
    Employee Benefit Security Administration.....................    22
    Pension Benefit Guaranty Corporation.........................    22
    Employment Standards Administration..........................    23
    Occupational Safety and Health Administration................    26
    Mine Safety and Health Administration........................    27
    Bureau of Labor Statistics...................................    28
    Office of Disability Policy..................................    28
    Departmental Management......................................    29
    General Provisions...........................................    33
Title II--Department of Health and Human Services:
    Health Resources and Services Administration.................    35
    Centers for Disease Control and Prevention...................    64
    NIH Preamble.................................................    95
    Substance Abuse and Mental Health Services Administration....   176
    Agency for Healthcare Research and Quality...................   185
    Centers for Medicare & Medicaid Services.....................   187
    Administration for Children and Families.....................   195
    Administration on Aging......................................   215
    Office of the Secretary......................................   220
    General Provisions...........................................   227
Title III--Department of Education:
    Education for the Disadvantaged..............................   230
    Impact Aid...................................................   236
    School Improvement Programs..................................   237
    Indian Education.............................................   246
    Innovation and Improvement...................................   246
    Safe Schools and Citizenship Education.......................   254
    English Language Acquisiton..................................   259
    Special Education............................................   259
    Rehabilitation Services and Disability Research..............   262
    Special Institutions for Persons With Disabilities:
        American Printing House for the Blind....................   268
        National Technical Institute for the Deaf................   268
        Gallaudet University.....................................   269
    Vocational and Adult Education...............................   269
    Student Financial Assistance.................................   272
    Student Aid Administration...................................   275
    Higher Education.............................................   275
    Howard University............................................   283
    College Housing and Academic Facilities Loans................   283
    Historically Black College and University Capital Financing 
      Program....................................................   283
    Institute of Education Science...............................   284
    Departmental Management:
        Program Administration...................................   286
        Office for Civil Rights..................................   286
        Office of the Inspector General..........................   287
    General Provisions...........................................   287
Title IV--Related Agencies:
    Armed Forces Retirement Home.................................   288
    Corporation for National and Community Service...............   288
    Corporation for Public Broadcasting..........................   291
    Federal Mediation and Conciliation Service...................   291
    Federal Mine Safety and Health Review Commission.............   292
    Institute of Museum and Library Services.....................   292
    Medicare Payment Advisory Commission.........................   294
    National Commission on Libraries and Information Science.....   294
    National Council on Disability...............................   294
    National Labor Relations Board...............................   295
    National Mediation Board.....................................   295
    Occupational Safety and Health Review Commission.............   296
    Railroad Retirement Board....................................   296
    Social Security Administration...............................   297
    U.S. Institute of Peace......................................   301
Title V--General Provisions......................................   302
Budgetary Impact of Bill.........................................   303
Compliance With Paragraph 7, Rule XVI of the Standing Rules of 
  the Sen- 
  ate............................................................   303
Compliance With Paragraph 7(C), Rule XXVI of the standing rules 
  of the Senate..................................................   304
Compliance With Paragraph 12, Rule XXVI of the Standing Rules of 
  the Senate.....................................................   305
Comparative Statement of New Budget Authority....................   306

       SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

    For fiscal year 2005, the Committee recommends total budget 
authority of $494,272,611,000 for the Departments of Labor, 
Health and Human Services, and Education, and Related Agencies. 
Of this amount, $142,317,000,000 is current year discretionary 
funding.

                      OVERVIEW AND BILL HIGHLIGHTS

    The Labor, HHS, and Education and Related Agencies bill 
constitutes the largest of the non-defense 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 the right to a basic 
education and job skills training; protection from illness and 
want; 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

    Job Training.--The Committee recommendation includes 
$5,377,662,000 for job training programs, an increase of 
$235,067,000 over the enacted 2004 level. In addition, 
$3,636,235,000 is recommended for State unemployment and 
employment service operations, an increase of $48,331,000 over 
the 2004 level.
    Worker Protection.--The Committee bill includes 
$1,536,800,000 to ensure the health and safety of workers, 
including $468,645,000 for the Occupational Safety and Health 
Administration and $280,002,000 for the Mine Safety and Health 
Administration. The recommendation is an increase of 
$51,900,000 over the 2004 level.
    Child Labor.--The Committee bill includes $82,000,000 for 
activities designed to end abusive child labor. This is 
$71,000,000 above the budget request, but the same as the 2004 
level.
    National Institutes of Health.--A total of $28,900,300,000 
is recommended to fund biomedical research at the 27 Institutes 
and Centers that comprise the NIH. This represents an increase 
of $1,100,252,000 over the fiscal year 2004 level and 
$373,429,000 over the budget request.
    Centers for Disease Control.--The Committee bill provides 
$4,807,692,000 for the Centers for Disease Control and 
Prevention, an increase of $228,393,000 over the fiscal 2004 
level. Included in this amount is $862,195,000 for chronic 
disease prevention and health promotion.
    Wellness Initiative.--The Committee recommendation includes 
a total of $809,539,000 for programs to increase physical 
activity, improve nutrition, and reduce obesity and overweight, 
an increase of $100,568,000 over the fiscal year 2004 
appropriation.
    Health Centers.--The recommendation includes $1,867,381,000 
for health centers, $31,456,000 above the budget request and 
$250,000,000 over the fiscal 2004 level.
    Substance Abuse.--The Committee bill provides 
$3,484,729,000 for substance abuse prevention and treatment 
programs. Included in this amount is $2,256,222,000 for 
substance abuse treatment, $94,455,000 for substance abuse 
prevention and $913,279,000 for mental health programs.
    Head Start.--The Committee recommendation includes 
$6,935,306,000 for the Head Start Program. This represents an 
increase of $168,586,000 over the 2004 level and is the same as 
the request.
    Low-income Home Energy Assistance State Grants.--The 
Committee recommends $2,000,500,000 for heating and cooling 
assistance for low-income individuals and families, the same as 
the budget request and $111,710,000 more than the 2004 level.
    Persons With Disabilities.--To promote independent living 
in home and community-based settings, the Committee has 
included $5,135,963,000 for services to persons with 
disabilities. This includes $47,555,000 for the Office of 
Disability Policy at the Department of Labor, $14,912,000 for 
Disabled Voter Services and $40,000,000 for Real Choice Systems 
Change Grants through the Center for Medicaid and Medicare 
Services.
    Education for the Disadvantaged.--The Committee has 
provided $15,500,684,000 in grants to enhance educational 
opportunities for disadvantaged children, an increase of 
$1,057,043,000 over the fiscal year 2004.
    Educator Professional Development.--The Committee 
recommends $2,975,126,000 for State grants to improve teacher 
quality. This is $45,000,000 more than the budget request.
    English Language Acquisition.--The Committee recommends 
$700,000,000 for bilingual education, $18,785,000 more than the 
budget request.
    Student Financial Aid.--The Committee recommends 
$14,859,694,000 for student financial assistance, an increase 
of $852,807,000 over the fiscal year 2004 level. The amount 
provided for the Pell Grant Program will allow for a maximum 
grant award of $4,050.
    Higher Education Initiatives.--The Committee bill provides 
$2,148,458,000 for initiatives to provide greater opportunities 
for higher education, including $844,500,000 for Federal TRIO 
programs and $302,500,000 for GEAR UP.
    Education for Individuals With Disabilities.--The Committee 
bill provides $12,063,344,000 to help 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 
$1,163,176,000 over the 2004 level and $140,958,000 above the 
budget request.
    Rehabilitation Services.--The bill recommends 
$3,077,328,000 for rehabilitation services, an increase of 
$66,058,000 above the amount provided in 2004. These funds are 
essential for families with disabilities seeking employment. 
The Committee restored funding for several important programs 
proposed for elimination, such as Supported Employment State 
Grants, Projects with Industry, Recreational programs and 
programs for migrant and seasonal farmworkers.
    Services for Older Americans.--For programs serving older 
Americans, the Committee recommendation includes 
$3,018,098,000, an increase of $105,242,000 over the fiscal 
year 2004 level. This recommendation includes $218,884,000 for 
senior volunteer programs, $440,200,000 for community service 
employment for older Americans, $357,000,000 for supportive 
services and centers, $157,000,000 for family caregiver support 
programs and $718,814,000 for senior nutrition programs. For 
the medical research activities of the National Institute on 
Aging, the Committee recommends $1,094,500,000. The Committee 
recommendation also includes not less than $31,700,000 for the 
Medicare insurance counseling program.
    Corporation for Public Broadcasting.--The Committee bill 
recommends an advance appropriation for fiscal year 2007 of 
$400,000,000 for the Corporation for Public Broadcasting. In 
addition, the Committee bill includes $49,705,000 for 
conversion to digital broadcasting and $50,000,000 for the 
replacement project of the interconnection system in fiscal 
year 2005 funding.

                  REPROGRAMMING AND TRANSFER AUTHORITY

    Reprogramming and transfers are the utilization of funds 
for purposes other than those contemplated at the time of 
appropriation enactment. These actions do not represent 
requests for additional funds from the Congress, rather, the 
reapplication of resources already available. A reprogramming 
is the shifting of budgetary resources within a Treasury 
account, whereas a transfer is the shifting of budgetary 
resources between Treasury accounts.
    The Committee has a particular interest in approving 
transfers and reprogrammings which, although they may not 
change either the total amount available or any of the purposes 
for which appropriations are is legally available, represent a 
significant departure from budget plans presented to the 
Committee in an agency's budget justification.
    For the Departments of Labor and HHS, the Committee has 
included bill language permitting reprogramming or transfers up 
to 1 percent between discretionary programs, projects, or 
activities, as long as no such program, project, or activity is 
increased by more than 3 percent by such reprogramming or 
transfer; however, the Appropriations Committees of both Houses 
of Congress must be notified at least 15 days in advance of any 
such action. For the Department of Health and Human Services, a 
program, project, or activity may be increased by an additional 
2 percent subject to written approval by the House and Senate 
Committees on Appropriations.
    For the Department of Education, the Committee directs that 
it make a written request to the chairman of the Committee 
prior to reprogramming or transfer of funds in excess of 10 
percent, or $500,000, whichever is less, between programs, 
projects, or activities, unless an alternate amount for the 
agency in question is specified elsewhere in this report. The 
Committee desires to have the requests for 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, projects, or 
activities specifically cited in the Committee's reports are 
affected or if the action can be considered to be the 
initiation of a new program or activity.
    The Committee directs that it be notified regarding 
reorganization of offices, agency employees programs, projects, 
or activities at least 15 days 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 45 days of final enactment of 
this Act.
    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.
    For purposes of implementing this provision, the term 
``program, project, or activity'' shall mean the most specific 
level of budgetary resources referred to in the House or Senate 
Committee reports or conference report and accompanying 
statement of the managers associated with the Departments of 
Labor, Health and Human Services, and Education Appropriations 
Act for fiscal year 2005. The 1 percent total referred to 
involves discretionary funds available for obligation in fiscal 
year 2005, including those available from prior years, user 
fees, offsetting collections or any other source of 
discretionary spending.

                          WELLNESS INITIATIVE

    The United States spends more than $1,500,000,000,000 each 
year on health care. That figure has doubled over the past 5 
years, and if current patterns hold, it is expected to double 
again within 6 years.
    The consequences of future increases are clear: More 
Americans will be left without access to health care, and more 
communities will suffer the closure of local hospitals and 
clinics. As a result, many Americans will forgo basic health 
maintenance visits, making it more likely that illnesses will 
go undiagnosed at early stages--a situation that will send 
health care costs spiraling even further.
    Many programs in this appropriations bill, especially those 
designed to improve the Nation's public health system and 
increase access to health care for underserved populations, 
directly confront the problems associated with rising health 
care costs, and the Committee remains committed to supporting 
them. But this year, the Committee is also placing an 
unprecedented emphasis on programs that encourage Americans to 
avoid getting sick in the first place--programs that promote 
the idea of ``wellness.''
    Wellness can take many forms. It means developing healthy 
habits like exercising regularly and eating right in order to 
prevent major illness or injury. It also means staying healthy 
mentally and avoiding tobacco and other harmful substances. All 
these ideals have the same goal: to change the system of care 
in America from a ``sick care'' paradigm, one focused almost 
exclusively on providing payments and support for the detection 
and treatment of illness, to a prevention paradigm that will 
provide incentives and supports to Americans to remain healthy.
    This initiative has four major components: physical 
activity, nutrition, mental health and tobacco cessation.
Physical Activity
    The Centers for Disease Control and Prevention recently 
determined that obesity is now the second leading cause of 
death in the United States, contributing to at least 400,000 
deaths annually. More than two-thirds of Americans are now 
overweight or obese, and more than 15 percent of our children 
are overweight. The Surgeon General estimates that direct and 
indirect costs of obesity in the United States come close to 
$120,000,000,000 annually, and research shows that being obese 
has an effect that is roughly comparable to aging 20 years.
    Promoting regular physical activity and creating an 
environment that supports these behaviors are essential steps 
to reduce this epidemic of obesity. Regular physical activity 
helps to control weight and is associated with fewer 
hospitalizations, physician visits, and medications. Despite 
the proven benefits of physical activity, more than 50 percent 
of American adults do not get enough physical activity to 
provide health benefits.
Nutrition
    Research shows that good nutrition lowers people's risk for 
many chronic diseases, including heart disease, stroke, 
osteoporosis, diabetes, and certain types of cancer. Yet, a 
large gap currently remains between recommended dietary 
patterns and what Americans actually eat. Only about one-fourth 
of U.S. adults, and only one-fifth of young people, eat the 
recommended 5 or more servings of fruits and vegetables each 
day.
    Adding to the lack of fruits and vegetables is a reported 
increase in calorie intake for both American men and women. 
Survey data collected over the last 30 years by the U.S. 
Department of Agriculture reports that this caloric increase 
can be traced to factors including an increase in consumption 
of food away from home, increased consumption of snacks, and 
increased portion sizes.
Mental Health
    The Surgeon General reports that mental disorders 
collectively account for 15 percent of the overall burden of 
disease from all causes--slightly more than the burden 
associated with all forms of cancer. The Substance Abuse and 
Mental Health Services Administration estimates that under-
treated and untreated mental disorders cost the Nation over 
$204,000,000,000 annually. In fact, 30,000 Americans die by 
suicide each year, with mental disorders a factor in 90 percent 
of those instances.
    Despite the cost and prevalence of depression, Americans 
still do not act to prevent and treat situational depression. 
According to the U.S. Surgeon General's report on mental 
health, nearly half of all Americans with a severe mental 
illness fail to seek treatment. Many people do not receive 
treatment for mental health problems due to a lack of awareness 
of the problem, fear of stigma, or lack of access to 
appropriate services.
Tobacco Cessation
    Tobacco use is the No. 1 killer of Americans, primarily due 
to its role in various cancers, and is a major contributing 
factor to heart disease, COPD and asthma. In fact, the latest 
Surgeon General's report on smoking finds that tobacco use 
causes diseases in nearly every organ of the body.
    Despite the availability of data on lung cancer, 61 million 
or 1 in 4 Americans smoke cigarettes. Every day in America, 
more than 4,000 kids try their first cigarette. Another 2,000 
children become new daily smokers. One-third of these newly 
addicted smokers will eventually die from smoking-caused 
diseases.
    The Committee strongly believes a commitment to wellness 
will encourage Americans to stay healthy, enhance the quality 
of life in America and reduce the demand on the Nation's 
healthcare system. For this reason, the Committee has included 
a total of $809,539,000 for the following programs designed to 
encourage healthy lifestyles and nutrition, an increase of 
$100,568,000 over the fiscal year 2004 appropriation. The 
Committee urges agencies receiving funds for this purpose under 
this bill to take special measures to coordinate their 
activities.
    Carol M. White Physical Education for Progress Program.--
Despite the well-publicized benefits of exercise, more than 50 
percent of American adults do not get enough physical activity 
to provide health benefits. This trend is not limited to 
adults--nearly one-half of Americans ages 12 to 21 are not 
vigorously active on a regular basis. Physical education 
classes are important for ensuring that young people have a 
minimal, regular amount of physical activity and for 
establishing physical activity patterns that may be carried 
into adulthood. Yet the Committee notes that daily enrollment 
in physical education classes dropped from 42 percent to 25 
percent among high school students between 1991 and 1995. To 
help reverse this trend, the Committee recommendation includes 
$75,000,000 for the Carol M. White Physical Education for 
Progress program. This is an increase of $5,413,000 over the 
fiscal year 2004 level. This program provides grants to local 
educational agencies and community-based organizations to 
initiate, expand, and improve physical education programs for 
students in kindergarten through 12th grade.
    Extramural Prevention Research.--The Committee commends CDC 
for its efforts to support research in humans that examines 
factors associated with preventing disease and promoting 
health. The Committee has included $36,000,000 for public 
health research at CDC, an increase of more than $5,000,000 
over the fiscal year 2004 level. Public health research helps 
to define the best strategies to motivate healthy lifestyles 
and to communicate that information to communities. The 
Committee has encouraged CDC to pay particular attention to 
research that will evaluate the effectiveness of business based 
wellness programs for employees and to develop and disseminate 
best practices in this area.
    Mental Health Surveillance.--The Committee has included 
$2,000,000 for a new initiative designed to measure mental and 
behavioral health needs in the Unites States. Despite the 
significant levels of Federal, State, and local funding for 
mental health services, there are currently no population-based 
sources of data on the mental and behavioral health needs in 
this country. Under this initiative, SAMHSA, in consultation 
with CDC, will develop ways of monitoring the mental health 
status of the population, the mental and behavioral health 
risks facing the Nation, and the immediate and long-term impact 
of emergencies on population mental health and behavior. The 
Committee envisions that when these measures are implemented in 
future years, the resulting data will be enormously useful to 
policymakers in deciding how to allocate mental health 
resources and reform the Nation's mental health care system.
    Nutrition, Physical Activity, Obesity State Grants.--The 
Committee has included $50,702,000 for the CDC State grant 
program that addresses nutrition, physical activity and 
obesity. This is an increase of $6,000,000. Currently, 23 
States are utilizing this funding for capacity-building 
activities including efforts to develop State nutrition and 
physical activity plans, identify community resources and gaps, 
implement small-scale interventions, and raise public awareness 
of system changes needed to help State residents achieve and 
maintain a healthy weight.
    Obesity Research.--Overall, the Committee recommendation 
includes $440,000,000 for research into the causes and cures 
for obesity. This figure is an increase of $40,000,000 over 
last year. This increase includes $22,000,000 for the 
development of a Strategic Plan for NIH Obesity Research, which 
will coordinate NIH obesity research across all of the 
Institutes.
    Pioneering Healthy Communities.--The Committee has included 
$2,000,000 to support the YMCA of the USA for its work in 
developing healthier communities through its Pioneering 
Healthier Communities conference. These funds will be used to 
support these healthy communities in the implementation of 
their community action plans. This program will be a proactive 
response to the surging epidemic of obesity and physical 
inactivity by supporting community-based solutions to these 
problems.
    Prevention Centers.--The Committee has provided 
$31,652,000, an increase of $5,000,000 for prevention research 
centers, which are a network of academic centers, public health 
agencies, and community partners conducting applied research 
and practice in chronic disease prevention and control. Centers 
design, test, and disseminate strategies that help build 
evidence-based interventions for public health programs. These 
centers are working with communities to evaluate programs meant 
to encourage increased physical activity, reduce the prevalence 
of smoking, and foster better eating habits.
    School Mental Health Services.--The Committee has included 
$10,548,000 for a new program to support the integration of 
schools and mental health systems under the Department of 
Education. This program, which was authorized in the No Child 
Left Behind Act but has not yet been funded, is designed to 
promote school-wide mental health strategies, provide training 
to elementary school and secondary school personnel to 
recognize early warning signs of mental illness, and increase 
student access to high-quality mental health services. An 
estimated 7 million to 10 million adolescents suffer from 
mental health issues that can lead to academic difficulties and 
poor life outcomes. Integrating mental health services in 
schools will increase the likelihood that they will receive the 
treatment they need.
    On a related note, the Committee has for the first time 
dedicated funding for the study of screening methods that are 
intended to identify students who are at risk of suicide. Some 
existing screening techniques show promise, but they require 
further testing. More must also be learned about ways to link 
at-risk students with appropriate treatment. The Committee has 
set aside $4,500,000 for SAMHSA to award grants for these 
purposes to school systems or nonprofit groups in conjunction 
with schools.
    STEPS to a Healthier U.S.--The Committee has provided 
$43,700,000, an increase of $5,000,000 over the fiscal year 
2004 level, to target obesity, diabetes, asthma, heart disease, 
stroke, and cancer. Programs should develop and implement 
comprehensive wellness programs that motivate and support 
responsible health choices, reduce the risk factors and 
complications of chronic disease, and encourage cooperation 
between agencies, policy makers, and the public to prevent 
diseases before they occur. Grants will be awarded to local and 
State health agencies, and tribal entities that develop 
community action plans which focus on community and school 
interventions for both the specific diseases and the related 
risk factors.
    Tobacco Cessation Activities at CDC.--The Committee has 
included $114,437,000 for tobacco control activities at CDC, an 
increase of $15,000,000. Tobacco use is the single most 
preventable cause of death and disease in our society. It 
causes more than 400,000 deaths in the U.S. each year, and 
costs the Nation $50,000,000,000 in medical expenses alone. 
Children are especially hard hit by tobacco--90 percent of 
adult smokers begin their habit as children. These funds are 
intended to expand the capacity of all State and local health 
departments, education agencies, and national organizations to 
build comprehensive tobacco control programs and to develop and 
begin implementation of a national public education campaign to 
reduce access to and the appeal of tobacco products among young 
people.

                      TITLE I--DEPARTMENT OF LABOR

                 Employment and Training Administration

                    TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2004....................................  $5,142,595,000
Budget estimate, 2005...................................   5,323,203,000
Committee recommendation................................   5,377,662,000

    The Committee recommends $5,377,662,000 for this account in 
2005 which provides funding primarily for activities under the 
Workforce Investment Act [WIA]. This is $235,067,000 more than 
the 2004 level, and $54,459,000 over the administration 
request.
    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 2005 will support 
the program from July 1, 2005 through June 30, 2006.
    Beginning with the fiscal year 2000 appropriation, budget 
constraints required that a portion of this account's funding 
be advance appropriated, with obligations for a portion of 
Adult and Dislocated Worker Employment and Training Activities 
and Job Corps delayed until the following fiscal year. This 
practice will continue in this year's appropriation.
    Fiscal year 2000 was the first full year of operations 
under the Workforce Investment Act, for the program year July 
1, 2000 through June 30, 2001. This legislation significantly 
enhanced employment and training services, consolidating, 
coordinating, and improving programs utilizing a local level 
one-stop delivery system.
    The legislation is due for reauthorization for fiscal year 
2005, and therefore, the Committee is acting on a current law 
request, deferring without prejudice proposed legislative 
language that should be addressed by the authorizing 
committees. The Committee is deferring consideration of a 
proposed program initiative for personal re-employment 
accounts.
    The Committee directs that Department take no action in 
fiscal year 2005 to amend, through regulatory or other 
administrative action, the definition established in 20 CFR 
677.220 for functions and activities under title I of the 
Workforce Investment Act until such time as legislation 
reauthorizing the Act is enacted.
    Adult Employment and Training.--For Adult Employment and 
Training Activities, the Committee recommends $898,107,000, the 
same as the fiscal year 2004 level. This program 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 Assistance.--For Dislocated Worker 
Assistance, the Committee recommends $1,479,419,000, an 
increase of $26,268,000 over the fiscal year 2004 level. Of the 
total, $1,196,048,000 is designated for State formula grants. 
This program 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. The recommendation includes 
$283,371,000 available to the Secretary for activities such as 
responding 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, including 
community college initiatives.
    The Committee bill continues language authorizing the use 
of funds under the dislocated workers program for projects that 
provide assistance to new entrants in the workforce and 
incumbent workers, as well as to provide assistance where there 
have been dislocations across multiple sectors or local areas 
of a State.
    The Committee recommendation includes, as it has in past 
years, funding for dislocated worker projects aimed at 
assisting the long-term unemployed.
    Due to economic reasons and family dysfunction, elderly 
caregivers care for thousands of preschool Hawaiian and part-
Hawaiian children with little or no preparation. The Committee 
urges the Department to expand funding to programs which work 
to train and assist these caregivers and the children they 
serve. The Committee was pleased to learn from the Secretary 
that the administration has established an interagency effort 
to address our Nation's nursing shortage. The shortage is 
especially critical in rural America and within various ethnic 
minority populations, such as native Hawaiians. The Department 
is accordingly strongly urged to work with nursing programs 
serving such populations, and in particular, to ensure that 
summer employment opportunities exist for nursing students.
    The Committee is aware of the ever changing agricultural 
worker training needs in Hawaii and recommends continued 
funding for a collaborative and adaptive effort involving the 
Hawaiian Department of Labor and Industrial Relations and the 
Hawaiian Cooperative Extension Service to provide 
multiculturally-sensitive on-farm food safety training, 
agribusiness training, and production training in support of a 
rapidly expanding landscaping and grounds keeping industry.
    The Committee continues to be troubled by the length of 
time it takes for the Department to approve applications for 
National Emergency Grants. The purpose of this program is to 
provide emergency help to workers who have recently lost their 
jobs get training to quickly find a new job. However, it 
routinely takes the Department several months to respond to 
emergency requests. The Committee requests that the Government 
Accountability Office examine the administration of this 
program, and make recommendations for improvement.
    The Committee recommendation includes $250,000,000 
requested by the administration to carry out the Community 
College/Community-Based Job Training Grant initiative. Of this 
amount, $125,000,000 is to be allocated from National Emergency 
Grant funds available under section 132(a)(2)(A) of the 
Workforce Investment Act. The Secretary is directed to 
initially use resources from the National Emergency Grants 
account for these awards that are designated for non-
emergencies under sections 171(d) and 170(b) of the Workforce 
Investment Act. Community-Based Job Training Grant awards will 
also be subject to the limitations of sections 171(c)(4)(A) 
through 171(c)(4)(C) of the Workforce Investment Act to ensure 
that these grants are awarded competitively. Funds used for 
this initiative should strengthen partnerships between 
workforce investment boards, community colleges, and employers, 
to train workers for high growth, high demand industries in the 
new economy.
    Youth Training.--For Youth Training, the Committee 
recommends $994,242,000, the same as the fiscal year 2004 
level. The Committee recommendation does not address the 
administration's legislative proposals for these activities. 
The purpose of Youth Training 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.
    Job Corps.--For Job Corps, now entering its 40th year, the 
Committee recommends $1,577,287,000. This is $20,000,000 more 
than the budget request, and $36,135,000 more than the 2004 
comparable level. The Committee applauds Job Corps for 
establishing partnerships with national employers, and 
encourages Job Corps to continue to work with both large 
employers and small businesses to ensure that student training 
meets current labor market needs. Job Corps 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 recommendation includes additional funds to 
begin the process of establishing up to four additional Job 
Corps centers, following up on directions contained in the 
conference report accompanying Public Law 108-199. In addition, 
consideration should be given to designating two of the 
proposed new Job Corps centers as ``High Growth Job Corps 
Centers,'' with emphasis placed on training students for 
industries facing labor shortages such as health care.
    The Committee recommendation includes funding to support a 
demonstration partnership with the Transportation Security 
Administration [TSA] at multiple Job Corps sites so that the 
Job Corps can help to fill unmet needs by providing TSA access 
to an expanded pool of job applicants. This funding will pay 
costs of both parties. The Department of Labor and the 
Department of Homeland Security are encouraged to develop a 
cooperative agreement that would help to leverage Federal 
resources, to provide TSA with an expanded pool of potential 
job applications and to utilize Job Corps facilities as 
appropriate to support the needs of TSA, including those of 
qualified private screening companies under contract to TSA.
    The Committee recognizes Project CRAFT (Community, 
Restitution, and Apprenticeship-Focused Training), a program of 
the Home Builders Institute, the workforce development arm of 
the National Association of Home Builders, as a modern 
intervention technique in the rehabilitation and reduced 
recidivism of adjudicated youth. The Committee also 
acknowledges the importance of housing to our Nation's economy 
and the role Project CRAFT plays in preparing young people to 
join the residential construction industry's workforce. The 
Committee therefore encourages the Department to replicate 
Project CRAFT to bring its outcomes-oriented approach to 
adjudicated juveniles throughout the country in order to help 
them become members of this industry's workforce and spur the 
Nation's economy.
    The Committee encourages Job Corps to strengthen working 
relationships with workforce development entities, including 
employers, that will enhance services to students and increase 
students' career opportunities. The Department is encouraged to 
continue its efforts to meet industry standards in its 
occupational offerings through a multi-year 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 continues 
to urge the Employment and Training Administration to encourage 
Job Corps centers to coordinate with community-based 
organizations, such as substance abuse treatment centers, in 
innovative ways.
    Responsible Reintegration of Youthful Offenders.--The 
Committee recommendation includes $50,000,000, the same as the 
budget request, to continue funding for the current 
Reintegration of Youthful Offenders Program. The Reintegration 
of Youthful Offenders Program targets critical funding to help 
prepare and assist young offenders to return to their 
communities. The program also provides support, opportunities, 
education and training to youth who are court-involved and on 
probation, in aftercare, on parole, or who would benefit from 
alternatives to incarceration or diversion from formal judicial 
proceedings. The recommendation also includes the $40,000,000 
budget request for the prisoner re-entry initiative, to extend 
assistance to a broader population of ex-offenders.
    Native Americans.--For Native Americans, the Committee 
recommends $55,000,000. This is the same as the budget request 
level. This program 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.
    Migrant and Seasonal Farmworkers.--For Migrant and Seasonal 
Farmworkers, the Committee recommends $76,874,000. This is the 
same as the 2004 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. Enrollees and their families are provided with 
employment training and related services intended to prepare 
them for stable, year-round employment within and outside of 
the agriculture industry.
    There are at least 3 million hard-working migrant and 
seasonal farmworkers in America whose annual incomes are below 
$10,000. At a time when most State budgets are shrinking and 
many of the basic services provided by State and local 
governments are being cut back, the Committee recognizes the 
importance of sustaining a national commitment, dating from 
1964, to help alleviate the chronic seasonal unemployment and 
underemployment that traps many farmworker families in a cycle 
of poverty across generations and that deprives many farmworker 
children of educational opportunities and real prospects for 
better jobs at higher wages. The Committee also recognizes that 
many State and local government officials will be reluctant to 
fund this training and related assistance for this vulnerable 
portion of our Nation's workforce who migrate through many 
States every year, even though the work they perform is 
essential to the economic well-being of our Nation's farmers, 
growers, and small businesses.
    The Committee recommendation of $76,874,000 for program 
year 2005 activities authorized under Section 167 of the 
Workforce Investment Act is reflected in two separate line 
items on the table accompanying the Committee Report: ``Migrant 
and Seasonal Farmworkers'' and ``National Activities/Other.'' 
Under the Migrant and Seasonal Farmworkers line item, the 
Committee recommends $76,370,000. The Committee recommendation 
includes bill language directing that $4,583,000 of this amount 
be used for migrant and seasonal farmworker housing grants, of 
which not less than 70 percent shall be for permanent housing. 
The principal purpose of these funds is to continue the network 
of local farmworker housing organizations working on permanent 
housing solutions for migrant and seasonal farmworkers. The 
recommendation also provides that the remaining amount of 
$71,787,000 be used for State service area grants, including 
funding grantees in those States impacted by formula reductions 
at no less than 85 percent of the comparable 1998 levels for 
such States. Within the National Activities/Other line item, 
the Committee recommendation includes $504,000 to be used for 
Section 167 training, technical assistance and related 
activities, including funds for migrant rest center activities. 
The Committee urges the Department to continue valuable 
technical assistance services provided by the Association of 
Farmworker Opportunity Programs. Finally, the Committee wishes 
to again advise the Department regarding the requirements of 
the Workforce Investment Act in selecting an eligible entity to 
receive a State service area grant under Section 167. Such an 
entity must have already demonstrated a capacity to administer 
effectively a diversified program of workforce training and 
related assistance for eligible migrant and seasonal 
farmworkers.
    National Programs.--This activity includes WIA-authorized 
programs in support of the workforce system including technical 
assistance and incentive grants, evaluations, pilots, 
demonstrations and research, and the Women in Apprenticeship 
Program.
    Technical Assistance.--The Committee recommends $3,486,000 
for the provision of technical assistance and staff 
development, an increase of $1,486,000 over the budget request. 
This includes $996,000 for technical assistance to employers 
and unions to assist them in training, placing, and retraining 
women in nontraditional jobs and occupations. As described in 
the Migrant and Seasonal Farmworker section of this report, it 
also includes $504,000 for WIA Section 167 activities.
    Pilots, Demonstrations, and Research.--The Committee 
recommends $62,751,000, an increase of $32,751,000 over the 
budget request, for grants or contracts to conduct research, 
pilots or demonstrations that improve techniques or demonstrate 
the effectiveness of programs.
    In addition, the Committee recommends $8,000,000, compared 
to the current level of $4,970,000, for the Denali Commission 
for job training in connection with infrastructure building 
projects it funds in rural Alaska. Funding will allow 
unemployed and underemployed rural Alaskans to train for high 
paying jobs in their villages.
    The Committee is deeply concerned about the ability of the 
28 million Americans who are deaf or hard-of-hearing to be 
informed of critical news and information in the post-9/11/01 
environment. The Committee is aware that court reporting 
schools may not be able to meet the ``unfunded mandate'' set by 
the Telecommunications Act of 1996 to provide closed captioning 
of 100 percent of broadcast programming by January 2006. These 
compelling concerns justify continued Federal support to those 
schools to increase their capability to attract and train more 
real time writers and to work closely with the broadcasting 
industry to significantly increase the amount of programming 
that is closed captioned, that 100 million Americans utilize 
closed captioning in some form and the shortage of providers 
need to be addressed immediately.
    Evaluation.--The Committee recommends $8,000,000 to provide 
for the continuing evaluation of programs conducted under the 
Workforce Investment Act, as well as of federally-funded 
employment-related activities under other provisions of law.
    Rescission.--This bill includes the cancellation of 
$100,100,000, that remains unobligated for the H-1B Technical 
Skills Grant program. This compares to the $100,000,000 
rescission proposed in the President's budget. The authority to 
impose fees that funded the program lapsed on September 30, 
2003, and therefore the program is ending. The Committee has 
utilized these savings to restore other job training programs 
that the administration has recommended for reduction or 
elimination.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2004....................................    $438,650,000
Budget estimate, 2005...................................     440,200,000
Committee recommendation................................     440,200,000

    The Committee recommends $440,200,000, the same as the 
budget request and $1,550,000 over the program year 2004 
comparable level for community service employment for older 
Americans. 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 2005 
appropriation will support the program from July 1, 2004, 
through June 30, 2005. 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 program provides a direct, efficient, and quick means 
to assist economically disadvantaged older workers because it 
has a proven effective network in every State and in 
practically every county. Administrative costs for the program 
are low, and the vast majority of the money goes directly to 
low-income seniors as wages and fringe benefits.
    The program provides a wide range of vital community 
services that would not otherwise be available, particularly in 
low-income areas and in minority neighborhoods. Senior 
enrollees provide necessary and valuable services at Head Start 
centers, schools, hospitals, libraries, elderly nutrition 
sites, senior center, and elsewhere in the community. These 
services would not be available without the program.
    A large proportion of senior enrollees use their work 
experience and training to obtain employment in the private 
sector. This not only increases our Nation's tax base, but it 
also enables more low-income seniors to participate in the 
program.
    The Committee believes that the program should pay special 
attention 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.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2004....................................  $1,338,200,000
Budget estimate, 2005...................................   1,057,300,000
Committee recommendation................................   1,057,300,000

    The Committee recommends $1,057,300,000, the same as the 
budget estimate for fiscal year 2005, a decrease of 
$280,900,000 below the fiscal year 2004 appropriation for 
Federal Unemployment Benefits and Allowances. However, new 
obligations in fiscal year 2005 are estimated to be 
$1,097,000,000, compared to $836,000,000 in fiscal year 2004 
due to an estimated unobligated balances of $549,200,000 in 
2004. Trade Readjustment Allowance [TRA] weekly benefits are 
estimated to increase from $2,500,000 in fiscal year 2004 to 
$4,200,000 in fiscal year 2005. Fiscal year 2005 will continue 
the implementation and operation of the Trade Adjustment 
Assistance program with an emphasis on melding the TAA program 
into the workforce investment system. The Committee expects the 
Department to provide funds to the State of Alaska to mitigate 
negative effects on Alaskan fishermen and other Alaskan 
displaced workers stemming from passage of Trade and Adjustment 
Assistance Act legislation in 2002. Funds should be provided on 
a flexible basis to cover costs of job training and placement 
programs, among other uses.
    The Trade Adjustment Assistance Reform Act of 2002 that 
amended the Trade Act of 1974 was signed into law on August 6, 
2002 (Public Law 107-210). This Act consolidated the previous 
Trade Adjustment Assistance [TAA] and NAFTA Transitional 
Adjustment Assistance [NAFTA-TAA] programs, into a single, 
enhanced TAA program with expanded eligibility, services, and 
benefits. While the amendments generally apply to workers 
covered on or after November 4, 2002, the Act includes 
provisions to continue eligibility for workers certified prior 
to November 4 until their eligibility under the previous 
legislation is exhausted. Therefore, the amounts appropriated 
to the FUBA account are to provide for services and benefits to 
workers certified under the amended program as well as the 
predecessor programs. Additionally, the Act provides a program 
of Alternative Trade Adjustment Assistance for Older Workers.

     STATE UNEMPLOYMENT INSURANCE AND EMPLOYMENT SERVICE OPERATIONS

Appropriations, 2004....................................  $3,587,904,000
Budget estimate, 2005...................................   3,593,434,000
Committee recommendation................................   3,636,235,000

    The Committee recommends $3,636,235,000 for this account. 
This is $42,801,000 above the budget request and $48,331,000 
above the 2004 comparable level. Included in the total 
availability is $3,494,438,000 authorized to be drawn from the 
``Employment Security Administration'' account of the 
unemployment trust fund, and $141,797,000 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 
$2,665,214,000. This includes $2,654,714,000 for State 
Operations, and $10,500,000 for UI national activities, which 
is directed to activities that benefit the State/Federal 
unemployment insurance program. The bill provides for a 
contingency reserve amount should the unemployment workload 
exceed an average weekly insured claims volume of 3,227,000, 
instead of 3,327,000 in the request. This contingency amount 
would fund the administrative costs of unemployment insurance 
workload over the level of 3,227,000 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.
    For the Employment Service grants to States, the Committee 
recommends $852,387,000 which includes $23,163,000 in general 
funds together with an authorization to spend $829,224,000 from 
the ``Employment Security Administration'' account of the 
unemployment trust fund. These funds are available for the 
program year of July 1, 2005 through June 30, 2006.
    The recommendation includes $65,500,000 for national 
activities, an increase of $1,529,000 over the fiscal year 2004 
level. This recommendation provides increased funding of the 
foreign labor certification program, but not the full amount 
requested by the administration. The recommendation includes 
$18,000,000, the budget request level, for the work opportunity 
tax credit program.
    The recommendation also includes $98,764,000, the 2004 
level, for One-Stop Career Centers. The Committee 
recommendation includes funding for America's Labor Market 
Information System, including core employment statistics, 
universal access for customers, improving efficiency in labor 
market transactions, and measuring and displaying WIA 
performance information.
    The recommendation includes the budget request level of 
$19,870,000 for the 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. Funding 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.

        ADVANCES TO THE UNEMPLOYMENT TRUST FUND AND OTHER FUNDS

Appropriations, 2004....................................    $467,000,000
Budget estimate, 2005...................................     517,000,000
Committee recommendation................................     517,000,000

    The Committee recommends $517,000,000, the same as the 
budget estimate for fiscal year 2005, an increase of 
$50,000,000 over 2004. 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 2004 advances will be made to the Black Lung 
Disability Trust Fund. The requested amount is required to 
provide for loan interest payments on Black Lung Trust Fund 
borrowed amounts.
    The separate appropriations provided by the Committee for 
all other accounts eligible to borrow from this account in 
fiscal year 2005 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 appropriate 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, 2004....................................    $172,349,000
Budget estimate, 2005...................................     181,018,000
Committee recommendation................................     177,615,000

    The Committee recommendation includes $117,576,000 in 
general funds for this account, as well as authority to expend 
$60,039,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund, for a total of 
$177,615,000. This level provides sufficient resources to cover 
built-in cost increases.
    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.
    The Committee believes that the public workforce system is 
strengthened by the effective participation of all of the 
stakeholders in the system and urges that the Department use a 
portion of its discretionary funds to support that 
participation through grants to intergovernmental, business, 
labor, and community-based organizations dedicated to training 
and technical assistance in support of Workforce Investment 
Boards and their members. Specifically, the Committee intends 
that the Employment and Training Administration renew grant 
funding for the Working for America Institute, at no less than 
the cost of the latest grant. In a hearing held July 22, 2004, 
the Committee heard testimony strongly supporting the work of 
the Institute, which has successfully administered Labor 
Department awards for more than 35 years.
    It has come to the attention of the Committee that the 
Department of Labor has recently chosen not to renew a contract 
with the Appalachian Council serving participants in the Job 
Corps program. It is of concern to the Committee that the 
Department has discontinued this important effort. In a hearing 
held July 22, 2004, the Committee heard witnesses describe the 
unique character of this organization that justifies its 
continued eligibility for a sole-source contract award at the 
national level. It is the Committee's intent that the 
Employment and Training Administration renew funding for the 
Appalachian Council to continue its nearly 40 years of service 
to the employment needs of our Nation.
    The Committee is concerned that there are limited 
opportunities for Native Hawaiian administrators in health care 
organizations and encourages effective training programs to 
prepare Native Hawaiians with the expertise to excel in these 
areas.
    The Committee is aware that a study is urgently needed to 
obtain a comprehensive and accurate understanding of the costs 
of replacing workers who leave the Federal work force and to 
evaluate the changes needed to attract and retain skilled older 
workers and the costs of implementing such a program. The 
Committee urges the Department of Labor to obtain such a study.
    The Committee urges the Department of Labor to work with 
leading national aging organizations with specialized expertise 
concerning older workers to conduct a Conference on the Aging 
Workforce. This Conference can be an appropriate forum to 
assess how our Nation can continue to progress economically 
when there will quite likely be a shortage of workers in a 
variety of present and future occupations. It can also evaluate 
the appropriate role that older workers can play in meeting 
future national skill needs.
    The Committee instructs that, for the purposes of the 
temporary visa programs, the Department of Labor shall treat 
loggers as agricultural workers and not as non-agricultural 
workers. Presently, the Department classifies loggers as non-
agricultural; however, since June 1987, it has imposed upon 
them the same worker protections and labor standards as H-2A 
agricultural workers. Employers wishing to hire logger aliens 
must already provide transportation, housing, and meals, and 
must make the same benefits available to U.S. workers based on 
Department policy that predates the 1986 immigration reforms. 
The provision applies strictly to loggers, and shall not affect 
any other H-2B workers.

                Employee Benefit Security Administration


                         SALARIES AND EXPENSES

Appropriations, 2004....................................    $124,040,000
Budget estimate, 2005...................................     132,345,000
Committee recommendation................................     132,345,000

    The Committee recommendation provides $132,345,000 for this 
account which is $8,305,000 above the 2004 comparable level. 
This includes funding of a requested program increase to 
enhance regional office enforcement activities.
    The Employee Benefit Security Administration [EBSA] is 
responsible for the enforcement of title I of the Employee 
Retirement Income Security Act of 1974 [ERISA] in both civil 
and criminal areas. ESBA is also responsible for enforcement of 
sections 8477 and 8478 of the Federal Employees' Retirement 
Security Act of 1986 [FERSA]. In accordance with the 
requirements of FERSA, the Secretary of Labor has promulgated 
regulations and prohibited transactions class exemptions under 
the fiduciary responsibility and fiduciary bonding provisions 
of the law governing the Thrift Savings Plan for Federal 
employees. In addition, the Secretary of Labor has, pursuant to 
the requirement of section 8477(g)(1) of FERSA, established a 
program to carry out audits to determine the level of 
compliance with the fiduciary responsibility provisions of 
FERSA applicable to Thrift Savings Plan fiduciaries. ESBA 
provides funding for the enforcement and compliance; policy, 
regulation, and public services; and program oversight 
activities.

                  Pension Benefit Guaranty Corporation

    The Corporation's estimated obligations for fiscal year 
2005 include single employer benefit payments of 
$3,295,000,000, multiemployer financial assistance of 
$39,000,000 and administrative expenses of $266,330,000. 
Administrative expenses are comprised of three activities: (1) 
pension insurance activities, $12,211,000; (2) operational 
support, $84,380,000; and (3) pension plan terminations 
expenses, $169,739,000. Such expenditures will be financed by 
permanent authority.
    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, assets of terminated pension plans, collection 
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 defined benefit plans fail or go out of existence.
    The 2005 budget does not recommend a discretionary limit on 
administrative expenditures [LAE] for PBGC. The PBGC's budget 
will reflects--in a way that is more accountable to the 
Committee--the level of administrative expenditures that the 
Committee believes is appropriate to PBGC's changing 
responsibilities to protect the pensions it insures. PBGC's 
dollar benefit levels and workload change from year to year as 
specific pension plans fail. Most of its workload involves 
terminating failed pension plans, so that pension benefits can 
be paid. The workload of plan termination especially fluctuates 
from year to year as large plans (or a spate of small ones) 
terminate, and then as the terminations are completed. The 
language provides the PBGC the flexibility to respond when 
dictated by increased workload and increased benefit payments, 
while increasing accountability to the Committee by requiring 
approval by the Office of Management and Budget and the 
Committees on Appropriations.
    The single-employer program protects about 34.5 million 
participants in about 29,500 defined benefit pension plans. The 
multi-employer insurance program protects about 9.7 million 
participants in more than 1,600 plans.

                  Employment Standards Administration


                         SALARIES AND EXPENSES

Appropriations, 2004....................................    $392,016,000
Budget estimate, 2005...................................     409,294,000
Committee recommendation................................     405,870,000

    The Committee recommendation includes $405,870,000 for this 
account. The bill contains authority to expend $2,058,000 from 
the special fund established by the Longshore and Harbor 
Workers' Compensation Act; the remainder of $403,812,000 are 
general funds. In addition, an amount of $32,646,000 is 
available by transfer from the black lung disability trust 
fund.
    This recommendation provides sufficient funding to offset 
the impact of inflation, and includes resources for a portion 
of requested program increases.
    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).

                            SPECIAL BENEFITS

Appropriations, 2004....................................    $163,000,000
Budget estimate, 2005...................................     233,000,000
Committee recommendation................................     233,000,000

    The Committee recommends $233,000,000, the same as the 
budget estimate for fiscal year 2005, and $70,000,000 more than 
fiscal year 2004. This appropriation primarily provides 
benefits under the Federal Employees' Compensation Act [FECA]. 
The payments are prescribed by law. In fiscal year 2005, an 
estimated 170,000 injured Federal workers or their survivors 
will file claims; 7,000 will receive long-term wage replacement 
benefits for job-related injuries, diseases, or deaths.
    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 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.
    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 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 use of fair share collections to fund capital 
investment projects and specific initiatives to strengthen 
compensation fund control and oversight.

               SPECIAL BENEFITS FOR DISABLED COAL MINERS

Appropriations, 2004....................................    $299,991,000
Appropriations, Advanced 2005...........................      88,000,000
Budget estimate, 2005...................................     276,000,000
Budget estimate, Advance 2006...........................      81,000,000
Committee recommendation, 2005..........................     276,000,000
Committee recommendation, Advanced 2006.................      81,000,000

    The Black Lung Consolidation of Administrative 
Responsibility Act was enacted on November 2, 2002. The Act 
amends the Black Lung Benefits Act to transfer part B black 
lung benefits responsibility from the Commissioner of Social 
Security to the Secretary of Labor, thus consolidating all 
black lung benefit responsibility under the Secretary. Part B 
benefits are based on claims filed on or before December 31, 
1973. The Secretary of Labor is already responsible for the 
part C claims filed after December 31, 1973. In fiscal year 
2005, an estimated 46,100 beneficiaries (5,100 miners and 
41,000 survivors) will receive benefits.
    The Committee recommends an appropriation of $276,000,000 
in fiscal year 2005 for special benefits for disabled coal 
miners. This is in addition to the $88,000,000 appropriated 
last year as an advance for the first quarter of fiscal year 
2005. 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.
    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 recommends an advance appropriation of 
$81,000,000 for the first quarter of fiscal year 2006, the same 
as the administration request. These funds will ensure 
uninterrupted benefit payments to coal miners, their widows, 
and dependents.

       ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM

Appropriations, 2004....................................     $51,651,000
Budget estimate, 2005...................................      40,821,000
Committee recommendation................................      40,821,000

    The Committee recommends $40,821,000, the same as the 
budget estimate for fiscal year 2005, and $10,830,000 below 
2004.
    The mission of the Energy Employees Occupational Illness 
Compensation Program is to deliver benefits to eligible 
employees and former employees of the Department of Energy, its 
contractors and subcontractors or to certain survivors of such 
individuals, as provided in the Energy Employees Occupational 
Illness Compensation Program Act. The mission also includes 
delivering benefits to certain beneficiaries of the Radiation 
Exposure Compensation Act. Benefit costs of $221,000,000 are 
anticipated in fiscal year 2005.
    The Department of Labor's Office of Workers' Compensation 
Programs within the Employment Standards Administration is 
responsible for adjudicating and administering claims filed by 
employees or former employees (or their survivors) under the 
Act. The program went into effect on July 31, 2001.

                    BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2004 (Definite).........................     $56,099,000
Appropriations, 2004 (Indefinite).......................     998,901,000
Budget estimate, 2005 (Definite)........................      57,049,000
Budget estimate, 2005 (Indefinite)......................   1,001,951,000
Committee recommendation (Definite).....................      57,049,000
Committee recommendation (Indefinite)...................   1,001,951,000

    The Committee recommends $1,059,000,000 for this account in 
2005, of which $57,049,000 is definite authority and 
$1,001,951,000 is indefinite authority. The appropriation 
language changed beginning in fiscal year 2003 for the Black 
Lung Disability Trust Fund to provide such sums as may be 
necessary to pay for benefits. This change eliminated the need 
for drawdowns from the subsequent year appropriation in order 
to meet current year compensation, interest, and other benefit 
payments. The appropriation language will continue to provide 
definite budget authority for the payment of administrative 
expenses for the operation and administration of the trust 
fund.
    The total amount available for fiscal year 2005 will 
provide $1,001,951,000 for benefits payments, and $56,693,000 
for administrative expenses for the Department of Labor. Also, 
included is $356,000 for interest payments on advances.
    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 41,400 people will be receiving black 
lung benefits financed through the end of the fiscal year 2005, 
compared to an estimated 44,500 receiving benefits in fiscal 
year 2004.
    The basic financing for the trust fund comes from a coal 
excise tax for underground and surface-mined coal. Additional 
funds come from reimbursement from the Advances to the 
Unemployment Trust Fund and Other Funds as well as payments 
from mine operators for benefit payments made by the trust fund 
before the mine operator is found liable. 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.

             Occupational Safety and Health Administration


                         SALARIES AND EXPENSES

Appropriations, 2004....................................    $457,541,000
Budget estimate, 2005...................................     461,599,000
Committee recommendation................................     468,645,000

    The Committee recommendation includes $468,645,000 for this 
account. This is an increase of $7,046,000 over the budget 
request and an increase of $11,104,000 above the 2004 
comparable level. This agency is responsible for enforcing the 
Occupational Safety and Health Act of 1970 in the Nation's 
workplaces.
    This recommendation provides sufficient funding to offset 
the impact of inflation, as well as additional resources to 
expand outreach to non-English speaking workers and small 
businesses.
    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 believes that OSHA's worker safety and health 
training and education programs, including the grant program 
that supports such training, are a critical part of a 
comprehensive approach to worker protection. The Committee is 
concerned that OSHA has again cut funding to help establish 
ongoing worker safety and health training programs and has 
provided $6,510,000 in additional funds to restore the Susan 
Harwood training grant program to $10,510,000. Bill language 
specifies that no less than $3,200,000 shall be used to 
maintain the existing institutional competency building 
training grants, provided that grantees demonstrate 
satisfactory performance.
    The Committee has provided $53,792,000, the budget request 
level, for the State consultation grant program and expects 
that this program will continue to be targeted to provide 
compliance assistance to small businesses.
    The Committee continues to be pleased with OSHA's efforts 
in placing high priority on the voluntary protection programs 
[VPP] and other voluntary cooperative programs. The Committee 
expects OSHA to continue to place high priority on the VPP. 
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 also intends that the Office of Regulatory 
Analysis continue to be funded as close as possible to its 
present level.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

Appropriations, 2004....................................    $268,857,000
Budget estimate, 2005...................................     275,567,000
Committee recommendation................................     280,002,000

    The Committee recommendation includes $280,002,000 for this 
account, an increase of $4,435,000 over the budget request.
    This recommendation provides sufficient funding to offset 
the impact of inflation, as well as additional resources for 
enforcement, compliance assistance, and the new office 
providing technical assistance to small mine organizations. It 
further includes funding to continue the Miner's Choice X-ray 
Program.
    The Committee recommendation also increases the requested 
bill language amount for mine rescue and recovery activities 
from up to $1,000,000 to up to $2,000,000, the same as the 
fiscal year 2004 comparable level. It also retains the 
provision allowing the Secretary of Labor to use any funds 
available to the Department to provide for the costs of mine 
rescue and survival operations in the event of a major 
disaster.
    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.
    In addition, bill language is included to allow the 
National Mine Health and Safety Academy to collect not to 
exceed $750,000 for room, board, tuition, and the sale of 
training materials to be available for mine safety and health 
education and training activities. Bill language also allows 
MSHA to retain up to $1,000,000 from fees collected for the 
approval and certification of equipment, materials, and 
explosives for use in mines, and may utilize such sums for such 
activities.

                       Bureau of Labor Statistics


                         SALARIES AND EXPENSES

Appropriations, 2004....................................    $518,496,000
Budget estimate, 2005...................................     533,518,000
Committee recommendation................................     533,518,000

    The Committee includes $533,518,000 for this account, 
$15,022,000 more than the 2004 comparable level. This includes 
$78,473,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund, and $455,045,000 in 
Federal funds. This funding level will cover the agency's 
built-in increases, and includes $5,000,000 to continue the 
Mass Layoff Statistics Program.
    The Bureau of Labor Statistics is the principal fact 
finding agency in the Federal Government in the broad field of 
labor economics.

                 Office of Disability Employment Policy

Appropriations, 2004....................................     $47,024,000
Budget estimate, 2005...................................      47,555,000
Committee recommendation................................      47,555,000

    The Committee recommends $47,555,000 for this account in 
2005. This is the same as the President's request and $531,000 
above 2004.
    Congress created the Office of Disability Employment Policy 
[ODEP] in the Department of Labor's fiscal year 2001 
appropriation. Programs and staff of the former President's 
Committee on Employment of People with Disabilities [PCEPD] 
have been integrated into this office.
    The ODEP mission, under the leadership of an Assistant 
Secretary, is to bring a heightened and permanent long-term 
focus to the goal of increasing employment of persons with 
disabilities. This will be achieved through policy analysis, 
technical assistance, and development of best practices, as 
well as outreach, education, constituent services, and 
promoting ODEP's mission among employers.
    Within the funds provided for the Office of Disability 
Employment Policy, the Committee has included $2,500,000 for 
the telework feasibility program. These funds are to be used to 
enable Government agencies to explore the feasibility of 
employing home-based workers with significant disabilities.
    The Committee recommends that the Office of Disability 
Employment Policy continue the existing, structured, internship 
program for undergraduate college students with disabilities, 
at no less than current appropriation levels. The Committee 
continues to believe that this innovative, structured 
internship program will provide important opportunities for 
undergraduate students with disabilities to pursue academic and 
career development opportunities within the Department of Labor 
and other Federal agencies.

                        Departmental Management


                         SALARIES AND EXPENSES

Appropriations, 2004....................................    $350,319,000
Budget estimate, 2005...................................     287,168,000
Committee recommendation................................     357,050,000

    The Committee recommendation includes $357,050,000 for this 
account, which is $69,882,000 more than the budget request and 
$6,731,000 more than the 2004 comparable level. In addition, an 
amount of $23,705,000 is available by transfer from the black 
lung disability trust fund, which is the same as the budget 
request.
    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 Committee recommendation includes $27,084,000 for 
Executive Direction, the same as the fiscal year 2004 
comparable level. Within this amount, which includes cost 
savings in excess of $4,000,000, the Committee concurs with the 
budget request of up to $5,000,000 to encourage greater use of 
flex time and telework options to help ease the pressures faced 
by workers and their families.
    The Committee recommendation includes $9,554,000 for the 
Women's Bureau. The Committee encourages the Women's Bureau to 
support effective programs such as ``Women Work!'', to provide 
technical assistance and training on programming for women in 
transition to reenter the workforce.
    The Committee is pleased with efforts to investigate the 
impact of the nursing shortage on the overall health care labor 
market across the country, particularly in rural areas, such as 
Hawaii. The Committee urges the Department to work with HRSA in 
creating solutions to remedy the ongoing shortage and report on 
these efforts.
    The University of Hawaii Center on the Family is dedicated 
to understanding and promoting the factors that foster 
resiliency in families facing personal, social, and financial 
crises. The uniqueness of this program is the emphasis on the 
psychological and behavioral processes, family resilience and 
vulnerability, and includes Asians, Pacific Islanders and 
Caucasians families. The State's diverse multicultural 
population adds to the reliability of the research conclusions.
    The Committee is disappointed that the Department of Labor 
has once again put forward a budget for the coming year that 
drastically reduces funding for the initiatives within the 
International Labor Affairs Bureau [ILAB] working with the 
International Labor Organization to combat abusive and 
exploitative child labor.
    Last December, a report on the economic impact of child 
labor programs commissioned by the Department of Labor was 
released. ``Investing In Every Child'' found that the average 
economic benefit of eliminating child labor around the world 
exceeds the cost of those efforts by a ratio of 6.7 to 1. Even 
in the region of the world whose economic benefit is the 
lowest, sub-Saharan Africa, the benefit is more than 5 to 1. 
The study also found that each year of additional education 
beyond the age of 14 yields an 11 percent increase in that 
individual's earning power resulting in just over 
$5,000,000,000,000 in global benefits.
    The Committee is pleased to have definitive economic 
analysis proving that eradicating child labor and investing in 
education will contribute to increased economic prosperity for 
developing nations. The Committee views the investment made by 
the United States and the programs run by the Department of 
Labor to eliminate child labor as a proven method for improving 
the economic infrastructure of developing nations and providing 
a market for U.S. goods. In addition, the Committee is pleased 
to note that its investment in programs to eliminate child 
labor has inspired matching funds from countries like India, 
Cambodia, Lebanon, and Yemen, thus exponentially increasing the 
reach of these valuable programs.
    Given this new Department of Labor data on the value of 
these programs in reducing the need for foreign economic 
assistance, the amount needed to service debt for developing 
countries and the clear impact of these programs for advancing 
the ability of nations to form sound trade agreements, the 
Committee is mystified by the Department's annual effort to 
eliminate these programs, this year proposing an astounding 87 
percent reduction.
    Therefore, the Committee recommendation includes 
$110,500,000 for the Bureau of International Labor Affairs. Of 
this amount, the Committee's recommendation includes 
$82,000,000 for international child labor prevention activities 
including $45,000,000 for the U.S. contribution to sustain and 
to extend to more countries in waiting the successful efforts 
of the ILO's International Program for the Elimination of Child 
Labor [IPEC]. The remaining $37,000,000 is for bilateral 
assistance to expand upon the program initiated by the 
Department in fiscal year 2001 to help ensure access to basic 
education for the growing number of children removed from the 
worst forms of child labor in impoverished nations where 
abusive and exploitative child labor is most acute. The 
Committee expects the Department of Labor to work with the 
governments of host countries to eliminate school fees that 
cause additional burdens to former exploited child laborers.
    The Committee notes that in the fiscal year 2003, ILAB 
contracted with two international aid organizations for 
$8,000,000 to create employment centers in Iraq. During this 
same fiscal year, Congress was presented with a request of 
$87,000,000,000 for the general reconstruction of Iraq and 
Afghanistan. Congress acted on this request and $87,000,000,000 
in aid was approved on November 6, 2003. The Committee is 
concerned that ILAB went outside the scope of congressional 
approval by diverting funds from the multilateral and bi-
lateral technical assistance programs to gain additional 
funding for the reconstruction of these two countries. The 
Committee expects a detailed report by March 31, 2005 on the 
use of the $8,000,000, including a timeline of when the funds 
were requested, by whom, the process by which the two aid 
organizations were selected, when the contracts were issued, 
and what such contracts entailed. The Committee understands 
that the contracts have changed drastically due to unforeseen 
events in Iraq and expect that the report will also detail the 
decision making process between the contractors, the CPA and 
ILAB on the changes and a detailed table explaining how the 
funds were eventually spent by the contractors.
    The Committee deems it very important that ILAB deepen and 
improve its permanent capacity to compile and report to the 
Congress annually on the extent to which each foreign country 
that has trade and investment agreements with the United States 
enforces internationally-recognized worker rights. This report 
is required under multiple U.S. laws and promotes core labor 
standards as embodied in the ILO Declaration on Fundamental 
Principles and Rights at Work as adopted and reaffirmed in 
1998. The Committee is aware that currently this report only 
tracks the progress of countries that are designated as 
beneficiaries under the U.S. Generalized System of Preferences 
[GSP]. The GSP program grants duty-free treatment to specified 
products imported from developing countries and territories. As 
the United States' negotiates separate Free Trade Agreements 
with GSP beneficiaries, the DOL stops tracking their progress 
in the elimination of abusive and exploitative child labor. 
Therefore, the Committee directs the Secretary to include in 
the 2005 report, all former GSP recipients that have negotiated 
Free Trade Agreements with the United States over the last 2 
years. The Committee has provided $5,000,000 for the 
compilation of this report. The Committee further includes 
$2,500,000 for bilateral and multilateral assistance, to be 
used to promote the International Labor Organization's 
Declaration of Fundamental Principles and Rights at Work.
    The Committee recommends $10,000,000 for HIV/AIDS workplace 
education, for the purpose of providing the ILO with assistance 
to conduct global education and prevention programs. For other 
ILAB programs, including 125 FTE for Federal Administration, 
the Committee recommends $11,000,000.
    The Committee expects that the administration's fiscal year 
2006 Departmental Management budget justification material will 
include detailed information on past year, current year, and 
budget year spending and estimate for international travel 
taken by Department of Labor employees and officials related to 
ILAB activities, including amounts by appropriation account 
throughout the Labor Department.
    Acknowledging the need to upgrade the information 
technology capability in the Department of Labor, the Committee 
provides $33,565,000 for the information technology fund, and 
$4,965,000 for management cross cut activities. The total 
provided includes support for cross-cutting investments such as 
common office automation suite implementation, architecture 
requirements, equipment, software, and related needs, as well 
as human resource management. In addition, $15,000,000 of the 
requested $25,000,000 is recommended for a separate Working 
Capital Fund appropriation, for implementation of a new core 
accounting system for the Department of Labor.
    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 notes with approval the increased attention 
being paid to the coordination of human services with 
transportation. The Committee notes the recent executive order 
issued by the President calling for a report on transportation 
coordination within 1 year. The Committee expects the Labor 
Department, as one of the lead agencies mentioned in the 
executive order to report its findings to the Committee as soon 
as the study is complete.

                    VETERANS EMPLOYMENT AND TRAINING

Appropriations, 2004....................................    $218,646,000
Budget estimate, 2005...................................     220,648,000
Committee recommendation................................     226,781,000

    The Committee recommendation includes $226,781,000 for this 
account, including $32,683,000 in general revenue funding and 
$194,098,000 to be expended from the ``Employment Security 
Administration'' account of the unemployment trust fund. This 
is $8,135,000 more than the 2004 comparable level.
    For State grants the bill provides $162,415,000, which 
includes funding for the Disabled Veterans Outreach Program and 
the Local Veterans Employment Representative Program.
    For Federal administration, the Committee recommends 
$29,683,000, the same as the budget request. 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 
this effective program.
    Individuals leaving the military may be at high risk of 
homelessness due to a lack of job skills transferable to the 
civilian sector, disrupted or dissolved family and social 
support networks, and other risk factors that preceded their 
military service. The Committee expects the Secretary of Labor 
to ensure that a module on homelessness prevention is added to 
the Transition Assistance Program curriculum. The module should 
include a presentation on risk factors for homelessness, a 
self-assessment of risk factors, and contact information for 
preventative assistance associated with homelessness.
    The Committee recommendation includes $2,000,000, the same 
as the budget request, 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 recommendation includes $23,000,000 for the 
Homeless Veterans Program, an increase of $4,000,000 over the 
budget request. Also included is $9,683,000 for the Veterans 
Workforce Investment Program, an increase of $2,133,000 over 
the budget request.
    The Committee is interested in ensuring that qualified job 
training programs of the Department of Labor fully extend 
priority of service for veterans as required by the Jobs for 
Veterans Act. Toward this effort, the Committee urges the 
Secretary to develop a guide for veterans in accessing 
workforce investment planning processes; and a guide to inform 
workforce systems on the employment services needs of veterans 
and the responsibility of such systems to prioritize veterans 
for services and to collaborate with veterans organizations and 
providers. The Committee urges the Secretary to instruct State 
workforce agencies to increase their outstationing of disabled 
veterans outreach program specialists and local veterans 
employment representatives in locations where homeless veterans 
congregate, including grantees under the homeless provider 
grant and per diem program and the homeless veterans 
reintegration program.

                    OFFICE OF THE INSPECTOR GENERAL

Appropriations, 2004....................................     $65,339,000
Budget estimate, 2005...................................      69,590,000
Committee recommendation................................      69,590,000

    The bill includes $69,590,000 for this account, $4,251,000 
above the 2004 comparable level. The bill includes $64,029,000 
in general funds and authority to transfer $5,561,000 from the 
``Employment Security Administration'' account of the 
unemployment trust fund. In addition, an amount of $342,000 is 
available by transfer from the black lung disability trust 
fund. This level provides sufficient resources to cover built-
in cost increases, as well as funding of requested program 
increases.
    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 II (sec. 
101).
    Limits reprogramming and transfers of appropriated funds 
between programs, projects, and activities, and requires 15 
days notification to both the House and Senate Appropriations 
Committees (sec. 102).
    Prohibit funding for the procurement of goods and services 
utilizing forced or indentured child labor in industries and 
host countries already identified by the Labor Department (sec. 
103 in accordance with Executive Order 13126).
    Authorize funds to be appropriated for job training for 
workers involved in construction projects funded through the 
Denali Commission (sec. 104).
    Require the Secretary of Labor to issue a monthly transit 
subsidy of not less than the amount each employee of the 
National Capitol Region is eligible to receive, not to exceed a 
maximum of $100 (sec. 105).
    Require the Department of Labor to submit its fiscal year 
2006 congressional budget justifications in the traditional 
budget structure rather than in a ``performance'' budget 
structure. The Department is directed to develop and present 
the fiscal year 2006 budget justification delineated by 
appropriation account, providing detailed information on the 
prior year, current year, and requested budget year funding and 
Federal staffing levels for each program, project, or activity 
funded within each account; a detailed narrative description of 
each program, project, or activity; and any proposed changes to 
such program, project, or activity. Additional performance 
budget and measurement information should be submitted as a 
separate appendix in the budget justification material. The 
Department is encouraged to continue using outcome and 
performance measures as the primary management tool for 
resource allocation and the evaluation of programs and 
individuals (sec. 106).
    Require that none of the funds provided in this Act may be 
used by the Department of Labor to implement or administer any 
changes to regulations regarding overtime compensation in 
effect on July 14, 2004, except those changes in section 
541.600 of the Department's final regulation specifying the 
amount of salary required to qualify as an exempt employee. 
This provision requires the immediate re-instatement and 
enforcement of the old overtime regulations in effect on July 
14, 2004, except for the new section 541.600 salary 
requirements (secs. 107 and 108).

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

              Health Resources and Services Administration

                     HEALTH RESOURCES AND SERVICES

Appropriations, 2004....................................  $6,618,303,000
Budget estimate, 2005...................................   6,047,833,000
Committee recommendation................................   6,966,280,000

    The Committee provides a program level of $6,966,280,000 
for the Health Resources and Services Administration [HRSA]. 
The Committee recommendation includes $6,941,280,000 in budget 
authority and an additional $25,000,000 via transfers available 
under section 241 of the Public Health Services Act. The fiscal 
year 2004 comparable program level was $6,618,303,000 and the 
administration request program level was $6,047,833,000. The 
Committee has also provided $503,649,000 in the Public Health 
and Social Services Emergency Fund for programs administered by 
HRSA. The HRSA portion of the Committee report has been 
organized in a manner consistent with the organizational 
structure of HRSA.
    Health Resources and Services Administration 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.
    As emphasized in past years, the Committee strongly 
supports the establishment of Centers of Excellence for 
Indigenous Health and Healing at schools that serve native 
peoples including American Indians, Alaska Natives and Pacific 
Islanders. The incorporation of traditional medicine and 
healing practices into the training of medical, nursing, social 
work, psychology, pharmacy and public health students will not 
only advance these disciplines but also enhance the health care 
services delivered to these populations. The Committee 
encourages HRSA to support these concepts in their awarding of 
grants wherever native and indigenous people reside.
    The Committee urges HRSA to consider waivers for rural or 
isolated area demonstration projects when calculating 
requirements such as population density in the State of Hawaii.

                     BUREAU OF PRIMARY HEALTH CARE

                             HEALTH CENTERS

    The Committee provides $1,867,381,000 for the consolidated 
health centers. The fiscal year 2004 comparable program level 
was $1,617,381,000 and the administration request program level 
was $1,835,925,000. This group of programs includes community 
health centers, migrant health centers, health care for the 
homeless, and public housing health service grants.
    Within the amount provided, $31,000,000 is for base grant 
adjustments for existing health centers. Funding should be used 
to offset the rising cost of health care nationwide, and also 
to resolve specific financial situations beyond the control of 
the local health center, such as unusual increases in the 
number of uninsured patients seeking care.
    The Committee supports the long-standing HRSA policy of 
approving specific qualified applications for future funding. 
This process enables high-quality applicants to take steps to 
develop and implement care delivery systems in their 
communities instead of wasting scarce resources to reapply for 
funding. However, HRSA should limit the use of this mechanism 
in a manner consistent with expected Presidential requests.
    The Committee is concerned that providers serving special 
populations (including migrant, homeless, school-based and 
frontier providers) have been largely unable to meet the 
current funding criteria used to determine health center 
funding, and encourages HRSA to establish distinct criteria and 
funding methodologies that recognize the unique needs of these 
communities and populations.
    The Committee has limited the amount of funds available for 
the payment of claims under the Federal Tort Claims Act to 
$45,000,000. This is the same as the amount provided in fiscal 
year 2004, and the same as the President's request. Bill 
language has been included to indicate that this funding is 
available until expended.
    The Committee does not provide additional funds for loan 
guarantee authority under section 330(d) of the Public Health 
Service Act. The Committee notes that $121,000,000 in loan 
guarantee authority from the $160,000,000 appropriated in 
fiscal years 1997 and 1998 continues to remain available for 
guarantees of both loan principal and interest.

Community Health Centers

    Community health centers improve the health of Americans by 
providing comprehensive primary and preventive health care 
services to underserved populations in rural and urban areas, 
regardless of ability to pay. Of the clients served by 
community health centers, over 39 percent had no insurance, 64 
percent were minorities, 47 percent lived in rural areas, and 
28 percent were children under 12 years of age.
    The Committee is concerned that Federal community health 
center funds are often not available to small, remote 
communities in Alaska, Hawaii and other similar States because 
the population base is too small. Many of these communities 
have no health service providers and residents are forced to 
travel long distances by boat or plane even in emergency 
situations. The Committee continues to support the 
administration's effort to double community health center 
funding to address the growing number of uninsured persons in 
this country, but, without new approaches to providing health 
services, many will not benefit from the proposed increases in 
funding. The Committee recommends that HRSA examine its 
regulations and applications procedures to ensure they are not 
unduly burdensome and are appropriately flexible to meet the 
needs of these communities. The Committee applauds the agency 
for its initiatives such as the ``Alaska Frontier Health Plan'' 
and encourages the agency to continue and expand its efforts 
with this program.
    The Committee continues to believe that community health 
centers are a critical source of care for the underserved in 
remote rural areas. The Committee commends HRSA for its 
continued efforts to visit and evaluate many rural and 
underserved areas across the country. New and expanded health 
centers in remote communities are critically needed. The 
Committee understands that nurse practitioners could be 
instrumental in expanding the services offered by new and 
existing centers. The Committee understands that opportunities 
exist for the increased use of nurses in rural community health 
centers through collaboration with the National Institute of 
Nursing Research. The Committee strongly urges such 
collaborations. In addition, the Committee understands that 
telemedicine technology is often used to maximize resources and 
collaborative communication, and encourages increased use of 
these technologies. The Committee applauds HRSA for the 
continued work that has been done to reexamine regulations and 
to create an on-line grant application process.
    The Committee recognizes that Nurse-Managed Health Centers 
[NMHCs] serve a dual function in strengthening the health care 
safety net by providing health care to populations in 
underserved areas and by providing the clinical experiences to 
nursing students that are mandatory for professional 
development. Recognizing that NMHCs are frequently the only 
source of health care to their patients and that a lack of 
clinical education sites for nurses is a contributing factor to 
the nationwide nursing shortage, the Committee encourages HRSA 
to provide alternative means to secure cost-based reimbursement 
for NMHCs, by providing that reimbursement or by granting 
university-based CHCs. In addition, the Committee urges HRSA to 
research the effectiveness of nurse-managed health centers as a 
national model to reduce health disparities.
    The Committee appreciates the attention paid by the HRSA 
Administrator to the special health care needs of Native 
Hawaiians and the medically underserved, especially to those 
living on the ``neighbor islands'' of Hawaii. The diverse, 
rural and underserved Native Hawaiian populations of the island 
of Molokai face challenges in obtaining comprehensive primary 
care and prevention interventions. Drug abuse prevention among 
youth is particularly difficult to obtain. The Committee urges 
HRSA to provide technical assistance in the preparation and 
submission of grants for new community health centers to the 
community health leaders of Molokai, Lanai, and all other 
underserved areas of the country. The Committee believes that 
linking new centers to existing health care programs and 
facilities is an efficient use of resources.
    The Committee is pleased with efforts at our Nation's 
community health centers to address the health disparities of 
American Samoans.
    Congress recognized the need to provide mental and 
behavioral health services to the underserved through the 
Federal Community Health Centers in the Safety Net Legislation 
of 2001. The Committee encourages HRSA to expand its efforts to 
provide mental and behavioral health services by increasing the 
number of psychologists in Community Health Centers nationwide.
    An estimated 80 million people have a potentially blinding 
eye disease, 3 million have low vision, 1.1 million are legally 
blind, and 200,000 are more severely visually impaired. While 
it is believed that half of all blindness can be prevented, the 
number of Americans who suffer vision loss continues to 
increase. To address this growing problem, the Committee urges 
the Administrator to strengthen the vision health services at 
community health centers by establishing partnerships with 
voluntary health organizations to improve the overall quality 
of eye care, including comprehensive vision screenings and 
appropriate follow up care.
    The Committee recognizes that prenatal alcohol exposure is 
the leading known cause of mental retardation in the United 
States. It is associated with lifelong difficulties with 
learning, memory, attention, and problem solving as well as 
problems with mental health and social interactions. Each year, 
approximately 40,000 children are born with Fetal Alcohol 
Spectrum Disorders [FASD]. This amounts to almost 1 out of 100 
live births, with a disproportionate impact on underserved 
American Indian and African American populations. The Committee 
has provided sufficient funding to coordinate, develop, and 
begin implementation of a program in collaboration with a 
national voluntary organization that incorporates sustainable 
systems in community health center delivery sites around the 
Nation focusing on the prevention, identification, and support 
of individuals with FASD.
    The Committee is concerned by the increasing disparity in 
the amount of applications received and grants awarded to 
States under section 330, in particular the Health Center 
grants. Because of this disparity, many high need States and 
local communities are not being benefited by a program 
specifically designed to serve their needs. The Committee 
acknowledges that this is a competitive grant program and not 
all grant applications submitted are of the quality necessary 
to receive funding. However, recent trends indicate that there 
may be other factors contributing to this problem. Therefore, 
the Committee requests that HRSA study this issue further and 
within 90 days of enactment of this Act, prepare and submit a 
report to the Committee that includes factors contributing to 
the disparity and ways that HRSA hopes to remedy these factors.

School-Based Health Centers

    This program provides grants for comprehensive primary and 
preventive health care services and health education to at-risk 
and medically underserved children and youth. Grants are 
awarded to public or private, nonprofit, community-based health 
care providers. Through agreements with a local school or 
school system, the health care entity provides the services in 
the school building or on school grounds.
    The Committee is pleased with the success of the school-
based health center initiative, however is concerned that in 
the last fiscal year only 3 of 43 applications were funded. The 
Committee expects HRSA to continue to target funds for school-
based health centers operated by fully qualified organizations 
and expresses concern that school-based health centers often 
experience difficulty completing the complex application 
process for community health center funding. The Committee 
requests that HRSA establish a separate application process for 
school-based health centers that recognizes the distinct 
patient volume, productivity, scope of service, and staffing 
requirements that are more appropriate to school-based delivery 
systems.

Migrant Health Program

    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.

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 sufficient funding 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 $15,000,000 be provided 
for these activities in fiscal year 2005.

Free Clinics Medical Malpractice Coverage

    The Committee provides $4,821,000 in funding for payments 
of claims under the Federal Tort Claims Act to be made 
available for free clinic health professionals as authorized by 
U.S.C. Title 42, Section 233(o) of the Public Health Service 
Act.
    This appropriation continues to extend Federal Tort Claims 
Act coverage to medical volunteers in free clinics in order to 
expand access to health care services to low-income individuals 
in medically underserved areas. According to Title 42, Section 
233(o), a free clinic must apply, consistent with the 
provisions applicable to community health centers, to have each 
health care professional ``deemed'' an employee of the Public 
Health Service Act, and therefore eligible for coverage under 
the Federal Tort Claims Act. The Committee urges HRSA to create 
a deeming process as quickly as possible to ensure that health 
professionals treating patients at free clinics have access to 
this coverage in a timely manner. HRSA should make every effort 
to make the deeming process as efficient as possible and to 
prevent the process from becoming a barrier to use of the 
program.

Radiation and Exposure Screening and Education Program

    The Committee provides $1,974,000 for the Radiation 
Exposure Compensation Act. The fiscal year 2004 comparable 
level was $1,974,000 and the administration request was 
$1,974,000. This program provides grants for the education, 
prevention, and early detection of radiogenic cancers and 
diseases resulting from exposure to uranium during its mining 
and milling at nuclear test sites.

Health Care Access for the Uninsured/Community Access Program

    The Committee provides $88,674,000 for the Community Access 
Program. The fiscal year 2004 comparable level was $83,674,000 
and the administration requested $9,998,000 for a new version 
of this program in fiscal year 2005. The Committee has provided 
these funds to continue the Community Access Program in its 
current form, which is designed to increase the capacity and 
effectiveness of community health care institutions and 
providers who serve patients, regardless of their ability to 
pay. The Committee does not approve the new use of these funds 
to create Health Center Networks. The Committee does approve 
the use of up to $4,900,000 for additional Chronic Disease 
Management activities provided by grantees of this program.
    Community Health Centers have the potential to serve as a 
valuable resource in biomedical and behavioral research aimed 
at reducing health status disparities among minority and 
medically underserved populations. The Committee continues to 
encourage HRSA, through the Community Access Program, to 
prioritize the establishment of demonstration projects between 
Community Health Centers and minority health professions 
schools for the purpose of health status disparities research 
and data collection. Such demonstration projects were 
authorized in the ``Health Care Safety Net Amendments of 
2002.''

National Hansen's Disease Program

    The Committee has included $17,413,000 for the National 
Hansen's Disease Program. The fiscal year 2004 comparable level 
was $17,413,000 and the administration request was $17,413,000 
in fiscal year 2005. This program offers Hansen's Disease 
treatment in Baton Rouge at the Center, at other contract 
supported locations in Baton Rouge, and in grant supported 
outpatient regional clinics. These programs provide treatment 
to about 3,000 of the 6,000 Hansen's disease sufferers in the 
United States.

National Hansen's Disease Program Buildings and Facilities

    The Committee provides $249,000 for buildings and 
facilities. The fiscal year 2004 comparable level was $249,000 
and the administration request was $249,000. This funding 
provides for the repair and maintenance of buildings at the 
Gillis W. Long Hansen's Disease Center.

Payment to Hawaii for Hansen's Disease Treatment

    The Committee provides $2,033,000 for Hansen's disease 
services. The fiscal year 2004 comparable level was $2,033,000 
and the administration requested $2,033,000.

Black Lung Clinics

    The Committee provides $6,000,000 for black lung clinics. 
The fiscal year 2004 comparable level was $5,963,000 and the 
administration requested $5,963,000. This program funds clinics 
that treat respiratory and pulmonary diseases of active and 
retired coal miners. These clinics reduce the incidence of 
high-cost inpatient treatment for these conditions.

                      BUREAU OF HEALTH PROFESSIONS

National Health Service Corps: Field Placements

    The Committee provides $45,735,000 for field placement 
activities. The fiscal year 2004 comparable level was 
$45,506,000 and the administration request was $45,735,000. 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.
    The Committee is pleased by the increasing percentage of 
placements of NHSC assignees at Community, Migrant, Homeless, 
and Public Housing Health Centers. The Committee encourages 
HRSA to further expand this effort to ensure that the health 
center expansion effort is sustainable and has access to a 
sufficient level of health professionals.
    The Committee is concerned by reports that the current HPSA 
scoring process used by HRSA may be disadvantaging many health 
centers located in medically underserved areas of the country. 
The Committee urges HRSA to look into these reports and 
reconsider requirements that might eliminate health centers 
from eligibility for the placement of NHSC scholars, Ready 
Responders, and HHS' J-1 Visa waiver program.

National Health Service Corps: Recruitment

    The Committee provides $127,397,000 for recruitment 
activities. The fiscal year 2004 comparable level was 
$124,397,000 and the administration request was $159,132,000. 
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. These funds should support multi-year, rather than 
single-year, commitments. The Committee has not included bill 
language requested by the administration that would have 
established a Commissioned Corps reserve within the National 
Health Service Corps and the Committee does not intend for 
funds to be used for this purpose.
    Of this amount, $3,000,000 is designated for the 
demonstration program which allows chiropractors to participate 
in the National Health Service Corps student loan forgiveness 
program, as authorized under section 338L of the Public Health 
Service Act. The Committee is concerned that funding provided 
for this demonstration in fiscal year 2003 resulted in only 
eight chiropractic demonstrations nationwide. The purpose of 
the demonstration program was to collect data on comprehensive 
patient outcomes associated with community health centers that 
provided chiropractic services. While the Committee is 
comfortable with conclusions drawn from the data collected on 
the 24 pharmacists in the demonstration program and looks 
forward to that information in the coming year, the Committee 
believes that eight chiropractors is not a statistically 
significant figure and conclusions cannot safely be drawn from 
this part of the demonstration. Therefore, the Committee 
expects HRSA to use these funds to conduct another 
demonstration on a cohort of exclusively chiropractors and 
report to the Committee on the findings.
    The Committee commends the National Health Service Corps 
for its focus on ensuring a workforce for integrated, 
comprehensive health care for the underserved that includes 
mental and behavioral health services. The Committee urges the 
NHSC to continue its efforts, increase the number of 
psychologists in the Loan Repayment Program and begin, for the 
first time, to support psychology students in the Scholarship 
Program.
    The national nursing shortage is pervasive throughout all 
of the varied practice, educational and research settings. The 
United States Public Health Commissioned Corps is a critical 
aspect of our Nation's public health infrastructure and will be 
relied upon to respond to a terrorist or bioterrorist event. 
With the passage of the Nurse Reinvestment Act in 2002, a 
National Nurse Corps grant program was established. Coupled 
with the National Health Service Corps, the new National Nurse 
Corps program may serve as a nurse recruiting pool for the 
Commissioned Corps. The Committee urges HRSA to establish 
mechanisms to encourage National Nurse Corps grant recipients 
to enter the Public Health Service Commissioned Corps.

                           HEALTH PROFESSIONS

    The Committee provides $465,357,000 for all HRSA health 
professions programs. The fiscal year 2004 comparable level was 
$436,080,000 and the administration requested $157,783,000 in 
fiscal year 2005.
    The Committee commends HRSA for its continuing efforts to 
address the growing gap between the size of the Nation's aging 
baby boom population and the number of pulmonary/critical care 
physicians. The committee understands that HRSA is still 
developing a report on the healthcare workforce shortage issue, 
and that the portion of the report that will attempt to 
identify the causes of, and potential responses to, the 
critical care workforce shortage will be informed, in part, by 
The Critical Care Medicine Crisis: A Call For Federal Action 
prepared by the American College of Chest Physicians [ACCP] and 
the members of the Critical Care Workforce Partnership. The 
Committee continues to encourage HRSA to address the critical 
care workforce shortage issue and use the pulmonary/critical 
care specialty as a model for developing and testing policy 
approaches to address workforce shortage issues.
    The Committee previously asked HRSA to complete a national 
study on the status of pediatric rheumatology in the United 
States. The Committee urges HRSA to conclude its research in 
this area in partnership with the Arthritis Foundation. As 
provided in the Children's Health Act of 2000, this study 
assesses the current pediatric services shortage and identifies 
strategies for addressing this significant shortage for 
children with arthritis.

Training for Diversity

            Centers of Excellence
    The Committee provides $33,882,000 for the Centers of 
Excellence program. The fiscal year 2004 comparable level was 
$33,882,000 and the administration did not request any funds 
for this program in fiscal year 2005. 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 HRSA has re-focused the 
Minority Centers of Excellence program on providing support to 
historically minority health professions institutions. The 
Committee recognizes the important role of this program in 
supporting faculty and other academic programs at minority 
institutions. The Committee continues to encourage the Centers 
of Excellence program to consider applications that are 
responsive to allied health professions which are experiencing 
shortages and high vacancy rates, such as laboratory personnel.
            Health Careers Opportunity Program
    The Committee provides $35,935,000 for the Health Careers 
Opportunity Program. The fiscal year 2004 comparable level was 
$35,935,000 and the administration did not request any funds 
for this program in fiscal year 2005. This program provides 
funds to medical and other health professions schools for 
recruitment of disadvantaged students and pre-professional 
school preparations. The Committee continues to encourage the 
H-COP program to consider applications that are responsive to 
allied health professions which are experiencing shortages and 
high vacancy rates, such as laboratory personnel.
    The Committee is concerned about the reduced level of 
support provided to minority health professions schools through 
the H-COP program in fiscal year 2004. For fiscal year 2005, 
the Committee encourages HRSA to give priority consideration to 
awarding grants to those institutions with a historic mission 
of training minorities in the health professions.
            Faculty Loan Repayment
    The Committee provides $1,313,000 for the Faculty Loan 
Repayment program. The fiscal year 2004 comparable level was 
$1,313,000 and the administration did not request any funds for 
this program in fiscal year 2005. 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
    The Committee provides $47,510,000 for the Scholarships for 
Disadvantaged Students program. The fiscal year 2004 comparable 
level was $47,510,000 and the administration requested 
$9,897,000 for this program in fiscal year 2005. 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.

Training in Primary Care Medicine and Dentistry

    The Committee provides $90,742,000 for Training in Primary 
Care Medicine and Dentistry programs. The fiscal year 2004 
comparable level was $81,742,000 and the administration did not 
request funding for this program in fiscal year 2005.
            Family Medicine Training
    Family medicine activities support grants for graduate 
training in family medicine, grants for pre-doctoral 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 recognizes that these programs play a 
critical role in meeting the oral health care needs of 
Americans; especially those who require specialized or complex 
care and represent vulnerable populations in underserved areas. 
Additionally, rural States are disproportionately underserved 
by pediatric dentists. The Committee notes that several States 
have fewer than 10 pediatric dentists. This clearly is not 
enough to address American children's needs. The Committee 
intends that the Pediatric Dental Program be continued with at 
least the fiscal year 2004 funding level.

Interdisciplinary, Community-based Linkages

            Area Health Education Centers
    The Committee provides $29,206,000 for the Area Health 
Education Centers program. The fiscal year 2004 comparable 
level was $29,206,000 and the administration did not request 
any funds for this program in fiscal year 2005. 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 Area Health Education Centers [AHEC] 
grants; and model programs to extend AHEC programs with 50 
percent Federal funding.
            Health Education and Training Centers
    The Committee provides $3,851,000 for the Health Education 
and Training Centers program. The fiscal year 2004 comparable 
level was $3,851,000 and the administration did not request any 
funds for this program in fiscal year 2005. 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 and Other Disciplines
    The Committee provides $11,849,000 for the Allied Health 
and Other Disciplines programs. The fiscal year 2004 comparable 
level was $11,849,000 and the administration did not request 
any funds for this program in fiscal year 2005. These programs 
seek to improve access, diversity, and distribution of allied 
health practitioners to areas of need. The program improves 
access to comprehensive and culturally competent health care 
services for underserved populations.
    The Committee continues to encourage HRSA to give priority 
consideration to projects for schools training allied health 
professionals experiencing shortages, such as medical 
technologists and cytotechnologists. The Committee is concerned 
about high vacancy rates for these critical laboratory 
personnel and urges HRSA to redouble efforts to address these 
shortages.
    The Committee understands the Graduate Psychology Education 
Program is the only federally funded psychology training 
program, and for this reason, considers its continuation a 
priority. This competitive program will continue to provide 
grant awards for work with underserved populations, 
particularly in rural communities, including elderly, children, 
the chronically ill, and victims of abuse or terror.
            Geriatric Education Centers and Training
    The Committee provides $31,805,000 for the Geriatrics 
Education Centers and Training programs. The fiscal year 2004 
comparable level was $31,805,000 and the administration did not 
request any funds for this program in fiscal year 2005. This 
program supports grants to health professions schools to 
establish geriatric education centers and to support geriatric 
training projects. 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 workforce necessary to care for the 
Nation's elderly.
            Quentin N. Burdick Program for Rural Health 
                    Interdisciplinary Training
    The Committee provides $6,126,000 for these programs. The 
fiscal year 2004 comparable level was $6,126,000 and the 
administration did not request any funds for this program in 
fiscal year 2005. 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.
    This program continues to be an important mechanism for 
addressing the shortages of health professionals in rural 
areas. Particularly commendable is the focus on rural health 
training projects that stimulate interdisciplinary practice and 
expose students to the unique needs of rural populations. The 
Committee encourages an emphasis on telemedicine technology to 
maximize accessibility to resources. The Committee remains 
concerned about the critical shortage of nurses and this should 
continue to be addressed at every opportunity.
            Podiatric Primary Care Training
    This 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
    This 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 continues to support the chiropractic 
research and demonstration grant program, originally authorized 
under Section 782 of Public Law 102-408, and funded by the 
Committee in previous years. The Committee recommends that the 
chiropractic-medical school demonstration grant program be 
continued.
    The Committee is aware that the initial authorization for 
this program indicated that the funds were to go to colleges 
and universities for the purpose of encouraging collaboration 
between chiropractors and physicians on identifying and 
providing effective treatment of spinal and lower back 
conditions. It is the contention of this Committee that 
interdisciplinary training programs are an integral component 
of expanding the identification and treatment of these 
conditions. The Committee is aware that a requirement of the 
program is the participation of a school of medicine or a 
school of osteopathic medicine. Given that the very purpose of 
these entities is to train healthcare professionals, the 
Committee concludes that training programs are well within the 
eligible activities of this program.

Workforce Information and Analysis

    The Committee provides $993,000 for these programs. The 
fiscal year 2004 comparable level was $722,000 and the 
administration requested $993,000.
            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 
workforce 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.

Public Health Workforce Development

    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, Preventive Medicine, and Dental Public 
                    Health Programs
    The Committee provides $9,170,000 for these programs. The 
fiscal year 2004 comparable level was $9,170,000 and the 
administration did not request any funds for this program in 
fiscal year 2005. 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.
            Health Administration Programs
    The Committee provides $1,079,000 for the Health 
Administration programs. The fiscal year 2004 comparable level 
was $1,079,000 and the administration did not request any funds 
for this program in fiscal year 2005. These programs provide 
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.

Nursing Workforce Development Programs

    The Committee provides $161,890,000 for the Nursing 
Workforce Development programs. The fiscal year 2004 comparable 
level was $141,890,000 and the administration requested 
$146,887,000 for this program in fiscal year 2005. The 
Committee recognizes that the current nursing shortage has 
reached a crisis state across America. The situation only 
promises to worsen due to a lack of young nurses in the 
profession, an aging existing workforce, and inadequate 
availability of nursing faculty to prepare future nurses. The 
Committee urges HRSA to support programs aimed at increasing 
nursing faculty and encouraging a diverse population's entry 
into nursing.
    The Committee is aware of the Labor Department's 
partnership with the Council for Adult and Experimental 
Learning [CAEL] to address the Nation's shortage of nurses. The 
Committee encourages HRSA to consider extending and expanding 
these, and other, successful nurse training partnerships.
            Advanced Education Nursing
    The Committee provides $58,636,000 for the Advanced 
Education Nursing programs. The fiscal year 2004 comparable 
level was $58,636,000 and the administration requested 
$43,637,000 for this program in fiscal year 2005. 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.
    With spiraling health care costs and the shortage of 
professionals, the need to prepare quality, cost effective 
providers such as nurse practitioners and nurse mid-wives 
continues to be acute. The Committee understands that Nurse 
Practitioners have been shown to provide high quality, cost 
effective care in whatever geographic environment they 
practice. The Committee believes that it is important to 
prepare enough of these providers to meet health needs within 
the current national shortages. The Committee urges HRSA to 
maximize advanced education traineeships for these two proven 
critical specialties.
            Nurse Education, Practice, and Retention
    The Committee provides $41,765,000 for the Nurse Education, 
Practice, and Retention Programs. The fiscal year 2004 
comparable level was $31,768,000 and the administration 
requested $41,765,000 for this program in fiscal year 2005. 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 nursing 
workforce and empower the workforce to meet the demands of the 
current health care system.
            Nursing Workforce Diversity
    The Committee provides $21,399,000 for the Nursing 
Workforce Diversity program. The fiscal year 2004 comparable 
level was $16,402,000 and the administration requested 
$21,399,000 for this program in fiscal year 2005. The goal of 
this program is to improve the diversity of the nursing 
workforce through increased educational opportunities for 
individuals from disadvantaged backgrounds. The Committee urges 
the Division of Nursing to develop and increase cultural 
competence in nursing and to increase the number of 
underrepresented racial and ethnic minorities in all areas of 
nursing education and practice to enhance nurses' ability to 
provide quality health care services to the increasingly 
diverse community it serves.
    Racial/ethnic minorities comprise about 12.3 percent of the 
current Registered Nurse population, compared to about 28 
percent in the U.S. population. While efforts to deliver 
culturally competent care with our current nursing population 
are considerable and somewhat successful, there remains a 
unique and critical need for more minority registered nurses. 
The Committee recognizes that recent layoffs have 
disproportionately impacted minority workers, and that nursing 
recruitment efforts may naturally find emphasis among this 
population. The Committee believes that increasing the ethnic 
and cultural competence of nursing and other health professions 
groups is critical to decreasing the health disparities of this 
Nation. The Committee encourages HRSA to partner with 
professional nursing organizations to create diversity 
leadership programming and training as well as recruiting, 
retaining and mentoring minority nurses in both the nursing 
profession and in leadership positions within the profession. 
These partnerships should focus on the goal of providing more 
culturally relevant health care so as to decrease the national 
infant mortality rate.
            Nurse Loan Repayment and Scholarship Program
    The Committee provides $31,742,000 for the Nurse Loan 
Repayment and Scholarship programs. The fiscal year 2004 
comparable level was $26,736,000 and the administration 
requested $31,738,000 for this program in fiscal year 2005. 
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.
            Nurse Faculty Loan Program
    The Committee provides $4,870,000 for the Nursing Faculty 
Loan program. The fiscal year 2004 comparable level was 
$4,870,000 and the administration requested $4,870,000 for this 
program in fiscal year 2005. This program supports the 
development of a student loan fund in schools of nursing to 
increase the number of qualified nursing faculty.
    The Committee recognizes that a shortage of faculty in 
schools of nursing is contributing to the nationwide shortage 
of Registered Nurses [RNs]. The Committee understands that in 
2003, nursing programs turned away more than 16,000 potential 
students due to a lack of faculty, clinical sites, and 
classroom space. The Committee cites the Bureau of Labor 
Statistics projected need for 1.1 million new and replacement 
RNs by the year 2012. With the growing demand for health 
services and the care provided by an essential nursing 
workforce, the Committee urges HRSA to focus funding and 
efforts on resolving the growing shortage of faculty necessary 
to educate the future nursing workforce.
            Comprehensive Geriatric Education
    The Committee provides $3,478,000 for Comprehensive 
Geriatric Education grants. The fiscal year 2004 comparable 
level was $3,478,000 and the administration requested 
$3,478,000 for this program in fiscal year 2005. These grants 
prepare nursing personnel to care for the aging population.

Children's Hospitals Graduate Medical Education Program

    The Committee has provided $303,258,000 for the Children's 
Hospitals Graduate Medical Education [GME] program. The fiscal 
year 2004 comparable level was $303,170,000 and the 
administration requested $303,258,000 for this program in 
fiscal year 2005.
    The program provides support for health professions 
training in children's teaching hospitals that have a separate 
Medicare provider number (``free-standing'' children's 
hospitals). Children's hospitals are statutorily defined under 
Medicare as those whose inpatients are predominantly under the 
age of 18. The funds in this program are intended to make the 
level of Federal Graduate Medical Education support more 
consistent with other teaching hospitals, including children's 
hospitals, which share provider numbers with other teaching 
hospitals. Payments are determined by formula, based on a 
national per-resident amount. Payments support training of 
resident physicians as defined by Medicare in both ambulatory 
and inpatient settings.

National Practitioner Data Bank

    The Committee provides $15,700,000 for the national 
practitioner data bank. The fiscal year 2004 comparable level 
was $16,000,000 and the administration request was $15,700,000. 
The Committee and the administration assume that full funding 
will be provided entirely through the collection of user fees 
and will cover the full cost of operating the data bank. 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 Committee provides $4,000,000 for the health care 
integrity and protection data bank. The fiscal year 2004 
comparable level was $4,000,000 and the administration request 
was $4,000,000. The Committee and the administration assume 
that full funding will be provided entirely through the 
collection of user fees and will cover the full cost of 
operating the data bank. The data bank is intended to collect, 
maintain, and report on certain actions taken against health 
care providers, suppliers, and practitioners.

                    Maternal and Child Health Bureau


Maternal and Child Health Block Grant

    The Committee provides $734,817,000 for the maternal and 
child health [MCH] block grant. The fiscal year 2004 comparable 
level was $729,817,000 and the administration request was 
$729,817,000.
    The Maternal and Child Health Block Grant program provides 
a flexible source of funding that allows States to target their 
most urgent maternal and child health needs through development 
of community-based networks of preventive and primary care that 
coordinate and integrate public and private sector resources 
and programs for pregnant women, mothers, infants, children, 
and adolescents. The program supports a broad range of 
activities including prenatal care, well child services and 
immunizations, reducing infant mortality, preventing injury and 
violence, expanding access to oral health care, addressing 
racial and ethnic disparities and providing comprehensive care 
for children, adolescents, and families through clinics, home 
visits and school-based health programs.
    The MCH block grant funds are provided to States to support 
health care for mothers and children. According to statute, 85 
percent of appropriated funds up to $600,000,000 are 
distributed to States and 15 percent are set aside for special 
projects of regional and national significance [SPRANS]. Also 
according to statute, 12.75 percent of funds over $600,000,000 
are to be used for community-integrated service systems [CISS] 
programs. The remaining funds over $600,000,000 are distributed 
on the same 85/15 percent split as the basic block grant. The 
Committee has provided $122,530,000 for SPRANS activities. This 
is $17,000,000 more than would otherwise have been available 
under the statutory formula.
    The Committee intends that $4,000,000 of the SPRANS amount 
will be used to continue the sickle cell newborn screening 
program and its locally based outreach and counseling efforts. 
In addition, $5,000,000 of the SPRANS amount is intended to 
continue the oral health demonstration programs and activities 
in the States. The Committee also intends that $3,000,000 of 
the SPRANS amount will be used for mental health programs and 
activities in the States, $3,000,000 of the SPRANS amount will 
be used for epilepsy demonstration projects, and $2,000,000 of 
the SPRANS amount will be used for newborn and child screening 
for heritable disorders as authorized in title XXVI of the 
Children's Health Act of 2000.
    The Committee has again provided $5,000,000 more for SPRANS 
activities than would otherwise be the case under the statutory 
formula for the continuation of oral health programs in the 
States. Through grants, cooperative agreements or contracts, 
these funds may be used to increase access to dental care for 
the most vulnerable low-income children, such as Medicaid, 
SCHIP, and Head Start eligible children and to implement State 
identified objectives for improving oral health. Anticipated 
activities include those targeting the reduction of early 
childhood caries, and strengthening school-linked dental 
sealant programs.
    The Committee also provides an additional $3,000,000 more 
for SPRANS activities than would otherwise be the case under 
the statutory formula for mental health programs and activities 
in the States. The Committee expects that the programs will 
include mental health grants for prevention and early 
intervention services for children and youth ages 0 to 24 years 
and for women's mental health as it relates to their role in 
the family, particularly for women diagnosed with postpartum 
depression [PPD]. One out of every ten new mothers suffers from 
PPD, a treatable condition that presents a range of emotional 
and physical changes. Unfortunately, half of these women never 
get help. The Committee encourages the Bureau to utilize this 
funding to focus on low-income women and mothers of children 
with low birth weight. The Committee recommends that funding be 
used on science-based programs or models such as the Starting 
Early Starting Smart Program that was funded by the Substance 
Abuse and Mental Health Service Administration [SAMHSA] and the 
Casey Family Programs to specifically target early intervention 
and prevention.
    Newborn screening is a public health activity used for 
early identification of infants affected by certain genetic, 
metabolic, hormonal and or functional conditions for which 
there are effective treatments or interventions. Screening 
detects disorders in newborns that, left untreated, can cause 
death, disability, mental retardation and other serious 
illnesses. Biliary atresia, a pediatric liver disease which 
affects 1 in 10,000 infants, is such a condition. If identified 
and treated before the infant reaches the age of 60 days, 
biliary atresia has a high cure rate. If left untreated, it 
will result in liver failure.
    The Committee again provides $2,000,000 within the SPRANS 
amount for the heritable disorders program authorized in title 
XXVI of the Children's Health Act. This program is designed to 
strengthen States' newborn screening programs and improve 
States' ability to develop, evaluate, and acquire innovative 
testing technologies, and establish and improve programs to 
provide screening, counseling, testing and special services for 
newborns and children at risk for heritable disorders. The 
Committee urges HRSA to include additional conditions, such as 
biliary atresia, Fragile X, and abnormally elevated levels of 
bilirubin, in this evaluation of testing programs with the goal 
of implementing cost-effective public health screening programs 
for these and other disorders. The Committee requests a report 
by March 15, 2005 on the steps taken to validate a screening 
tool for biliary atresia and to launch a screening program 
across the country. Given the potential of Fragile X screening 
as a viable prototype for newborn and infant screening, the 
Committee encourages HRSA to allocate funding from the 
heritable disorders screening program toward screening and 
epidemiological research activities related to Fragile X.
    The Committee is aware of the extreme disparities that 
exist among State newborn screening programs for metabolic and 
genetic disorders. Parents and healthcare providers responsible 
for the care of newborns should be able to provide the best 
chance at a healthy start on life. For this reason, the 
Committee strongly urges HRSA to include as a requirement for 
funding a provision that parents be informed in writing of the 
availability of additional tests that may not be required under 
State law.
    The Committee continues to support the Maternal and Child 
Health Bureau's support of comprehensive treatment centers for 
thalassemia patients under the SPRANS program and notes that 
the current funding is due to expire in fiscal year 2005. The 
Committee strongly encourages HRSA to continue this program, 
expand it to include additional centers around the country, and 
to continue to coordinate its activities with those of the 
Cooley's Anemia Foundation.
    The Committee recognizes epilepsy, a chronic neurological 
condition, as a significant public health concern affecting 
over 2,500,000 persons in the United States. As 125,000 new 
cases of epilepsy are diagnosed annually, delayed diagnosis, 
along with inadequate seizure treatment, greatly increases the 
risk of subsequent seizures, brain damage, disability, and 
death. Therefore, timely, effective treatment is essential. The 
Committee is supportive of the epilepsy public health program 
as described by the Children's Health Act of 2000 and of the 
current model demonstration programs and public awareness 
campaigns funded last year that would improve access to health 
and other services to encourage early detection and treatment 
for children and others residing in rural, urban and otherwise 
medically underserved areas. The Committee supports the 
implementation of recommendations addressing access to 
specialty care for underserved and minority populations made in 
Living Well With Epilepsy II. The Committee is pleased that 
HRSA has partnered with a national voluntary epilepsy 
organization to carry out these activities and encourages HRSA 
to continue this partnership, the public awareness campaigns, 
and the demonstration programs.
    The Committee recognizes that numerous and challenging 
problems exist for native Hawaiian children and adolescent 
populations. The Committee urges children and adolescent 
focused initiatives be pursued to provide integrated services 
to this high risk population.
    The Committee commends the work of the Sudden Infant Death 
Syndrome Program Support Center, and encourages the Maternal 
and Child Health Bureau to continue its support of this 
important center. The Committee is pleased with the 
collaboration between the NIH and the SIDS and Other Infant 
Death Program Support Center to address the disproportionately 
high incidence of SIDS among African Americans.
    The Committee recognizes the critical role of the national 
network of hemophilia treatment centers in providing needed 
comprehensive care for bleeding disorders. The Committee urges 
HRSA to provide additional resources to ensure continued access 
to this model disease management network.
    Chronic Fatigue Syndrome [CFS] patients' most crucial need 
is for effective, compassionate medical care. Through its 
demonstration grants program, HRSA has experience in piloting 
new, efficient ways of delivering health care services to those 
with emerging illnesses. The Committee encourages HRSA to 
develop model CFS clinical centers with the goal of delivering 
effective, multidisciplinary clinical care to persons with CFS.
    The Committee recognizes the critical role that Maternal 
and Child Health Centers for Leadership in Pediatric Dentistry 
Education provide in preparing dentists with dual training in 
pediatric dentistry and dental public health. Dentists in the 
three currently funded programs concentrate on working with 
Federal, State and local programs that provide services for 
vulnerable populations including low-income children and women 
and children with special health care needs. Dentists trained 
through these centers provide State and community leadership in 
maternal and child oral health programs, and become future 
faculty specializing in pediatric dentistry and maternal and 
child health. The Committee encourages the Maternal and Child 
Health Bureau to extend this program to all regions.

Traumatic Brain Injury Program

    The Committee provides $9,375,000 for the traumatic brain 
injury program. The fiscal year 2004 comparable level was 
$9,375,000 and the administration requested $9,375,000. The 
program supports implementation and planning grants to States 
for coordination and improvement of services to individuals and 
families with traumatic brain injuries as well as protection 
and advocacy. Such services can include: pre-hospital care, 
emergency department care, hospital care, rehabilitation, 
transitional services, education, employment, and long-term 
support. The Committee includes $3,000,000 for protection and 
advocacy services, as authorized under section 1305 of Public 
Law 106-310.

Healthy Start Initiative

    The Committee provides $105,000,000 for the healthy start 
infant mortality initiative. The fiscal year 2004 comparable 
level was $97,751,000 and the administration request was 
$97,751,000.
    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 Children's Health Act of 2000 
fully authorized this initiative as an independent program.
    The Committee urges HRSA to give preference to current and 
former grantees with expiring or recently expired project 
periods. This should include grantees whose grant applications 
were approved but not funded during fiscal year 2004.

Universal Newborn Hearing Screening and Early Intervention

    The Committee provides $9,872,000 for universal newborn 
hearing screening and early intervention activities. The fiscal 
year 2004 comparable level was $9,872,000 and the 
administration did not request funds for this program in fiscal 
year 2005. The Committee again rejects the administration 
proposal to consolidate this program into the Maternal and 
Child Health Block Grant program.
    The Committee expects HRSA to coordinate projects funded 
with this appropriation with projects related to early hearing 
detection and intervention by the National Center on Birth 
Defects and Developmental Disabilities, the National Institute 
on Deafness and Other Communication Disorders, the National 
Institute on Disability and Rehabilitation Research, and the 
Office of Special Education and Rehabilitative Services.

Emergency Medical Services for Children

    The Committee provides $20,360,000 for emergency medical 
services for children. The fiscal year 2004 comparable level 
was $19,860,000 and the administration requested $19,860,000 
for this program in fiscal year 2005. The program supports 
demonstration grants for the delivery of emergency medical 
services to acutely ill and seriously injured children.
    The Committee continues to be pleased with the efforts made 
for the emergency medical services for children program. The 10 
year Institute of Medicine [IOM] report and study was extremely 
helpful. The Committee is pleased and encouraged with the 
progress being made toward a 20 year update to the IOM report.

Poison Control Centers

    The Committee provides $24,000,000 for poison control 
center activities. The fiscal year 2004 comparable level was 
$23,696,000 and the administration requested $23,696,000 for 
this program in fiscal year 2005. The funds provided support 
activities authorized in the Poison Control Center Enforcement 
and Enhancement Act as well as the development and assessment 
of uniform patient management guidelines.
    The Committee recognizes that poison control centers may 
serve as the entry point for sickened individuals into the 
public health system. Early detection of public health threats 
is critical to limiting the consequences of a threat. 
Therefore, the Committee strongly urges HRSA to work with the 
CDC to find innovative ways to further incorporate the poison 
control centers into the public health infrastructure, 
including the new BioSense initiative. HRSA and CDC should 
cooperate to improve real-time data collection and analysis 
from the poison control centers to identify the presence of a 
potential health threat, including chemical or biological 
attack, as early as possible.

                            HIV/AIDS Bureau


                  ACQUIRED IMMUNE DEFICIENCY SYNDROME

Ryan White AIDS Programs

    The Committee provides $2,079,861,000 for Ryan White AIDS 
programs. The recommendation includes $25,000,000 in transfers 
available under section 241 of the Public Health Service Act. 
The fiscal year 2004 comparable level was $2,044,861,000 and 
the administration request was $2,079,861,000.
    Next to the Medicaid program, the Ryan White CARE Act (the 
CARE Act) is the largest Federal investment in the care and 
treatment of people living with HIV/AIDS in the United States. 
The CARE Act provides a wide range of community based services, 
including primary and home health care, case management, 
substance abuse treatment, mental health services, and 
nutritional services.
    Within the total provided, the Committee intends that Ryan 
White AIDS activities that are targeted to address the growing 
HIV/ AIDS epidemic and its disproportionate impact upon 
communities of color, including African Americans, Latinos, 
Native Americans, Asian Americans, Native Hawaiians, and 
Pacific Islanders continue with at least the level of funding 
provided in fiscal year 2004.
    Advances in diagnosis, treatment, and medical management of 
HIV/AIDS 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 develop 
strategies to address these problems in light of the changing 
medical needs of a patient population that is living longer 
with current therapies.
    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.

Emergency Assistance--Title I

    The Committee provides $615,023,000 for emergency 
assistance grants to eligible metropolitan areas 
disproportionately affected by the HIV/AIDS epidemic. These 
funds are provided to metropolitan areas meeting certain 
criteria. Half of the funds are awarded by formula and the 
other half are awarded through supplemental competitive grants.

Comprehensive Care Programs--Title II

    The Committee provides $1,120,900,000 for HIV health care 
and support services. 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 
anti-retroviral 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 $783,872,000 for AIDS medications.

Early Intervention Program--Title III-B

    The Committee provides $197,170,000 for early intervention 
grants. 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.

Women, Infants, Children, and Youth--Title IV

    The Committee provides $73,108,000 for title IV pediatric 
AIDS. Funds are awarded to community health centers, family 
planning agencies, comprehensive hemophilia diagnostic and 
treatment centers, federally qualified health centers under 
section 1905(1)(2)(B) of the Social Security Act, county and 
municipal health departments and other nonprofit community-
based programs that provide comprehensive primary health care 
services to populations with or at risk for HIV disease.
    Title IV of the CARE Act provides a program of grants for 
coordinated services and access to research for women, infants, 
children and youth. Title IV grantees may engage in a broad 
range of activities to reduce mother-to-child transmission, 
including voluntary testing of pregnant women and treatment to 
reduce mother-to-child transmission. In addition, title IV 
grantees are required to provide individuals with information 
and education on opportunities to participate in HIV/AIDS 
clinical research.
    The Committee expects HRSA to maximize available funds 
under this part to existing grantees. The Committee is 
concerned that instructions to HRSA regarding the analysis of 
data pertaining to administrative costs in title IV have not 
been followed. The Committee strongly urges HRSA to collaborate 
with grantees under this title to produce necessary tools for 
the accurate collection of expense data. Unless HRSA can 
produce data regarding administrative expenses with a precise 
definition to ensure accuracy and comparability, the agency 
will be unable to impose a limitation on such expenses without 
harming the ability of grantees to provide services for women, 
children, youth and families infected with HIV.
    The Committee is aware of the efforts of title IV grantees 
to care for youth infected with HIV and urges HRSA to 
disseminate the effective practices and models of care 
developed by title IV grantees across all Ryan White CARE Act 
providers.
    Technical assistance may be provided to title IV grantees 
using up to 2 percent of the funds appropriated under this 
section. Within this amount sufficient funds exist to maintain 
the current activities of the national title IV grantee 
membership organization and its ability to provide technical 
assistance to title IV grantees and to conduct policy analysis 
and research.

AIDS Education and Training Centers

    The Committee provides $35,335,000 for the AIDS education 
and training centers [AETC's]. 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.

AIDS Dental Services

    The Committee provides $13,325,000 for AIDS Dental 
Services. This program provides grants to dental schools, 
dental hygiene 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. The Committee 
recognizes that these dental services are vital because they 
are often the only services available to AIDS patients since 
many State Medicaid programs do not cover adult dental 
services.

Telehealth

    The Committee provides $5,000,000 for telehealth 
activities. The fiscal year 2004 comparable level was 
$3,949,000 and the administration request was $3,949,000. The 
telehealth program funded through the Office for the 
Advancement of Telehealth promotes the effective use of 
technologies to improve access to health services for people 
who are isolated from healthcare and distance education for 
health professionals.
    Physician licensure is frequently identified as one of the 
most critical barriers to the increased use of telemedicine. 
There is a need to stimulate cooperation and communication 
among licensing authorities to address these issues and to 
facilitate multi-State practice, ensure public safety and 
create an environment for advancing telehealth services. The 
Committee has provided $1,000,000 above the fiscal year 2004 
level to support incentive grants that would be used as 
authorized in the Health Care Safety Net Act of 2002 to develop 
and implement policies to reduce barriers to telehealth 
services.

                        SPECIAL PROGRAMS BUREAU

Organ Donation and Transplantation

    The Committee provides $24,632,000 for organ transplant 
activities. The fiscal year 2004 comparable level was 
$24,632,000 and the administration request was $24,632,000. 
These funds support a scientific registry of organ transplant 
recipients 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 is encouraged by the initial success of Organ 
Donation Collaborative project and has included funds for its 
continuation. This project is focused on the nation's largest 
hospitals and has adopted the goal of assisting these hospitals 
achieve organ donation rates of 75 percent or higher, which 
will result in at least 6,000 additional organs available for 
transplantation. The Committee also urges the agency to 
facilitate the adoption of a national system of simultaneous 
referrals of available organs as opposed to the current system 
of sequential or serial referrals, as this will further 
guarantee that all available organs are utilized.
    The Committee also urges an increase in grants or contracts 
to public and non-profit private entities for the purpose of 
carrying out studies and demonstration projects to increase and 
maximize organ donation and recovery rates, including living 
donation.
    The Committee commends HRSA for its leadership in promoting 
increased organ and tissue donations across the nation and 
encourages the Division of Transplantation to continue its 
partnership with the pulmonary hypertension community in this 
important area. Moreover, the Committee is aware that the Organ 
Procurement and Transplantation Network/United Network for 
Organ Sharing has issued a proposed rule governing the 
allocation of lungs for transplantation. The Committee 
encourages OPTN/UNOS to work with the pulmonary hypertension 
community to address its concerns regarding the methodology 
used to determine transplantation eligibility for pulmonary 
hypertension patients.

National Cord Blood Stem Cell Bank Program

    The Committee has provided $9,941,000 for the National Cord 
Blood Stem Cell Bank Network. The fiscal year 2004 comparable 
level was $9,941,000 and the administration request was 
$9,941,000.
    The Committee continues to be supportive of the effort to 
build the Nation's supply of cord blood stem cells available 
for therapy and research. The Committee is awaiting the 
conclusions of the Institute of Medicine study required by 
House Report 108-401 and expects fiscal year 2005 funds to be 
used as described in that report.

National Bone Marrow Donor Program

    The Committee provides $22,662,000 for the National Bone 
Marrow Donor Registry. The fiscal year 2004 comparable level 
was $22,662,000 and the administration request was $22,662,000. 
The National Bone Marrow Donor Registry is a network, operated 
under contract, which 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.

Trauma Care

    The Committee provides $4,000,000 for trauma/emergency 
medical services. The fiscal year 2004 comparable level was 
$3,449,000 and the administration did not request funds for 
this program in fiscal year 2005. This program is intended to 
improve the Nation's overall emergency medical systems, which 
are constantly activated to respond to a wide range of natural 
and man-made disasters.

State Planning Grants for Health Care Access

    The Committee provides $8,000,000 for State Planning Grants 
for Health Care Access. The fiscal year 2004 comparable level 
was $14,810,000 and the administration did not request funding 
for this activity in fiscal year 2005.

                         RURAL HEALTH PROGRAMS

Rural Health Policy Development Program

    The Committee provides $8,902,000 for the Rural Health 
Policy Development Program. The fiscal year 2004 comparable 
level was $8,902,000 and the administration request was 
$8,902,000. The funds provide support for the Office of Rural 
Health Policy to be 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, the National Advisory Committee on Rural 
Health, and a reference and information service.

Rural Health Care Services Outreach Grants

    The Committee provides $39,601,000 for health outreach 
grants. The fiscal year 2004 comparable level was $39,601,000 
and the administration request was $11,098,000. This program 
supports projects that demonstrate new and innovative models of 
outreach in rural areas such as integration and coordination of 
health services.
    The Committee understands that many primary care clinics in 
isolated, remote locations are providing extended stay services 
and are not staffed or eligible to receive reimbursement for 
this service. The Committee encourages the agency to continue 
its support for a demonstration project authorized in the 
Medicare Modernization Act to evaluate the effectiveness of a 
new type of provider, the ``Frontier Extended Stay Clinic,'' to 
provide expanded services in remote and isolated primary care 
clinics to meet the needs of seriously ill or injured patients 
who cannot be transferred quickly to acute care referral 
centers, and patients who require monitoring and observation 
for a limited time without requiring costly medivacs.
    Mississippi's Delta is a community in which residents 
disproportionately experience disease risk factors and children 
are significantly mentally and physically developmentally 
behind. The Committee recognizes that communities such as this 
show positive behavioral change when community based programs 
and infrastructure are in place. The Committee believes that 
collaborative programs offering health education, coordination 
of health services and health-related research offer the best 
hope for breaking the cycle of poor health in underprivileged 
areas such as the Mississippi Delta. Therefore, the Committee 
recommends the continued funding of these activities as already 
initiated and undertaken by the coordinated efforts of the 
Mississippi Delta Health Alliance, which is a collaboration 
involving Delta State University, Mississippi State University, 
the University of Mississippi Medical Center, and the 
Mississippi State Department of Health.

Rural and Community Access to Emergency Devices

    The Committee provides $10,933,000 for rural and community 
access to emergency devices. The fiscal year 2004 comparable 
level was $10,933,000 and the administration request was 
$2,015,000. This includes $9,933,000 for the rural program 
under section 413 of the Public Health Service Act and 
$1,000,000 for the community access demonstration under section 
313. These programs provide grants to expand placement of 
automatic external defibrillators [AEDs] and to ensure that 
first responders and emergency medical personnel are 
appropriately trained.

Rural Hospital Flexibility Grants

    The Committee provides $39,499,000 for rural hospital 
flexibility grants. The fiscal year 2004 comparable level was 
$39,499,000 and the administration request did not request 
funds for this program.
    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.
    Of the amount provided, the Committee includes $15,000,000 
to continue the Small Rural Hospital Improvement Grant Program, 
as authorized by Section 1820(g)(3) of the Social Security Act 
and Public Law 107-116 and outlined in House Report 107-342.

State Offices of Rural Health

    The Committee provides $8,390,000 for the State Offices of 
Rural Health. The fiscal year 2004 comparable level was 
$8,390,000 and the administration request was $8,390,000. The 
State Office of Rural Health program helps the States 
strengthen rural heath care delivery systems by allowing them 
to better coordinate care and improve support and outreach in 
rural areas. The Committee believes that continued funds for 
this purpose are critical to improving access and quality 
health care services throughout rural communities.

Rural Emergency Medical Services

    The Committee has provided $997,000 for the Rural EMS 
Training and Assistance Grants program. The comparable fiscal 
year 2004 level was $497,000 and the administration did not 
request funding for this program in fiscal year 2005.

Native and Rural Alaskan Health Care

    The Committee provides $41,794,000 for the Denali 
Commission. The fiscal year 2004 comparable level was 
$34,793,000 and the administration requested $22,000,000 for 
this program in fiscal year 2005. These funds support 
construction and renovation of health clinics, hospitals and 
social service facilities in rural Alaska as authorized by 
Public Law 106-113. Provision of the funding will help remote 
communities in Alaska develop critically needed health and 
social service infrastructure for which no other funding 
sources are available. The Committee expects the Denali 
Commission to continue its support of joint venture projects to 
replace the aging hospitals in Nome and Barrow.

Family Planning

    The Committee provides $308,283,000 for the title X family 
planning program. The fiscal year 2004 comparable level was 
$278,283,000 and the administration request was $278,283,000.
    Title X grants support primary health care services at more 
than 4,600 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 
provision of a broad range of acceptable and effective family 
planning methods and preventive health services. This includes 
FDA-approved methods of contraception.
    The Committee has increased funding for clinics receiving 
title X funds to address increasing financial pressures in 
their effort to provide high-quality, subsidized family 
planning services and preventive health care to 5 million women 
each year, many of whom are low-income and uninsured. These 
pressures include rising medical costs of newer and longer 
lasting contraceptive methods, pharmaceuticals, and screening 
and diagnostic technologies (as well as a rising uninsured 
population). Due to these financial pressures, it will be 
difficult for title X clinics to serve the current number of 
patients, up 10 percent since 2000, without a significant 
funding increase. The Committee also recognizes that the 
increased availability of new contraceptive methods and 
screening technologies will improve women's health and result 
in a decrease in unintended pregnancies nationwide.
    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 any remaining year-end funds in section 1001 activities. 
Any increases in funding in fiscal year 2005 are intended to 
address rising medical costs and must be spent on medical 
services and supplies.

Community Based Abstinence Education Program

    The Committee has provided funding for the Community Based 
Abstinence Education and related programs in the Administration 
for Children and Families and the Office of the Secretary as 
proposed in the administration request.

Health Care-related Facilities and Activities

    The Committee provides $371,536,000 for the construction 
and renovation (including equipment) of health care-related 
facilities and other health care-related activities. The fiscal 
year 2004 comparable level was $371,536,000 and the 
administration did not request funds for this program in fiscal 
year 2005. This account makes funds available to public and 
private entities for the construction and renovation of health 
care-related facilities and other health care-related 
activities.

Program Management

    The Committee provides $148,533,000 for program management 
activities for fiscal year 2005. The fiscal year 2004 
comparable level was $148,533,000 and the administration 
request was $151,317,000.
    The Committee is pleased with the successful distribution 
of compassionate payments through the Ricky Ray Hemophilia 
Relief Fund to the many hemophilia victims who were infected 
with HIV/AIDS through contaminated anti-hemophilia factor 
concentrates. The Ricky Ray Hemophilia Relief Fund terminated 
by law on November 12, 2003. The Committee has been advised of 
cases in which only one-half of the compassionate payment has 
been issued to the surviving parent. The Committee understands 
that HRSA has made budgetary arrangements in anticipation of 
potential additional payments. The Committee urges HRSA to work 
with members of the hemophilia patient community to complete 
this effort.
    Section 340B of the Public Health Service Act created the 
340B Drug Discount Program to lower drug prices for over 10,000 
public health grantees including community health centers and 
public hospitals. The Committee was disappointed to learn that 
participating entities were being overcharged for drugs 
purchased under the program. The Inspector General of Health 
and Human Services found that entities participating in the 
340B Program did not receive the correct discount for 31 
percent of sampled drug purchases made by the Inspector General 
in September of 2002 and estimated that grantees were 
overcharged over $41,000,000 during that one month period. The 
problem appears to be systemic. The Committee is concerned that 
HRSA does not have the technology or personnel to properly 
administer the program. In addition, HRSA does not supply 
entities with accurate pricing information to verify the 
charges made by the pharmaceutical industry.
    The Committee urges HRSA to allocate the necessary 
information technology and personnel resources needed to 
properly oversee this program. The Committee requests a report 
from HRSA no later than March 31, 2005 on how it plans to 
respond to the problems detailed by the Inspector General in 
its oversight of the 340(b) program.

               MEDICAL FACILITIES GUARANTEE AND LOAN FUND

    The Committee has not included funding for the Medical 
Facilities and Guarantee and Loan Fund. This fund was 
established in 1972 under the Medical Facilities Construction 
Program in order to make funds available for construction of 
medical facilities. The fund is established in the Treasury 
without fiscal year limitation to pay interest subsidies, make 
payments of principal and interest in the event of default on a 
guaranteed loan, and repurchase, if necessary loans sold and 
guaranteed. There are sufficient carryover funds from prior 
years' appropriations to pay defaults and interest subsidy 
payments; therefore, no appropriation is required to cover 
these payments.

                   HEALTH EDUCATION ASSISTANCE LOANS

    The Committee provides $4,000,000 to liquidate obligations 
from loans guaranteed before 1992. The fiscal year 2004 
comparable level was $25,000,000 and the administration request 
was $4,000,000. For administration of the HEAL Program 
including the Office of Default Reduction, the Committee 
provides $3,270,000. The fiscal year 2004 comparable level was 
$3,353,000 and the administration request was $3,270,000.
    The HEAL Program insures loans to students in the health 
professions. 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, 2004....................................     $69,190,000
Budget estimate, 2005...................................      69,176,000
Committee recommendation................................      69,176,000

    The Committee provides that $69,176,000 be released from 
the vaccine injury compensation trust fund in fiscal year 2005, 
of which $3,176,000 is for administrative costs. The total 
fiscal year 2004 comparable level was $69,190,000 and the total 
administration request was $69,176,000.
    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, 2004....................................  $4,579,299,000
Budget estimate, 2005...................................   4,462,654,000
Committee recommendation................................   4,807,692,000

    The Committee provides a program level of $4,807,692,000 
for the Centers for Disease Control and Prevention. The 
Committee recommendation includes $4,538,592,000 in budget 
authority and an additional $269,100,000 via transfers 
available under section 241 of the Public Health Services Act. 
The fiscal year 2004 comparable program level was 
$4,579,299,000 and the administration request program level was 
$4,462,654,000. The Committee has also provided $1,239,571,000 
in the Public Health and Social Services Emergency Fund for 
programs administered by CDC.
    The activities of the CDC focus on several major 
priorities: provide core public health functions; respond to 
urgent health threats; monitor the Nation's health using sound 
scientific methods; build the Nation's health infrastructure to 
insure our national security against bioterrorist 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 CDC portion of the Committee report has been organized 
in a manner that is broadly consistent with the new structure 
of CDC. To separate actual program costs from the 
administration of those programs, the Committee has reallocated 
all management and administrative costs (except those of the 
National Institute for Occupational Safety and Health) to two 
new accounts: Public Health Improvement and Leadership and 
Business Services Support. This will enable CDC to more easily 
interpret Congress' intent with funding increases meant for 
either programs or administration of those programs. All 
comparisons to fiscal year 2004 levels and the budget request 
have been adjusted to reflect this reallocation.

                          INFECTIOUS DISEASES

    The Committee recommends $1,688,594,000 for infectious 
disease related programs at the CDC. The fiscal year 2004 
comparable level was $1,654,394,000 and the administration 
requested a comparable level of $1,656,393,000 for fiscal year 
2005. The Committee recommendation includes $12,794,000 in 
transfers available under section 241 of the Public Health 
Services Act.
    The Coordinating Center for Infectious Diseases includes 
the National Center for Infectious Diseases, the National 
Center for STD, TB, and HIV Prevention, and the National 
Immunization Program.

Infectious Disease Control

    Within the total provided, the following amounts are 
provided for the specified activities above the comparable 
amount for fiscal year 2004: $4,000,000 to expand west nile 
virus control activities; $6,000,000 to expand all other 
emerging infectious disease activities; and $1,000,000 to 
expand prion disease surveillance activities. All other 
activities are funded at the level of the administration's 
request.
    These activities focus on: national surveillance of 
infectious disease; 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 disease prevention 
technologies; and strengthening the capability to respond to 
outbreaks of new or reemerging disease.
    Disease outbreaks endanger U.S. citizens at home and 
abroad, threaten U.S. Armed Forces overseas, and exacerbate 
social and political instability. Outbreaks can interfere with 
the global marketplace, affecting tourism, trade, and foreign 
investment. CDC's strategies to combat infectious diseases 
invest in and build upon both the public health system that was 
established over a century ago to increase the preparedness to 
address the emergence of dangerous new threats.
    Chronic Fatigue Syndrome.--The Committee commends the CDC 
for building the leading CFS program in the Nation, supporting 
crucial population studies, clinical and laboratory research 
and education. The Committee directs CDC to provide sufficient 
resources to maintain the high caliber of this program. The 
Committee is very interested in CDC efforts to document the 
economic impact of the illness, to identify biomarkers using 
genomic and proteomics technology and to address health care 
providers' inability to appropriately diagnose and treat CFS. 
Further, the Committee encourages CDC to better inform the 
public about this condition, its severity and magnitude and to 
use heightened awareness to create a registry of CFS patients 
to aid research in this field.
    Hepatitis.--The Committee has included sufficient funding 
for the National Hepatitis C Prevention Strategy, and urges 
that this funding be focused on expanding the capability of 
State health departments and national voluntary health 
organizations to provide hepatitis C testing and counseling as 
well as more aggressive outreach and medical referrals. The 
Committee is concerned that the CDC has reduced the number of 
hepatitis C prevention demonstration project sites from 15 
sites to only 5 sites in fiscal year 2005. The Committee urges 
CDC to reconsider the closing of these 10 sites, and encourages 
CDC to begin implementation of a National Hepatitis C 
Prevention and Control program.
    The Committee is concerned that more than 75 percent of the 
4 million HCV positive individuals are unaware of their 
condition and therefore urges a campaign of public 
announcements to urge appropriate screening and medical follow 
up of target populations. The Committee urges the expansion of 
cooperative agreement programs with national voluntary health 
organizations to meet this and other public health goals of 
CDC's Division of Viral Hepatitis. Finally the Committee is 
concerned with increasing rates of adult infection with 
hepatitis A and B, and urges that an expanded vaccination 
program be launched in response to this health issue.
    The Committee continues to be concerned about the 
prevalence of hepatitis and urges CDC to work with voluntary 
organizations and professional societies to promote liver 
wellness with increased attention toward education and 
prevention. In addition, the CDC is urged to continue to 
support the activities of the National Viral Hepatitis 
Roundtable.
    Patient Safety.--The Committee encourages the CDC to 
continue the National Health Care Safety Network, a national 
electronic medical error/adverse events monitoring system. This 
system will encompass a representative sample of U.S. 
hospitals, managed care organizations, long-term care 
facilities, and other healthcare venues linked to health 
departments and CDC. The Committee also encourages the CDC to 
enhance the capacity for detection and response to medical 
errors and other adverse healthcare events at State and local 
levels through active monitoring, improved epidemiologic/root 
cause investigation, and onsite intervention to promote patient 
safety and improve patient outcomes. These efforts will enable 
the CDC to promote research on preventing medical errors and 
adverse healthcare events through feedback on adverse outcomes.
    Prevention Epicenter Program.--The Committee applauds CDC's 
support for the Prevention Epicenter Program and encourages CDC 
to continue and expand this program to address patient safety 
issues.
    Sepsis.--The Committee is aware that sepsis, an 
overwhelming systemic response to infection that leads to organ 
dysfunction and death, kills more that 215,000 Americans every 
year. The Committee understands that new treatments have been 
developed which significantly improve prognosis when sepsis is 
diagnosed in a timely fashion. In addition, new guidelines have 
been developed to aid health care professionals in identifying 
the syndrome. Unfortunately, too few medical personnel know how 
to properly diagnose sepsis. To improve patient outcomes, the 
Committee encourages CDC to develop a sepsis education program 
to train infectious disease physicians, emergency room doctors, 
and critical care nurses in the proper identification of 
sepsis.

HIV, STD, and TB Prevention

    Recognizing the intersection among these diseases, and the 
need for a focal point for leadership and accountability, CDC 
combines HIV, STD, and TB activities to provide leadership in 
preventing and controlling human immunodeficiency virus 
infection, other sexually transmitted diseases [STDs], and 
tuberculosis. CDC works in collaboration with partners at 
community, State, national, and international levels, applying 
multi-disciplinary programs of research, surveillance, 
technical assistance and evaluation. These diseases are not yet 
vaccine preventable and must be controlled and prevented 
through identifying, diagnosing, and treating infected persons; 
through provision of confidential, culturally competent 
counseling to identify and reach those who have been exposed to 
infection and who may not know it; and through individual and 
population level health promotion to reduce high risk 
behaviors.
    HIV/AIDS Prevention.--CDC's HIV/AIDS prevention programs 
are working in every State and territory to prevent new 
infections, link people who are already infected to medical 
care, and translate scientific research findings into practical 
prevention programs available to every person at risk. CDC will 
continue to adapt these prevention programs to meet new and 
different needs.
    The Committee is concerned by the high rates of HIV 
infection among young men who have sex with men in the United 
States. Data recently reported at the International AIDS 
Conference in Barcelona indicate that infection rates are nine 
times higher for gay men than for women and heterosexual men 
and that African Americans and Latinos are at particularly high 
risk. The Committee urges the CDC to develop and implement new 
approaches to reach young men with life-saving HIV prevention 
services.
    Microbicides.--The Committee commends CDC for recognizing 
the urgent public health need to develop new HIV prevention 
options by supporting microbicide research and development, and 
has provided sufficient funding to continue these activities. 
CDC's role is particularly important in the clinical evaluation 
of potential new products as set forth in CDC's HIV Prevention 
Strategic Plan and its topical microbicide 5-year research 
agenda.
    Tuberculosis.--The Committee is pleased with the efforts of 
the tuberculosis control program, which has reduced the number 
of new tuberculosis cases for the past 10 years. However, the 
number of new tuberculosis cases in foreign-born individuals in 
the United States remains a concern. Although tuberculosis 
rates have been falling, the Committee is aware that similar 
low rates have been achieved in the past only to see a 
reemergence of the disease due to inadequate control efforts. 
In the end, any savings achieved during that period were more 
than used to again gain control of the incidence of the 
disease. The Committee has provided $3,200,000 over the fiscal 
year 2004 level to expand tuberculosis control efforts to 
prevent a similar reemergence. The Committee urges CDC to work 
with the U.S. Citizenship and Immigration Services [USCIS] to 
develop novel tuberculosis screening strategies for individuals 
emigrating from high tuberculosis incidence countries. The 
Committee encourages CDC to consider implementing screening 
programs for high-risk individuals residing in the United 
States for latent tuberculosis. The Committee also encourages 
the CDC to expand efforts to reduce racial disparities in 
tuberculosis incidence in the Southeastern United States. 
African-Americans in the Southeast bear a disproportionate 
burden of tuberculosis.
    Tuberculosis is an enormous and deadly problem in the 
developing world, killing millions of people in the prime of 
their lives every year. Approximately 2 billion people (30 
percent) have been infected with Mycobacterium tuberculosis, 
the causative agent of TB. Tuberculosis is a leading cause of 
death in HIV-infected individuals and in women of childbearing 
age. Each year, TB takes the lives 2 million people and there 
are 8 million new cases; another million die of the combination 
of HIV and TB. Among infectious diseases, only HIV and 
diarrheal diseases kill more people. The worldwide pandemic of 
tuberculosis continues largely unabated in spite of increased 
attention to the disease globally, the expansion of DOTS 
(Directly Observed Therapy--Short course) therapeutic regimes, 
and the widespread use of an existing vaccine against 
tuberculosis. Clearly a better vaccine against tuberculosis is 
urgently needed. Modeling studies show that a modestly 
effective vaccine (50-70 percent efficacious) used in 
combination with drug therapy could save tens of millions of 
lives, and a highly effective vaccine could eventually control 
the disease. The Committee encourages the CDC to continue the 
TB vaccine research cooperative agreement in partnership with 
the leading private foundation conducting clinical field site 
trial work on tuberculosis vaccines. The Committee encourages 
CDC to provide leadership and technical assistance on field 
site development and surveillance.
    The Committee is aware that the Centers for Disease Control 
[CDC] has developed a new funding formula for the 2005 CDC 
Tuberculosis [TB] Prevention and Control. This formula 
calculation is a major step forward and the Committee 
recognizes CDC for taking into account the burden of this 
disease and the complexity of cases. The Committee also notes 
that CDC intends to make 20 percent of these funds available on 
a per-case basis in fiscal year 2005 and 35 percent of these 
funds on a per-case basis by fiscal year 2008. The success of 
TB control in the United States depends on the ability of 
States to maintain past gains in TB control and move toward TB 
elimination. The Committee encourages CDC to use all of the 
increased funding provided to maximize the percentage of TB 
control funds available on a per-case basis while ensuring that 
no State receives less funding than it received in fiscal year 
2004. The Committee further requests that CDC identify the 
optimal percentage of funding that should be distributed on a 
per-case basis.

Immunization

    The Committee recommends $488,789,000 for the program 
authorized under section 317 of the Public Health Service Act. 
The fiscal year 2004 comparable level was $468,789,000 and the 
administration requested $468,789,000 for fiscal year 2005. The 
Committee recommendation includes $12,794,000 in transfers 
available under section 241 of the Public Health Service Act.
    The Omnibus Reconciliation Act [OBRA] of 1993 established a 
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.
    Despite great success in lowering disease levels and 
raising immunization coverage rates, much remains to be done to 
ensure the protection of children and adults worldwide. 
Approximately 1 million 2-year-old children in the United 
States have not received one or more of the more established, 
recommended vaccines. New vaccines, although greatly beneficial 
to public health, complicate an already complex immunization 
schedule and make it increasingly difficult to ensure complete 
immunization. One of our Nation's greatest challenges is 
extending our success in childhood immunization to the adult 
population. The burden due to the occurrence of vaccine-
preventable diseases in adults in the United States is 
staggering. As many as 50,000 U.S. adults die of influenza, 
pneumococcal infections and hepatitis B. CDC is addressing 
these obstacles to the greatest extent possible and continues 
to provide leadership to reduce disability and death resulting 
from diseases that can be prevented through vaccination.
    The Committee encourages 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 
infrastructure costs of delivering vaccines to children in 
Alaska are substantially higher than in other areas of the 
country, because of the many small, remote communities which 
must be served primarily by air. The Committee encourages the 
agency to give careful consideration to Alaska's request for 
sufficient funding for the purchase of vaccines needed for 90 
percent of Alaskan children and to provide infrastructure 
support needed to deliver these vaccines at the community 
level, including development of a statewide immunization 
registry to ensure that all children in Alaska are immunized. 
The Committee notes that failure to immunize children in remote 
areas of Alaska results in deaths each year from exposure to 
open sewage lagoons and contaminated water.
    Vaccine Stockpiles.--The Committee is concerned that recent 
interpretations of revenue recognition guidelines of the 
Securities and Exchange Commission may jeopardize the three-
decade history of stockpiles and prevent the establishment and 
continued maintenance of stockpiles managed by the Department 
of Health and Human Services containing both childhood vaccines 
and bio-defense medical countermeasures. The Committee requests 
that the Secretary of Health and Human Services, after 
consultation with the Securities and Exchange Commission and 
other appropriate agencies, submit a report and recommendations 
within 90 days to the Committee. The report should include what 
administrative actions are being taken, solutions proposed, or 
identify what legislative clarification may be necessary to 
resolve this problem.
    Vaccine Tracking.--The Committee is pleased by CDC's 
development of the Surveillance, Preparedness, Awareness and 
Response System and has included $5,000,000 to continue and 
expand these efforts. In light of vaccine shortages that have 
occurred over the past several flu seasons, the Committee 
understands that this system could serve as a valuable 
surveillance and tracking system for private and public sector 
inventory levels of vaccine. Increases in funding should be 
directed toward system expansion to include pharmaceuticals and 
other products that would be necessary in the medical treatment 
of disease and injury resulting from natural or manmade disease 
outbreaks beyond that currently provided by the strategic 
national stockpile.

                            HEALTH PROMOTION

    The Coordinating Center for Health Promotion includes the 
National Center for Chronic Disease Prevention and Health 
Promotion and the National Center for Birth Defects and 
Developmental Disabilities.
    The Committee recommends $988,090,000 for Health Promotion 
related activities at the CDC. The fiscal year 2004 comparable 
level was $932,067,000 and the administration requested 
$989,780,000.

            CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION

    Within the total provided, the following amounts are 
provided for the specified activities above the comparable 
amount for fiscal year 2004: $5,000,000 to expand Heart Disease 
and Stroke related activities; $5,000,000 to expand Diabetes 
related activities; $24,300,000 to expand Cancer Prevention and 
Control activities; $2,000,000 to establish an Alzheimer's 
Disease component of the Healthy Aging program; $800,000 to 
expand Inflammatory Bowel Disease related activities; $700,000 
to initiate activities related to Interstitial Cystitis; 
$15,000,000 to expand Tobacco related activities; $6,000,000 to 
expand Nutrition, Physical Activity, and Obesity Programs; 
$2,000,000 to establish the Pioneering Healthier Communities 
Activities with the YMCA of the USA; $1,000,000 to expand the 
Behavioral Risk Factor Surveillance System; $200,000 to expand 
Mind-Body related activities; $1,000,000 to expand Glaucoma 
Screening and Visual Screening Education programs; $600,000 to 
expand oral health related activities; $5,000,000 to expand 
Prevention Center activities; $5,000,000 to expand the Steps to 
a Healthier U.S. program. All other activities are funded at 
the level of the administration's request.
    Chronic diseases have had a profound human and economic 
toll on our Nation. Nearly 125 million Americans today are 
living with some form of chronic condition, including cancer, 
cardiovascular disease, diabetes, arthritis, and various 
neurological conditions such as epilepsy. These and other 
chronic diseases now account for nearly 70 percent of all 
health care costs, as well as 70 percent of all deaths 
annually. A few modifiable risk factors bring suffering and 
early death to millions of Americans. Three such factors--
tobacco use, poor nutrition, and lack of physical activity--are 
major contributors to our Nation's leading causes of death.
    Behavioral Risk Factor Surveillance System.--The Committee 
has provided $1,000,000 above the fiscal year 2004 level for 
the Behavioral Risk Factor Surveillance System [BRFSS]. The 
Committee notes that gathering, analyzing, and distributing 
data on behavioral risk factors is key to addressing a host of 
health problems, especially chronic diseases. The BRFSS program 
collects behavior-related data so that scarce resources can be 
directed efficiently to address chronic diseases, such as heart 
disease, cancer, diabetes, obesity, and vascular diseases such 
as stroke. The Committee believes the increase in BRFSS funding 
should be used to increase infrastructure at the State and CDC 
levels; improve the rates of response of survey questions; 
increase the timeliness of data; improve CDC's web site to make 
data more accessible for analysis; and create State 
demonstration projects to examine and assess innovative methods 
in chronic disease health tracking.
    Cancer Prevention and Control.--The programs included in 
the CDC's cancer line item have proven to be highly effective, 
but are only a starting point if we are to reduce the mortality 
from cancer. The Committee is strongly supportive of the CDC 
cancer programs focused on awareness, education and early 
detection and has included a significant increase for these 
programs.
    The significant growth of cancer prevention and control 
programs within State health agencies has resulted in the 
recognition that improved coordination of cancer control 
activities is essential to maximizing resources and achieving 
desired cancer prevention and control outcomes. The Committee 
commends CDC for its work with health agencies to enhance the 
number and quality of cancer-related programs that are 
available to the U.S. population and to develop an integrated 
and coordinated approach to reduce the cancer burden through 
prevention, early detection, treatment, and rehabilitation.
    Within the amounts provided, the following amounts are 
provided for the specified activities above the comparable 
amount for fiscal year 2004: $9,000,000 to expand breast and 
cervical cancer related activities; $5,000,000 to expand cancer 
registries; $2,000,000 to expand colorectal cancer activities; 
$7,000,000 to expand comprehensive cancer activities; $100,000 
to expand ovarian cancer activities; $100,000 to expand 
prostate cancer activities; $100,000 to expand skin cancer 
activities; and $1,000,000 to establish the Cancer Survivorship 
Resource Center. All other activities are funded at the level 
of the administration's request.
    Breast and Cervical Cancer.--CDC's National Breast and 
Cervical Cancer Early Detection Program has provided more than 
3 million potentially life-saving screening tests for women. 
Despite its success in screening these women, the program is 
still only able to screen 15-20 percent of the eligible 
population due to the difficulties in finding these hard to 
reach women. Therefore, the Committee recommends that 50 
percent of funds be used for actual provision of screening and 
clinical services and the remaining 50 percent of funds be used 
by States for outreach, effective management, public and 
professional education, and quality assurance to ensure 
enhancement of infrastructure development activities that will 
provide screening and diagnostic services to eligible women. 
The Committee's recommendation will enable more women to 
receive these vital screening services.
    Cancer Survivorship Resource Center.--The Committee 
applauds the partnership between CDC and the Lance Armstrong 
Foundation [LAF] to address the needs of the nearly 10 million 
cancer survivors by expanding the agency's State-based 
comprehensive cancer control program to include issues of 
survivorship, as outlined in the recently released National 
Action Plan for Cancer Survivorship. The Committee supports the 
development and expansion of Live Strong to serve as a national 
resource for cancer patients, survivors, and their family and 
friends. Therefore, the Committee provides $1,000,000 to 
enhance the Live Strong cancer survivorship resource center.
    Colorectal Cancer.--Colorectal Cancer is the third most 
commonly diagnosed cancer in both men and women in the United 
States, and the second leading cause of cancer related deaths. 
In 2003, approximately 147,000 new cases were diagnosed and 
56,000 people died from the disease. When colorectal cancer is 
detected and treated early, survival is greatly enhanced. 
However, despite the availability of proven screening tests, 
only 37 percent of colorectal cancers are diagnosed while the 
disease is still in a localized stage. The Committee is pleased 
with the leadership 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 the CDC to continue to expand its 
partnerships with State health departments, professional and 
patient organizations, and private industry to combat this 
devastating disease.
    Comprehensive Cancer Control.--The significant growth of 
cancer prevention and control programs within State health 
agencies has resulted in the recognition that improved 
coordination of cancer control activities is essential to 
maximizing resources and achieving desired cancer prevention 
and control outcomes. The Committee commends CDC for its work 
with health agencies to enhance the number and quality of 
cancer-related programs that are available to the U.S. 
population and to develop an integrated and coordinated 
approach to reduce the cancer burden through prevention, early 
detection, treatment, and rehabilitation. CDC is funding States 
to develop comprehensive cancer control programs that help 
build the foundation for a nationwide, comprehensive cancer 
control program. Comprehensive cancer programs integrate the 
full range of cancer prevention activities including research, 
evaluation, health education and communication, program 
development, public policy development, surveillance, and 
clinical services. The Committee has provided increased funding 
to expand the number of health agencies funded for 
comprehensive cancer control and support research and cancer 
tracking to develop, implement, and evaluate comprehensive 
approaches to cancer prevention at the State and community 
level.
    Cooley's Anemia.--The Committee is pleased with the 
progress that CDC has made with regard to the establishment of 
a blood safety surveillance program for Cooley's anemia 
patients, who are the largest consumers of red blood cells. The 
program involves six treatment centers that handle the medical 
aspects, and the Cooley's Anemia Foundation that provides 
education and awareness, patient recruitment, and other 
services, while CDC is creating an archive of tested and 
analyzed blood samples. As the program moves forward and one 
time costs are met, the Committee urges the CDC to direct an 
increasing amount of the funds available to active patient 
recruitment, education and awareness, and related services.
    Delta Health Initiative.--The Mississippi Delta Region 
experiences some of the Nation's highest rates of chronic 
diseases, such as diabetes, hypertension, obesity, heart 
disease and stroke. The Committee recognizes the efforts of the 
Delta Health Alliance in health education, coordination of 
health services and health-related research in the Mississippi 
Delta. The Committee believes that such collaborative, 
community-based programs offer the best hope for breaking the 
cycle of poor health in underprivileged areas such as the 
Mississippi Delta. The Committee recommends that the CDC 
collaborate with the Delta Health Alliance in addressing the 
chronic health issues of the Mississippi Delta.
    Diabetes.--The Division of Diabetes Translation [DDT] is 
charged with addressing diabetes public health issues across 
the country. This is done primarily through funding State 
Diabetes Prevention and Control Programs. The Committee 
encourages CDC to fund as many States as possible at the basic 
implementation level.
    Today, approximately 16 million Americans have diabetes, 
including 5.9 million who do not know they have the disease. 
Diagnosed diabetes rose 49 percent nationally between 1990 and 
2000. Type 2 diabetes, once considered an adult disease, is now 
found in children. Recently released results from the largest-
ever clinical study on diabetes prevention confirmed that 
diabetes can be prevented in high-risk adults. The NIH-led and 
CDC-supported Diabetes Prevention Program demonstrated that 
sustained lifestyle change, including modest weight loss and 
physical activity, resulted in prevention of diabetes in those 
diagnosed as ``pre-diabetic''. Sixteen million Americans are 
``pre-diabetic''. The Committee has provided $5,000,000 over 
the fiscal year 2004 funding level for diabetes-related 
activities at the CDC. The Committee encourages CDC to work 
with State Diabetes Control Programs to establish pilot 
projects to test strategies that will become effective public 
health interventions to prevent or significantly delay the 
onset of diabetes in high-risk individuals and develop systems 
to identify and monitor the number of people who are at highest 
risk for developing diabetes.
    Diabetes Education.--The Committee is concerned about the 
over 18 million Americans currently living with diabetes, a 
number that is increasing every year and is estimated to reach 
almost 10 percent of the total U.S. population by the year 
2025. In response to this public health crisis, the Committee 
applauds CDC for its new cooperative agreement, which is 
intended to ensure early diagnoses of people with diabetes and 
the best treatment and care of those trying to manage the 
disease. The Committee encourages CDC to work in partnership 
with diabetes educators to identify strategies for evaluating 
the effectiveness of diabetes education in improving the self-
care of people with diabetes and in reducing risk factors for 
diabetes.
    Epilepsy.--The Committee continues to strongly support the 
CDC epilepsy program to make progress in research, epidemiology 
and surveillance, early detection, improved treatment, public 
education and expansion of interventions to support people with 
epilepsy and their families in their communities. The Committee 
understands that the ``Living Well II'' public health agenda 
conference will take place again this year using these funds.
    Food Marketing.--The Committee commends the CDC on the 
initiation of a food marketing study as requested in the fiscal 
year 2004 report and has included sufficient funding for the 
continuation of those efforts.
    Geraldine Ferraro Cancer Education Program.--In fiscal year 
2004, Congress provided funding to initiate the Geraldine 
Ferraro Cancer Education Program, as authorized by the 
Hematological Cancer Research Investment and Education Act of 
2002. The Committee is pleased that CDC has established a 
cooperative agreement program with national health 
organizations to develop strategies to provide information and 
education for patients, their family members, friends, and 
caregivers with respect to hematologic cancers. The Committee 
expects CDC to increase efforts to address hematologic cancer 
survivorship issues and improve quality of national hematologic 
data. The Committee strongly encourages CDC to support 
activities related to the development of interactive web based 
education for health care providers on the signs, symptoms and 
current treatment of blood cancer by comprehensive cancer 
centers.
    Glaucoma and Other Vision Disorders.--Age-related threats 
to sight, including age-related macular degeneration, glaucoma, 
cataracts and diabetes retinopathy are expected to nearly 
double by the year 2030 with the aging of the baby-boomer 
generation. Recognizing this emerging public health threat, the 
Committee is aware of the demonstrated success of vision 
screening programs in preventing blindness and vision 
impairments among many of the more than 30 million adults that 
suffer from eye-related disorders.
    The Committee is encouraged by the CDC's exploration of 
strategies to implement a national initiative to combat the 
effects of eye-related disorders, especially glaucoma. The 
Committee has included $300,000 above the fiscal year 2004 
level for CDC to expand vision screening and education programs 
in partnership with national voluntary health agencies and for 
CDC to continue to develop a national surveillance system to 
monitor trends over time and assess the economic costs of 
vision loss especially related to glaucoma. In addition, the 
Committee has included $700,000 above the fiscal year 2004 
level to expand a model project that is testing and evaluating 
the efficacy of glaucoma screening using mobile units.
    Healthy Aging and Alzheimer's Disease.--Recent preliminary 
studies suggest that some of the same strategies that preserve 
overall health may also help prevent or delay Alzheimer's 
disease and dementia. For example, epidemiological studies have 
revealed that individuals taking anti-inflammatory drugs to 
treat conditions such as arthritis appear to have a lower-than-
expected occurrence of Alzheimer's disease. Furthermore, a 
growing body of evidence appears to link known risk factors for 
diabetes, heart disease, including high blood pressure and high 
cholesterol, and risk factors for Alzheimer's disease and 
dementia. Additionally, evidence supports that maintaining 
intellectual and physical activity and remaining socially 
connected may also help stave off dementia. In light of this 
information, the Committee strongly urges the CDC to work with 
the Alzheimer's Association to design and launch an 
Alzheimer's-specific segment of the Healthy Aging Program, to 
aggressively educate the public and health professionals as to 
ways to reduce the risks of developing Alzheimer's by 
maintaining a healthy lifestyle. The Committee has provided 
$2,000,000 for this initiative. CDC should also coordinate this 
effort with the National Institute on Aging and the 
Administration on Aging.
    Heart Disease and Stroke.--The Committee commends the CDC 
for convening national leaders across Federal and State 
Governments and voluntary and professional organizations to 
develop and release A Public Health Action Plan to Prevent 
Heart Disease and Stroke. The Committee is concerned about the 
more than 64 million Americans who live with the often 
disabling consequences of heart disease, stroke and other 
cardiovascular diseases. The Committee strongly urges the CDC 
to expand, intensify and coordinate heart disease and stroke 
prevention activities, such as enhancing both the State Heart 
Disease and Stroke Prevention Program and the Paul Coverdell 
National Acute Stroke Registry. The funds provided will allow 
the CDC to initiate a health communications campaign about 
heart attack and stroke signs and symptoms, and public and 
health care provider education, and invest in standardized 
methodology on lipid and other measurements. Concerned that the 
CDC lacks a Division to address heart disease and stroke, the 
Committee encourages the agency to consolidate and elevate its 
efforts on these diseases by creating a Heart Disease and 
Stroke Division. The Committee is aware that many States still 
need a State-based heart disease and stroke prevention program. 
The Committee strongly believes that each State should receive 
funding for basic implementation of a State Heart Disease and 
Stroke Prevention Program and has included additional funding 
to move toward that goal. The Committee has provided $5,000,000 
above the fiscal year 2004 level for heart disease and stroke-
related activities.
    Inflammatory Bowel Disease.--It is estimated that up to 1 
million people in the United States suffer from Crohn's disease 
or ulcerative colitis, collectively known as inflammatory bowel 
disease [IBD]. An epidemiological study of IBD is needed to 
gain a better understanding of the prevalence of IBD in the 
United States and the demographic characteristics of the IBD 
patient population. Over the last 3 years, the Crohn's and 
Colitis Foundation of American has provided the CDC with a 
$750,000 to initiate this epidemiological study. Now that this 
project has been established through an investment by the 
patient community, the Committee has provided $800,000 to 
continue this study.
    Juvenile Diabetes.--The Committee appreciates the CDC's 
participation and coordination with the National Institute of 
Diabetes and Digestive and Kidney Diseases [NIDDK] on the 
Genetics of Kidneys in Diabetes [GoKinD] Study. The GoKinD 
Study collection provides a unique opportunity to study the 
genetics of renal disease in a well-defined population. CDC and 
NIDDK are charged with ensuring that the collection becomes 
available to the research community, to accelerate progress in 
the prevention and treatment of kidney disease in diabetes.
    Interstitial Cystitis.--The Committee is aware that it 
takes an average of 5 to 7 years for patients to obtain an 
accurate diagnosis of interstitial cystitis [IC]. The Committee 
has provided $700,000 to CDC to educate the public and medical 
communities about interstitial cystitis. To implement this 
initiative, CDC should partner with a voluntary patient 
organization dedicated to assisting persons with IC to support 
activities targeted at disseminating information regarding IC 
identification, diagnosis and support services for both 
families and health care providers.
    Lung Cancer.--The Committee urges the CDC through its 
Cancer Registries Program and in coordination with the 
Comprehensive Cancer Control Program to conduct a study that 
would analyze the current trends of lung cancer screening and 
would evaluate the number of people currently screened for lung 
cancer; how lung cancer screening is being promoted; which 
screening methods are being promoted; how the benefits and 
risks of screening are communicated by health professionals to 
at risk populations; determine if shared decision making taking 
place; and attempt to measure trends in the number of biopsies 
being performed following screening exams and trends in the 
stage of lung cancer diagnosis.
    Oral Health.--The Committee recognizes that to effectively 
reduce disparities in oral disease will require improvements at 
the State and local levels. The Committee has provided 
additional funding to States to strengthen their capacities to 
assess the prevalence of oral diseases, to target 
interventions, like additional water fluoridation and school-
linked sealant programs, and resources to the underserved, and 
to evaluate changes in policies, programs and disease burden. 
The Committee also expects the CDC to advance efforts to reduce 
the disparities and the health burden from oral cancers and 
oral diseases that are closely linked to chronic diseases like 
diabetes and heart disease.
    Nutrition, Physical Activity and Obesity.--Obesity is 
rampant in the United States. Between 1980 and 1994, the 
prevalence of obesity in the United States has increased by 100 
percent in children and adolescents. More than 20 percent of 
the adult population is 30 pounds or more overweight and 10 to 
15 percent of children and adolescents are overweight. Risk 
factors associated with obesity--physical inactivity and 
unhealthy eating--account for at least 300,000 preventable 
deaths each year and increase the risk for many chronic 
diseases like diabetes, heart disease and cancer. The Committee 
is aware that the CDC's own statistics show that Native 
Americans, including Native Alaskans and Native Hawaiians 
suffer higher rates of obesity than other Americans. The 
Committee has included $6,000,000 over the fiscal year 2004 
level for Nutrition, Physical Activity, and Obesity related 
activities.
    The significance of the rising epidemic of overweight and 
obesity among our Nation's children has been widely 
acknowledged. The current trajectory of its continuing increase 
indicates grave consequences for our young people, as being 
overweight in youth sets the stage for a lifetime of being 
overweight. In the U.S., more than 6 million, or approximately 
1 in 12, children are living in households headed by 
grandparents or other relatives. And, in some locales, the rate 
is as high as one in five. In many of these households, 
grandparents and other relatives are the primary caregivers. 
While some programs focusing on childhood overweight and 
obesity include a component that involves parents, grandparents 
and other caregivers often are overlooked. The Committee 
encourages CDC to develop model programs that assist African 
American and Hispanic grandparents in encouraging their 
grandchildren to eat more healthfully and be more physically 
active.
    Pain Management.--Millions of Americans, the vast majority 
of whom do not receive proper treatment, suffer from chronic 
pain. The Committee encourages the CDC to develop physician 
education and training programs related to optimal diagnosis 
and treatment of chronic pain. CDC should establish a plan to 
disseminate information to physicians and to educate patients 
about treatment options available for the management of chronic 
pain.
    Paul Coverdell National Acute Stroke Registry.--Established 
by Congress during the fiscal year 2001 appropriations process, 
the Paul Coverdell National Acute Stroke Registry is designed 
to track and improve the delivery of care to patients with 
acute stroke. The CDC developed and conducted prototypes for 
this Registry from 2001-2003 and plans to fund three State 
Registries in 2004 to enable them to monitor and improve stroke 
emergency transport response times, delivery of acute care, and 
use of treatments to prevent recurrent strokes in their 
communities. The Committee encourages the CDC to fund as many 
additional State Registries as possible.
    Pioneering Healthier Communities.--The Committee commends 
the YMCA of the USA for its work toward developing healthier 
communities through its Pioneering Healthier Communities 
conference. The Committee has included $2,000,000 to support 
these communities in the implementation of their community 
action plans and to support the annual Pioneering Healthier 
Communities conference to enable additional communities to 
benefit from this effort.
    Prader-Willi Syndrome.--Prader-Willi Syndrome is the most 
common known genetic cause of life-threatening obesity in 
children. The Committee encourages the CDC to initiate a study 
of the incidence rate of Prader-Willi Syndrome and to provide a 
system for tracking the complications from the syndrome 
including causes of premature death. Additionally, early 
diagnosis and treatment is crucial to the proper treatment of 
Prader-Willi Syndrome and can significantly reduce the long 
term care costs. The Committee encourages the CDC to develop 
and disseminate educational materials to clinicians, educators, 
and parents in collaboration with voluntary organizations.
    Pregnancy Risk Assessment Monitoring System.--The Committee 
encourages CDC to expand the Pregnancy Risk Assessment 
Monitoring System [PRAMS] to enable CDC to make national 
estimates on behavioral and demographic risk factors for 
preterm birth. Data collected through PRAMS is used to increase 
understanding of maternal behaviors and experiences and their 
relationship to adverse pregnancy outcomes, to develop and 
modify maternal and child health programs, and to help 
incorporate the latest research findings in standards of 
practice.
    Prevention Research Centers.--The Committee has provided 
$5,000,000 over the fiscal year 2004 funding level for 
prevention research centers [PRCs], which are a network of 
academic centers, public health agencies, and community 
partners conducting applied research and practice in chronic 
disease prevention and control. Partners design, test, and 
disseminate strategies that help build evidence-based 
interventions for public health programs. In this capacity, 
PRCs serve a unique role to address the gaps that exist in 
putting research findings and the translation of findings into 
public health practice and policy change. Within the amount 
provided, the Committee expects that CDC will be able to ensure 
that all currently funded centers will continue to receive 
funding.
    Prostatitis.--The Committee understands that chronic 
prostatitis affects 10 percent of the male population and may 
act as a reservoir for bacterial resistance and contribute to 
the spread of chronic disease in men and women by various 
pathogens. The Committee urges the CDC to continue and expand 
its investigation of the etiology of prostatitis.
    Pulmonary Hypertension.--The Committee continues to be 
interested in pulmonary hypertension [PH], a rare, progressive 
and fatal disease that predominantly affects women, regardless 
of age or race. PH causes deadly deterioration of the heart and 
lungs and is a secondary condition in many other serious 
disorders such as scleroderma and lupus. Because early 
detection of PH is critical to a patient's survival and quality 
of life, the Committee continues to encourage CDC to give 
priority consideration to supporting a cooperative agreement 
with the pulmonary hypertension community designed to foster 
greater awareness of the disease.
    School Health.--The Committee applauds CDC for establishing 
effective coordinated school health programs in States and 
local education agencies. The Committee has included sufficient 
funding to continue addressing risk behaviors such as tobacco 
use, unhealthy diets, and physical inactivity.
    Sleep Disorders.--The Committee is concerned about the 
prevalence of sleep disorders and recognizes the need for 
enhanced public and professional awareness on sleep and sleep 
disorders. The Committee urges CDC to work with other agencies 
and voluntary health organizations to support the development 
of a sleep education and public awareness initiative. Several 
agencies have had success with this collaborative model.
    Steps to a Healthier United States.--The Committee applauds 
the Department's continued commitment to tackling the problems 
of obesity, diabetes, and asthma. The Committee agrees that 
these are three of the most critical chronic conditions 
afflicting Americans. The Committee is concerned that existing 
programs that address these problems have not yet been 
implemented in all of the States. The Committee has increased 
funding for this initiative and also increased existing 
programs within CDC that are aimed at obesity, diabetes, and 
asthma. The Committee strongly urges CDC to coordinate the 
efforts of these programs such that the best possible outcome 
is achieved using these funds.
    Sudden Infant Death Syndrome.--The Committee notes the work 
of CDC, the National Institute of Child Health and Human 
Development and the Health Resources and Services 
Administration in developing model guidelines for death scene 
protocol for Sudden Infant Death Syndrome. The Committee 
continues to encourage CDC to implement projects to demonstrate 
the effectiveness of the death scene protocol in a variety of 
locales (urban, suburban, and rural) throughout the Nation. The 
Committee looks forward to reports of progress on this 
initiative as was requested in the fiscal year 2004 Committee 
report.
    Tobacco Use.--In fiscal year 2004, the Committee approved a 
reprogramming request by the Secretary to provide $15,000,000 
in competitive grants to States that wanted to upgrade their 
existing tobacco quitlines or initiate new ones. This 
reprogramming was financed in fiscal year 2004 by reducing from 
12 to 9 months the project period for ongoing tobacco control 
grants to States. The Committee understood at that time that 
this would have no impact on ongoing State operations, as CDC 
would accelerate by 3 months the date that continuation grants 
are issued in fiscal year 2005. The Committee has provided 
$15,000,000 above the fiscal year 2004 level for tobacco-
related programs. This will ensure that both the tobacco 
control grants and the tobacco quitline grants are able to 
continue with at least the fiscal year 2004 funding levels.
    WISEWOMAN Program.--The WISEWOMAN program builds on the 
CDC's National Breast and Cervical Cancer Early Detection 
Program to also screen women for heart disease, stroke and 
other cardiovascular disease risk factors. The CDC also 
provides lifestyle counseling and education to these women to 
improve their health and to prevent cardiovascular diseases, 
the leading cause of death of American women. Heart disease, 
alone, is the No. 1 killer of American women and stroke is the 
No. 3 killer. Since its inception in 1995, tens of thousands of 
low-income and uninsured women ages 40-64 have been screened 
for high blood pressure and elevated cholesterol and have 
received lifestyle counseling and education. From 50 percent to 
75 percent of these women were found to have either high blood 
pressure or elevated cholesterol. With more than two-thirds of 
the women returning for follow-up services, the program has 
been effective in retaining participants and providing needed 
services.
    Worksite Health Promotion.--The Committee commends CDC for 
its efforts to evaluate worksite health promotion programs 
including the impact that such programs have on reducing health 
risks, health insurance costs, and employee absenteeism. The 
Committee encourages CDC to develop an employer wellness model 
program based on the results of these studies and disseminate 
that information to businesses.

Birth Defects, Developmental Disabilities, Disability and Health

    Within the total provided, the following amounts are 
provided for the specified activities above the comparable 
amount for fiscal year 2004: $1,000,000 to expand autism 
surveillance, awareness, and education activities; $250,000 to 
expand activities related to Fetal Alcohol Syndrome; $1,000,000 
to initiate activities related to Fragile X; $400,000 to expand 
the National Spina Bifida Program; $1,000,000 to expand the 
craniofacial malformation program; $1,000,000 to continue the 
Fetal Death Prevention program; $600,000 to establish a Diamond 
Blackfan Anemia public health outreach and surveillance 
program; $500,000 to expand activities related to Tourette 
Syndrome; $1,500,000 to expand surveillance and epidemiological 
efforts of Duchenne and Becker muscular dystrophies; $1,500,000 
to expand support for the Special Olympics Healthy Athletes 
Initiative; $1,000,000 to expand Rehabilitation Treadmill 
Therapy activities; and $250,000 to expand the work of the 
Attention Deficit Resource Centers. All other activities are 
funded at the level of the administration's request.
    Attention Deficit Hyperactivity Disorder.--The Committee 
understands that current estimates indicate that as many as 7 
percent of school-age children have Attention-Deficit/
Hyperactivity-Disorder [AD/HD] and more than two-thirds of 
these children will continue to experience symptoms through 
adulthood. Only half of all children with AD/HD receive 
necessary treatment with lower care rates among girls, 
minorities and children in foster care. The Surgeon General has 
reported a severe lack of professions trained to diagnose and 
treat the condition effectively. The Committee continues to 
support the National Resource Center on AD/HD and has provided 
$250,000 above the fiscal year 2004 level to expand the 
activities at the Center to respond to the overwhelming demand 
for information and support services; to better reach special 
populations in need; to develop on-line educational tools for 
professionals; and, to enable CDC to expand its population-
based research and surveillance.
    Autism.--The Committee acknowledges the importance of CDC's 
work in the area of autism surveillance, research, and 
awareness, and has provided $1,000,000 above the fiscal year 
2004 level to continue and expand the autism-related programs.
    Childhood Obesity Prevention in Children with Special 
Health Care Needs.--As authorized under Title XXIV of the 
Children's Health Act of 2000, the Committee encourages the CDC 
to fund public health research, surveillance and educational 
activities related to obesity among children with special 
health care needs, with a special emphasis on children with 
Prader-Willi Syndrome.
    Craniofacial Malformation.--The Committee has included 
$1,000,000 over the fiscal year 2004 level to build on its 
initiative to help families of children with craniofacial 
malformations. The Committee recommends that these funds be 
used to work with one or more of CDC's Centers for Birth 
Defects Research and Prevention to collect data on the 
prevalence of these malformations, the ability of families to 
access services, and the long-term outcomes associated with 
craniofacial malformation. Funds are also available for CDC to 
work with a national voluntary organization to analyze and 
disseminate this information.
    Diamond Blackfan Anemia.--The Committee has included 
$600,000 to establish a public health outreach and surveillance 
program for Diamond Blackfan anemia. These funds should be used 
to (a) educate clinicians and blood disorder treatment centers 
about DBA and how to diagnose it and (b) collaborate with a 
Clinical Care Center, which already has significant experience 
in treating DBA patients, to create a critical mass of DBA 
expertise where DBA patients may be referred.
    Disability and Health.--The Committee urges the CDC to 
significantly expand and strengthen its investment in the 
public health research, surveillance activities, and 
dissemination of scientific and programmatic health promotion 
and wellness information for children and adults with 
disabilities.
    Down Syndrome.--The Committee encourages the CDC to conduct 
two epidemiological studies on Down syndrome to (1) obtain an 
accurate estimate of the number of people in the United States 
living with the disorder and to identify them by age and ethnic 
group, and (2) to document the onset and course of secondary 
and related developmental and mental disorders in individuals 
with Down syndrome. The Committee commends the National Center 
for Birth Defects and Developmental Disorders for planning and 
initiating these studies in fiscal year 2004.
    Fetal Alcohol Spectrum Disorders.--The Committee recognizes 
that prenatal alcohol exposure is the leading known cause of 
mental retardation in the United States. It is associated with 
lifelong difficulties with learning, memory, attention, and 
problem solving as well as problems with mental health and 
social interactions. Each year, approximately 40,000 children 
are born with Fetal Alcohol Spectrum Disorders [FASD]. This 
amounts to almost 1 out of 100 live births, with a 
disproportionate impact on underserved American Indian and 
African American populations. The Committee has provided 
$250,000 over the fiscal year 2004 level for FASD-related 
programs and recommends that the CDC expand surveillance 
efforts to document the magnitude of the problem and continue 
to support the development of an information clearinghouse on 
FASD and the dangers of drinking while pregnant.
    Fetal Deaths.--CDC has reported that fetal deaths at 20 
weeks gestation or greater account for nearly as many deaths as 
those that occur to infants during the first year of life. The 
Committee understands that prevention strategies must first 
recognize fetal deaths as a public health problem, improve 
fetal death surveillance and reporting, and conduct research to 
understand the causes of fetal death. To that end, the 
Committee has included $1,000,000 for a demonstration project 
with several States to link existing birth defect surveillance 
systems and fetal death registries and to use that data to help 
develop strategies to reduce fetal deaths.
    Fragile X.--The Committee believes that the CDC's focus on 
maximizing prevention potential, minimizing impact on families 
and promoting early intervention through developmental 
screening should incorporate individuals affected by Fragile X. 
To support this effort, CDC is encouraged to create a Fragile X 
public health program to expand surveillance and 
epidemiological study of Fragile X, as well as provide patient 
and provider outreach on Fragile X and other developmental 
disabilities in collaboration with voluntary organizations, 
such as the National Fragile X Foundation. The Committee has 
provided $1,000,000 to support these activities.
    Muscular Dystrophies.--The Committee is concerned with the 
pace of the development of the CDC Birth Defects Surveillance 
program covering the muscular dystrophies and recommends that 
the agency substantially increase the internal staff commitment 
to the program. The Committee has provided $1,500,000 above the 
fiscal year 2004 level to expand these activities. Within the 
increase, the Committee has provided $500,000 to initiate a 
coordinated education and outreach initiative in collaboration 
with a volunteer organization, such as the Parent Project 
Muscular Dystrophy.
    Paralysis Resource Center.--More than 2 million Americans 
live with paralysis, including spinal cord injury, stroke, 
multiple sclerosis, cerebral palsy, spina bifida and, ALS. 
Those living with paralysis have a desperate need for 
information and support to improve their health and quality of 
life. In 2000, Congress established the Christopher and Dana 
Reeve Paralysis Resource Center to provide information and 
support to individuals living with paralysis, their caregivers 
and their families. To keep up with the exploding demand for 
information and support services, the Committee has provided 
sufficient funds to continue to support the Paralysis Resource 
Center at no less than the fiscal year 2004 level.
    Regional Centers for Birth Defects Research and 
Prevention.--The Committee encourages CDC to expand research 
activities conducted by the 10 regional Centers for Birth 
Defects Research and Prevention. The centers are located in 
Arkansas, California, Georgia, Iowa, Massachusetts, New Jersey, 
New York, North Carolina, Texas, and Utah. These centers are 
participating in the National Birth Defect Prevention Study, 
the largest case-control study of birth defects ever conducted. 
The Committee is deeply concerned that for the first time since 
1958, infant mortality rates have increased, and therefore 
encourages the expansion of studies on the causes of birth 
defects, the leading cause of infant mortality.
    Rehabilitation Treadmill Therapy.--The Committee provides 
$1,000,000 over the fiscal year 2004 level to continue and 
expand programs that translate clinical rehabilitation 
treadmill therapy research to community based settings and to 
train health care professionals to appropriately deliver this 
promising therapy. Within the additional funding provided, 
$500,000 is to continue and expand the existing demonstration 
programs in collaboration with the Christopher Reeve Paralysis 
Foundation. The remaining $500,000 is to be used by CDC to 
evaluate the feasibility of widespread implementation of these 
rehabilitation programs.
    Spina Bifida.--The Committee recognizes that Spina Bifida 
is the leading permanently disabling birth defect in the United 
States. While Spina Bifida and related neural tube defects are 
highly preventable through proper nutrition, including 
appropriate folic acid consumption, and its secondary effects 
can be mitigated through appropriate and proactive medical care 
and management, such efforts have not been adequately supported 
or coordinated to result in significant reductions in these 
costly conditions. In an effort to improve the quality-of-life 
for individuals affected by Spina Bifida and reduce and prevent 
the occurrence of--and suffering from--this birth defect, the 
Committee provides $400,000 above the budget request to expand 
the the National Spina Bifida Program. Within the total 
provided, $200,000 is to partner with a national voluntary 
organization for the creation of a National Spina Bifida 
Clearinghouse and Resource Center to meet the current and 
growing demand for information and support services for 
individuals and families affected by Spina Bifida.
    Special Olympics Healthy Athletes Initiative.--To address 
the unmet health needs among its athletes, Special Olympics 
created the Healthy Athletes Program, which provides Special 
Olympics athletes access to an array of health assessment, 
education, preventive health services and supplies, and 
referral for follow-up care where needed. These services are 
provided to athletes without cost in conjunction with 
competitions at local, State, national, and international 
levels. The Committee has included $1,500,000 above the fiscal 
year 2004 level for this program.
    State Cooperative Agreements for Birth Defects 
Surveillance.--The Committee encourages CDC to increase support 
to States to develop, implement, and/or expand community-based 
birth defects tracking systems, programs to prevent birth 
defects, and activities to improve access to health services 
for children with birth defects.
    Thrombophilia.--The Committee understands that at least 1 
in 15 Americans has thrombophilia, which increases their risk 
of developing life threatening thrombosis (blood clots), and 
60,000 deaths annually are directly attributable to blood 
clots. Many more die from blood clot related complications. The 
Committee is concerned that physicians and the public are 
poorly informed about the risks of thrombosis and 
thrombophilia. CDC has funded eight sites to begin gathering 
information on the dimensions of this disease and related 
thrombosis. The Committee encourages the CDC to expand the 
number of sites to address the dimensions of this widespread 
public health problem.
    Tourette Syndrome.--The Committee encourages CDC to 
establish public health education and research programs in 
partnership with a national voluntary health association 
dedicated to assisting parents and families of children with 
Tourette Syndrome. The programs should be designed to reach 
parents, educators, pediatricians, physicians, and other health 
workers in a campaign consistent with the authority and 
direction of the Children's Health Act of 2000, and to increase 
scientific knowledge on the prevalence, risk factors and co-
morbidities of Tourette Syndrome. The Committee has provided 
$500,000 above the fiscal year 2004 level to expand Tourette 
Syndrome-related activities.

                     HEALTH INFORMATION AND SERVICE

    The Coordinating Center for Health Information and 
Services.--Includes the National Center for Health Statistics, 
a new National Center for Health Marketing, and a new National 
Center for Public Health Informatics.
    The Committee recommends a program level of $235,658,000 
for Health Information and Service related activities at the 
CDC. This recommendation includes $139,209,000 in transfers 
available under section 241 of the Public Health Service Act. 
The fiscal year 2004 comparable program level was $216,692,000 
and the administration requested $235,658,000.

Health Statistics

    CDC's statistics give us context and perspective on which 
we can base important public health decisions. By aggregating 
the experience of individuals, we gain a collective 
understanding of our health, our collective experience with the 
health care system, and our problems and public health 
challenges. NCHS data are used to create a basis for 
comparisons between population groups or geographic areas, as 
well as an understanding of how trends in health change and 
develop over time.
    The NCHS is the Nation's preeminent source of health 
statistics and therefore provides the foundation for assessing 
National health trends and developing sound programs and 
policies to protect and enhance the Nation's health. The 
Committee is concerned with the adequacy and overall 
coordination of the various Federal programs that collect, 
analyze, and report the health statistics necessary for policy 
development and public health interventions. During this period 
of rapid advance in health and welfare policy, medical 
practice, and biomedical knowledge, the Committee is committed 
to ensuring that timely and relevant health statistics are 
available to guide policy decisions. The Committee has provided 
additional funds for the NCHS to strengthen its data collection 
infrastructure.

               ENVIRONMENTAL HEALTH AND INJURY PREVENTION

    As funded by the Committee, the Coordinating Center for 
Environmental Health and Injury Prevention includes the 
National Center for Environmental Health, the Agency for Toxic 
Substances and Disease Registry, and the National Center for 
Injury Prevention and Control.
    The Committee recommends $290,126,000 for environmental 
health and injury prevention related activities at the CDC. The 
fiscal year 2004 comparable level was $282,926,000 and the 
administration requested $282,926,000 for fiscal year 2005.

Environmental Health

    Within the total provided, the following amounts are 
provided for the specified activities above the comparable 
amount for fiscal year 2004: $1,000,000 to expand the Health 
Tracking Network; $1,000,000 to expand Primary Immune 
Deficiency activities; and $500,000 to expand Asthma related 
activities. All other activities are funded at the level of the 
administration's request.
    Many of the public health successes that were achieved in 
the 20th century can be traced to innovations in environmental 
health practices. However, emerging pathogens and environmental 
toxins continue to pose risks to our health and significant 
challenges to public health. The task of protecting people's 
health from hazards in their environment requires a broad set 
of tools. First among these tools are surveillance and data 
collection to determine which substances in the environment are 
getting into people and to what degree. It also must be 
determined whether or not these substances are harmful to 
humans, and at what level of exposure. Many scientists estimate 
that about two-thirds of all cancers result from environmental 
exposure, but much better data are needed to improve this 
estimate and determine which exposures cause cancer and other 
diseases.
    Asthma.--The Committee is pleased with the work that the 
CDC has done to address the increasing prevalence of asthma. 
However, the increase in asthma among children 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 populations in 
underserved communities. To further facilitate this effort, CDC 
is urged to partner with voluntary health organizations to 
support program activity consistent with the CDC's efforts to 
fund community-based interventions that apply effective 
approaches demonstrated in research projects within the 
scientific and public health community.
    In addition, the Committee commends CDC's efforts to 
collect national and local data on the incidence and prevalence 
of asthma and to implement asthma prevention programs. The 
Committee encourages CDC to continue with these activities and 
expand its prevention programs into areas of high pediatric 
asthma incidence.
    Childhood Lead Poisoning Prevention.--The Committee 
commends the CDC for its commitment to support the enhanced 
development of a portable, hand-held lead screening device that 
holds great promise for increasing childhood screening rates in 
underserved communities. Further development of this device 
will help ensure its application in community health settings.
    Environmental Health Laboratory.--The CDC environmental 
health laboratory performs assessments for State investigations 
of diseases (such as cancer and birth defects) and 
investigations of chemical exposures, such as dioxin, 
pesticides, mercury and cadmium. CDC is also working with 
States to improve public health laboratories that assess State 
level biomonitoring needs. CDC works closely with academic 
institutions, other Federal agencies, and other partners to 
measure human exposure to toxic substances and the adverse 
effects of that exposure.
    The CDC's National Report on Human Exposure to 
Environmental Chemicals is a significant new exposure tool that 
provides information for setting research priorities and for 
tracking trends in human exposures over time. However, as CDC 
has recognized, this information does not by itself provide 
information on causes for effects in humans. Therefore, 
communicating these results in context is vitally important. 
The Committee applauds the CDC's efforts in this regard and 
encourages the agency to continue to do so.
    Environmental Health Workforce.--The Committee encourages 
the CDC to begin the enhancement and revitalization of 
environmental health services at the National, State, and local 
levels. A 1980 Health and Human Services report stated that 
there were 235,000 individuals in the Nation's environmental 
health work force and the report forecasted 137,000 additional 
professionals would be needed over the following decade. In 
2000, a Health and Human Services report estimated that the 
size of our country's environmental health work force had 
shrunk to 19,431. During this same period, the demand for 
environmental health services had expanded to include external 
and internal air quality, drinking water quality, food safety, 
childhood lead poisoning, asthma control, rodent control, and 
hazardous chemical control and management. In addition, city 
and State environmental health personnel are responsible for 
providing the initial response to acts of chemical and 
radiological terrorism. In light of this increased demand and 
our country's reduced capacity, the Committee is concerned 
about the need to enhance and revitalize environmental health 
services at the National, State, and local levels.
    Health Tracking Network.--The Committee has provided 
$1,000,000 over the fiscal year 2004 level to continue and 
expand the development of a Health Tracking Network, which 
seeks to develop a surveillance system that can integrate 
environmental hazards data with human exposure and health 
effects data that have possible links to the environment. With 
health tracking, public health officials can better target 
preventive services, health care providers can offer better 
health care, and the public will be able to develop a clear 
understanding of what is occurring in their communities and how 
overall health can be improved.
    The initial efforts to establish such a Network are now 
being carried out through a series of State grants to develop 
pilot initiatives and projects. The Committee understands that 
a critical component of the nationwide tracking program is 
assuring that communities are engaged in the process of 
developing the State-based networks and informed of the 
results. The Committee urges CDC and the State and local 
programs to work with the citizens in local communities.
    Perchlorate Contamination.--The Committee is concerned 
about contamination due to perchlorate, which is primarily used 
as an oxidizer for rocket fuel and munitions. Perchlorate 
contamination has been discovered in 34 States and is known to 
have adverse health affects on pregnant women, newborns, and 
young children. The Committee strongly urges the CDC to conduct 
surveys on the level of perchlorate in humans, to provide 
information for assessments on a national level, and to address 
regional concerns in areas most affected.
    Primary Immunodeficiency Diseases.--In each of the last 3 
years, Congress has made available funds for CDC to support the 
national physician education and public awareness campaign 
developed by the Jeffrey Modell Foundation. The Foundation has 
leveraged more than $7 from donors and the media for every 
Federal dollar appropriated and is a model of public-private 
cooperation. The campaign has featured physician symposia, 
publications, public service announcements, and the development 
of website and educational materials, as well as mailings to 
physicians, school nurses and others. This very successful 
physician and public awareness campaign now must expand its 
reach to underserved communities, including African-American 
and Hispanic populations, and the Committee has provided 
sufficient funding to reach that critical goal. In addition, 
the Committee encourages CDC to expand it programmatic activity 
on primary immune deficiency diseases to include pilot programs 
focused on newborn screening and school wellness. The Committee 
has provided $1,000,000 over the fiscal year 2004 level for 
these purposes.
    Severe Combined Immune Deficiency Disease.--It has come to 
the Committee's attention that NIH has developed the technology 
to screen newborns for severe combined immune deficiency 
disease [SCID] or ``the bubble boy disease.'' The Committee 
commends the Newborn Screening Branch at the National Center 
for Environmental Health at CDC for their commitment to 
developing a newborn screening program for SCID. The Committee 
encourages the CDC to consider support for the development of a 
newborn screening program for SCID.

Injury Prevention and Control

    CDC 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 helmet use; lack of seatbelt and proper baby seat use; 
and other injuries. The national injury control program at CDC 
encompasses non-occupational injury and applied research in 
acute care and rehabilitation of the injured. Funds are 
utilized for both intramural and extramural research as well as 
assisting State and local health agencies in implementing 
injury prevention programs. The Committee recognizes the vital 
role CDC serves as a focal point for all Federal injury control 
activities.
    The Committee has provided additional funding to the 
National Center for Injury Prevention and Control. In part, 
these funds should be used to strengthen the capacity of State 
and local health agencies to prevent injuries and support 
extramural public health research to conduct and translate 
science into practice. The increase would expand public health 
support for injury prevention programs in States and ensure 
provision of necessary tools for developing effective injury 
prevention programs in our communities.
    Sufficient funds have been included to continue support for 
all existing Injury Control Research Centers.
    Fire and Fall Injury Prevention.--CDC funds five States to 
implement and evaluate Remembering When, a fire and fall injury 
prevention program directed at older adults. Remembering When 
was developed by the National Fire Protection Association, with 
assistance from CDC, the Consumer Product Safety Commission and 
others. CDC also funds 13 States to install 10-year lithium 
powered smoke alarms and to provide fire-safety education in 
homes in high-risk communities. High-risk communities are those 
with fire death rates higher than State and national averages 
and median household incomes below the poverty level. Homes 
with children and older adults are especially targeted for 
smoke alarm installation and education outreach. The Committee 
encourages CDC to continue the implementation of this project.
    National Violent Death Reporting System.--The Committee 
provides an increase of $700,000 over the fiscal year 2004 
level for the National Violent Death Reporting System [NVDRS] 
to allow additional States to be funded to gather and share 
State-level data about violent deaths. This State-based system 
collects data from medical examiners, coroners, police, crime 
labs, and death certificates to understand the circumstances 
surrounding violent deaths. The information can be used to 
develop, inform, and evaluate violence prevention programs.
    Rape Prevention and Education.--The CDC provides one of the 
only sources of funding for rape prevention and education. Most 
other funding sources are focused on services to survivors and 
the criminal justice system. The Committee urges CDC to ensure 
that States receiving funds from the grants for assistance to 
victims of sexual assault, as provided in the Violence Against 
Women Act, support State sexual assault coalitions, community-
based rape crisis centers, and other non-profit entities whose 
work is focused on ending sexual violence, operating hotlines 
for victims of sexual violence and their families, and those 
which provide crisis intervention, advocacy and support 
services to victims. The Committee urges the CDC to ensure that 
States work collaboratively with State sexual assault 
coalitions in planning and funding activities. The Committee 
has provided $2,000,000 over the fiscal year 2004 level for 
these activities. The Committee recommends that a portion of 
these additional funds be used to fund awareness activities and 
materials in conjunction with Sexual Assault Awareness Month.
    Through its technical assistance, training and 
informational materials, the National Resource Center on Sexual 
Assault has played an increasingly important role in bringing 
direction, coordination and voice to a movement that was 
previously dispersed and disconnected. The Committee has 
provided sufficient resources to fund this Center at the 
statutory maximum of $1,000,000.
    Suicide Prevention.--The Committee encourages CDC to 
conduct suicide prevention research and support demonstration 
projects to identify promising and effective suicide prevention 
strategies. Research will enhance the knowledge base about risk 
and protective factors and the consequences of suicidal 
behavior in order to develop more effective prevention 
strategies.
    Traumatic Brain Injury.--The Committee understands that a 
National Information Center for Traumatic Brain Injury is 
expanding as a pilot program providing persons with brain 
injury, their families, and those who serve them with toll-free 
information on State-specific resources and linkage to service. 
The Committee encourages the CDC to be supportive of this 
National Information Center. The Committee also encourages the 
CDC to fulfill its duties under the TBI Act as part of the 
Children's Health Act, such as monitoring the outcomes and 
services of people who sustain injuries, including TBI, during 
mass casualty events such as a terrorist attack; strengthen 
support for State and local efforts to collect data on TBI; 
increasing education and awareness efforts; conduct public 
health research related to TBI and collecting annual incidence 
and outcome data on ``mild'' TBI.
    Violence Against Women.--The Committee urges the CDC to 
increase research on the psychological consequences of violence 
against women and expand research on special populations and 
their risk for violence including adolescents, older women, 
ethnic minorities, women with disabilities, and other affected 
populations.

                     OCCUPATIONAL SAFETY AND HEALTH

    The Committee recommends $294,587,000 for occupational 
safety and health programs. The fiscal year 2004 comparable 
level was $276,988,000 and the administration requested 
$278,587,000 for fiscal year 2005. The Committee recommendation 
includes $82,097,000 in transfers available under section 241 
of the Public Health Service Act.
    The CDC's National Institute for Occupational Safety and 
Health [NIOSH] is the only Federal agency responsible for 
conducting research and making recommendations for the 
prevention of work-related illness and injury. The NIOSH 
mission spans the spectrum of activities necessary for the 
prevention of work-related illness, injury, disability, and 
death by gathering information, conducting scientific 
biomedical research (both applied and basic), and translating 
the knowledge gained into products and services that impact 
workers in settings from corporate offices to construction 
sites to coal mines.
    NIOSH has a unique legislative history that is distinct 
from other components of CDC. NIOSH was created under the 
Occupational Safety and Health Act of 1970, to be a separate 
Institute within what is now the Department of Health and Human 
Services. NIOSH was charged with carrying out the many 
responsibilities given the Secretary under the authorizing 
legislation, including conducting research, recommending 
criteria for standards, providing information on toxic 
substances and training occupational safety and health 
professionals. Since that time Congress has significantly 
expanded NIOSH's role to include carrying out responsibilities 
given the Secretary of Health and Human Services under the Mine 
Safety and Health Act and Energy Employees Occupational Illness 
and Compensation Act. Today, NIOSH is responsible for a wide 
range of programs and activities to enhance workers safety and 
health. With its sister agencies, the Occupational Safety and 
Health Administration [OSHA] and the Mine Safety and Health 
Administration [MSHA], NIOSH has made significant contributions 
to the major reduction in workplace injuries over the last 
three decades.
    Congress established NIOSH with the expressed intent ``to 
provide occupational safety and health research with the 
visibility and status it merits'' and ``to elevate the status 
of occupational safety and health research'' (Legislative 
History of the Occupational Safety and Health Act of 1970, S. 
2193, Public Law 91-596). The Committee strongly supports these 
principles. The Committee expects CDC to ensure that the 
ongoing CDC reorganization does not impede nor diminish NIOSH's 
ability to meet its statutory responsibilities to protect the 
safety and health of America's workers. The Committee believes 
that NIOSH must have the stature necessary to work effectively 
with OSHA, the Department of Labor, and the Department of 
Health and Human Services in the manner described by statute. 
Therefore, the Committee directs the CDC to maintain the status 
quo with respect to the direct reporting relationship of the 
NIOSH director to the CDC director. The Committee further 
directs the CDC to: (1) make no changes to NIOSH's current 
operating procedures and organizational structure and (2) 
ensure that no funds or personnel will be transferred from 
NIOSH to other components of CDC by means other than 
traditional reprogramming of funds.
    Construction Safety and Health.--The Committee once again 
is very pleased with the progress that NIOSH has made in its 
program directed at occupational illnesses and injuries in the 
building and construction industry. However, the Committee is 
still concerned with the continued high fatality rate in the 
industry, and encourages NIOSH to continue studying this 
important issue.
    Education and Research Centers.--The Committee recognizes 
the important role Education and Research Centers [ERCs] play 
in preventive health research and the training of occupational 
safety and health professionals, and includes an increase of 
$2,000,000 for ERCs over the amount appropriated for ERCs in 
fiscal 2004.
    Farm Health and Safety.--The Committee has included funding 
to continue the farm health and safety initiative. 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.
    Miners' Choice Health Screening Program.--The Committee has 
been advised that NIOSH will begin solely administering the 
Miners' Choice Health Screening Program in fiscal year 2005, 
and that funds have been included in the administration's 
request to support these activities. This program was initiated 
to encourage all miners to obtain free and confidential chest 
x-rays to obtain more data on the prevalence of Coal Workers' 
Pneumonconiosis [CWP] in support of development of new 
respirable coal dust rules. The Committee is strongly 
supportive of these efforts and urges NIOSH to work to improve 
this health screening program thereby helping to protect the 
health and safety our Nation's miners.
    Mining Research Program.--The Committee has provided 
$6,000,000 over the fiscal year 2004 level for NIOSH's Mining 
Research Program. The Committee recommends that $4,000,000 of 
the additional funding be used to increase base funding of the 
NIOSH in-house research programs to offset the effects of 
inflation. The Committee recommends that $1,000,000 of the 
additional funding be used to expand the extramural mining 
research program, and that the remaining $1,000,000 be used to 
respond to emerging issues.
    National Occupational Research Agenda.--The Committee 
recommendation includes an increase of $5,000,000 over the 
fiscal year 2004 level for CDC's National Occupational Research 
Agenda [NORA]. The Committee believes that NORA is a critical 
scientific research program that protects employees and 
employers from the high personal and financial costs of work 
site health and safety losses. Industries such as agriculture, 
construction, health care, and mining benefit from the 
scientific research supported by NORA. The program's research 
agenda focuses on prevention of disease and injury resulting 
from infectious diseases, cancer, asthma, hearing loss, 
musculoskeletal disorders, traumatic injuries, and allergic 
reactions, among others. The Committee continues to strongly 
support NORA and encourages expansion of its research program 
to cover additional causes of work place health and safety 
problems.
    National Personal Protective Technologies Laboratory.--The 
Committee provides $3,000,000 over the fiscal year 2004 level 
for the NIOSH National Personal Protective Technologies 
Laboratory to expedite research and development in, and 
certification of, protective equipment, such as powered air 
purifying respirators, and combined self-contained breathing 
apparatus/escape sets.
    Radiation Exposure.--The Committee strongly encourages 
NIOSH to expedite decisions on petitions filed under the 
Procedure for Designating Classes of Employees as Members of 
the Special Exposure Cohorts (42 CFR Part 83). It was Congress' 
intent in passing the Energy Employees Compensation Act of 2000 
to provide for timely, uniform and adequate compensation for 
employees made ill from exposure to radiation, beryllium and 
silica, while employed at Department of Energy nuclear 
facilities or while employed at beryllium vendors and atomic 
weapons employer facilities. The Committee encourages the 
Department to recognize that in situations where records 
documenting internal or external radiation doses received by 
workers at the specific facility are of poor quality or do not 
exist that workers should promptly be placed in a special 
exposure cohort.
    Research to Practice Initiative.--The Committee is 
supportive of NIOSH's Research to Practice Initiative to 
develop and expand efforts to put research findings into 
practice. The Committee encourages NIOSH to use this initiative 
to translate useful research findings into best practices, 
products, and technologies and to disseminate this information 
to employers and employees to improve the health and safety of 
workers.

                             GLOBAL HEALTH

    The Committee recommends $305,239,000 for global health 
related activities at the CDC in fiscal year 2005. The fiscal 
year 2004 comparable level was $279,944,000 and the 
administration requested $304,444,000 for fiscal year 2005. The 
Office of Global Health will lead and coordinate CDC's global 
programs to promote health and prevent disease in the United 
States and abroad, including ensuring rapid detection and 
response to emerging health threats.
    Global HIV/AIDS.--CDC works with governments in 25 
countries in Africa, Asia and Latin America and the Caribbean 
focusing on primary prevention of HIV/AIDS; care and treatment 
of tuberculosis and other opportunistic infections, palliative 
care and appropriate use of antiretroviral medications; and 
infrastructure and capacity development.
    The Committee understands that little attention has been 
given to the increased risk of HIV infection for individuals 
with disabilities in some parts of the world, including sub-
Saharan Africa. Information, testing, and treatment are often 
inaccessible and denied to individuals with disabilities. The 
Committee encourages the CDC to investigate this issue and 
report on the problem and efforts to address it. The Committee 
also encourages the CDC to provide technical assistance to 
grantees on how to develop inclusive and accessible public 
awareness campaigns, educational materials, testing, treatment, 
palliative and preventive care to ensure that people with 
disabilities have equal access to services and supports for 
HIV/AIDS.
    The Committee encourages the CDC to assist African nations 
in developing systems to ensure that blood supplies are 
screened for HIV/AIDS and other communicable diseases.
    The Committee notes that funding for continuation of the 
International Mother and Child HIV Prevention Initiative [MTCT] 
has been requested in the budget for the Department of State 
under the jurisdiction of the Foreign Operations Appropriations 
Subcommittee. Therefore, the Committee does not providing any 
funding for the program in the CDC, however, the Committee 
remains supportive of this critical program. The Committee 
encourages CDC to ensure that funds provided to the MTCT 
program, the CDC GAP initiative, and the Global Fund for HIV/
AIDS, Tuberculosis, and Malaria are used in a coordinated and 
complementary fashion.
    Global Disease Detection.--The Committee commends CDC for 
its role in strengthening the capacity of the public health 
community, both at home and abroad, to respond to global 
threats, such as SARS, monkeypox, West Nile virus, pandemic flu 
and bioterrorism. CDC's Global Disease Detection System is 
integral to these efforts. This system is designed to provide 
worldwide technical support to ensure rapid and accurate 
diagnoses of emerging infectious disease events, and to provide 
a secure link between clinicians and laboratories and CDC and 
the World Health Organization to ensure real-time reporting of 
emerging threats. The Global Disease Detection System also will 
support sentinel sites in key regions around the globe to 
ensure prompt disease detection and referral to a regional 
laboratory service. These capacities are critical to mitigate 
the consequences of a catastrophic public health event, whether 
the cause is an intentional act of terrorism or the natural 
emergence of a deadly infectious virus, like SARS. The 
Committee has provided $24,500,000 over the fiscal year 2004 
level for these efforts.
    Global Immunization Activities.--The Committee includes 
$557,000 above the fiscal year 2004 level for polio vaccine, 
surveillance, and program operations for the highly successful, 
yet unfinished polio eradication efforts; and $238,000 above 
the fiscal year 2004 level for the purchase of measles vaccine 
for measles mortality reduction and regional measles 
elimination initiatives and to expand epidemiologic, 
laboratory, and programmatic/operational support to WHO and its 
member countries.
    The Committee appreciates CDC's contribution to global 
immunization efforts to eradicate polio and eliminate measles 
worldwide. Federal dollars help leverage private dollars in 
both the Polio Eradication Campaign and the Measles Initiative, 
partnerships among international agencies, NGOs and CDC. Polio 
eradication is close to completion; however, polio is still 
endemic in six countries. Any ground lost in maintaining 
``immunization days,'' surveillance and labs is disastrous. 
Immunization is respected in these developing countries to the 
point that they cause temporary ceasefires in countries at war.

                         PUBLIC HEALTH RESEARCH

    Public Health Research and Prevention Research.--The 
Committee has provided $35,000,000 in transfers available under 
section 241 of the Public Health Service Act to fund the Public 
Health Research and Extramural Prevention Research programs. In 
fiscal year 2004, the combined funding for these programs was 
$29,107,000 and the administration requested $15,000,000 for 
these programs in fiscal year 2005. The Committee is strongly 
supportive of public health and prevention research, which 
bridge the gap between medical research discoveries and 
behaviors that people adopt by identifying the best strategies 
for detecting new diseases, assessing the health status of 
populations, motivating healthy lifestyles, communicating 
effective health promotion messages, and acquiring and 
disseminating information in times of crisis.
    The Committee recognizes the need to enhance the 
recognition and understanding of mind/body medicine's role in 
the practice of medicine. To foster and expand the uses of 
mind/body interactions in healthcare and other appropriate 
settings, the Committee encourages the Public Health Research 
Program to provide support to research, test, and disseminate 
the practices related to mind/body techniques. To receive 
appropriate technical assistance, CDC is strongly encouraged to 
consult experts in the mind/body field.

                 PUBLIC HEALTH IMPROVEMENT & LEADERSHIP

    The Committee provides $261,858,000 for public health 
improvement and leadership activities at the CDC. The fiscal 
year 2004 comparable level was $232,687,000 and the 
administration requested a comparable program level of 
$200,537,000 for fiscal year 2005.

Leadership and Management

    To more easily identify and quantify administrative, 
management, and leadership costs at the CDC, the Committee has 
provided the administrative funds for the agency and its 
institutes, centers, and offices (except NIOSH) within this 
account. The Committee provides $179,977,000 for leadership and 
management costs at the CDC in fiscal year 2005. The fiscal 
year 2004 comparable level was $170,780,000 and the 
administration requested a comparable level of $180,444,000 for 
fiscal year 2005.
    Director's Discretionary Fund.--The Committee has provided 
$18,000,000 for a Director's Discretionary Fund. This fund will 
allow the Director to quickly respond to emerging public health 
issues and threats not contemplated at the time of enactment of 
the appropriations.
    Epidemic Services and Response.--CDC's epidemic services 
and response program provides resources and scientific 
expertise for operating and evaluating surveillance systems; 
developing and refining research methods and strategies to the 
benefit of public health practice; training public health 
professionals who are prepared to respond to public health 
emergencies, outbreaks and other assistance requests; and 
communicating with multi-faceted audiences accurate public 
health information and effective messages. The Committee 
recognizes that CDC maintains a keen appreciation for the fact 
that local outbreaks of illness can develop rapidly into 
epidemics, that previously unidentified health problems can 
appear at any time, that contaminated food or defective 
products may appear in the community without warning, and that 
the threat of bioterrorism is present in many areas of the 
world. When CDC participates in an investigation, all of the 
resources of the agency are at the disposal of the affected 
area, including its state-of-the-art laboratories.
    Individual Learning Accounts.--The Committee commends CDC 
for its commitment to workforce development, and supports the 
use of Individual Learning Accounts to provide CDC employees 
with flexible opportunities for continuing education. In a 
recent assessment of the use of such accounts at 13 Federal 
agencies, the Office of Personnel Management recommended their 
implementation government-wide so as to enhance workforce 
development opportunities for all Federal employees. The 
Committee recommendation includes up to $30,000,000, within 
current appropriations, to establish Individual Learning 
Accounts for full-time equivalent employees at CDC.
    Leadership and Management Savings.--The Committee strongly 
believes that as large a portion as possible of CDC funding 
should go to programs and initiatives that improve the health 
and safety of Americans. To facilitate this goal, any savings 
in leadership and management may be reallocated to the 
Director's Discretionary Fund upon notification of the 
Committee.
    Transfer Authority.--The Committee has included authority 
for the Director to transfer up to 1 percent of any CDC 
program, project, or activity to any other CDC program, 
project, or activity. No program, project, or activity may be 
decreased by more than 1 percent and no program, project, or 
activity may be increased by more than 3 percent.

           PREVENTATIVE HEALTH & HEALTH SERVICES BLOCK GRANT

    The Committee has provided $131,814,000 for the 
Preventative Health & Health Services Block grant. The fiscal 
year 2004 comparable level was $131,814,000 and the 
administration requested a comparable level of $131,814,000 for 
fiscal year 2005.
    The block grant provides funding for primary prevention 
activities and health services that address urgent health 
problems in local communities. This flexible source of funding 
can be used to target concerns where other funds do not exist 
or where they are inadequate to address the extent of the 
health problem. The grants are made to the 50 States, the 
District of Columbia, two American Indian tribes, and eight 
U.S. territories.

                        BUILDINGS AND FACILITIES

    The Committee has provided $294,500,000 for the planning, 
design, and construction of new facilities, repair and 
renovation of existing CDC facilities, and data security and 
storage. The fiscal year 2004 comparable level was $260,454,000 
and the administration requested $81,500,000 for fiscal year 
2005.
    The Committee recommendation includes $250,000,000 for the 
continuation of CDC's Buildings and Facilities Master Plan in 
Atlanta, Georgia and $44,400,000 to complete construction of 
CDC's Division of Vector Borne Infectious Diseases Laboratory 
in Fort Collins, Colorado.
    The Committee has again provided bill language to allow CDC 
to enter into a single contract or related contracts for the 
full scope of development and construction of facilities and 
instructs CDC to utilize this authority, when necessary, in 
constructing the Atlanta and Fort Collins facilities.
    The Committee is aware that a number of small buildings 
from the former U.S. Bureau of Mines now comprise the current 
NIOSH National Personal Protective Technologies Laboratory. A 
modern laboratory is needed to conduct certification tests and 
related respiratory protection research. As CDC reviews its 
CDC-wide Master Plan, the agency is urged to give priority 
consideration to modernizing this laboratory space.

                       BUSINESS SERVICES SUPPORT

    The Committee provides $282,226,000 for business services 
support functions at the CDC. The fiscal year 2004 comparable 
level was $282,226,000 and the administration requested a 
comparable level of $286,015,000 for fiscal year 2005. These 
funds will be used to support CDC-wide support functions.
    The Committee strongly believes that as large a portion as 
possible of CDC funding should go to programs and initiatives 
that improve the health and safety of Americans. To facilitate 
this goal, any savings in business services support may be 
reallocated to the Director's Discretionary Fund upon 
notification of the Committee.

                              NIH Preamble

    As a Nation, we can take justifiable pride in our 
achievements in the fields of science and medicine. The fruits 
of medical research have made possible the drugs, surgical 
techniques and prevention strategies that have virtually 
conquered many of the leading killers of past generations of 
Americans, such as tuberculosis, rheumatic fever, smallpox, 
pneumonia and many others. Much of what has been accomplished 
to help save lives and improve the quality of life can be 
attributed, directly or indirectly, to the world's leading 
medical research enterprise: the National Institutes of Health. 
One accomplishment alone--the sequencing of the human genome--
has opened the way to heretofore unimagined opportunities to 
explore human biology in both health and disease. Medical 
genetics, once a tool for diagnosing a handful of rare 
diseases, can now be used to predict a healthy person's risk of 
diseases such as breast cancer and heart disease, provide new 
tests for diagnosing illness and determine individual responses 
to drugs and environmental agents. But the conquest of some 
diseases, by increasing our life span, has made us more 
vulnerable to others. As the baby boom generation moves past 
age 50 at the rate of 10,000 per day, a large cohort of 
Americans are entering the age of high risk for cancer, 
cardiovascular disease, Alzheimer's, arthritis, diabetes and 
oral disease. Emerging infectious agents such as SARS, West 
Nile Virus and hepatitis C kindle new threats to health, while 
with the menace of bioterrorism poses new challenges for rapid 
detection, containment and treatment. And despite improvements 
in the overall health of America, minority populations continue 
to suffer an unequal burden of disease, disability and death.
    This Committee has long recognized the role NIH can and 
does play in transforming the health status of America. In 
1998, the Committee embarked on a 5-year endeavor to double the 
investment in NIH in an effort to quicken the pace and 
intensity of this transformation. Although it is impossible to 
predict what cures or new treatments will emerge as a result, 
it is certain that the infusion of new funds during the 
doubling process helped push back the frontiers of scientific 
knowledge, while attracting the best and brightest minds to 
careers in medical research. However, the accumulation of 
fundamental knowledge for its own sake is of little value 
unless it finds its way to hospitals and physicians, where it 
can be put to use in promoting good health or diagnosing, 
preventing and treating disease. For that to happen requires a 
robust commitment of resources over a sustained period. The 
Committee recommends $28,900,300,000 for the NIH. This amount 
is $1,100,252,000 above the fiscal year 2004 appropriation and 
$373,429,000 over the budget request.
    Biomedical Research and Development Price Index.--The 
Committee is disappointed that the budget request would require 
NIH to break its funding commitments to existing grantees, 
contradicting the principles of the agency's own 1992 Cost 
Management Plan. Forcing grantees to reduce the scope of 
research that is already underway would establish an 
unfortunate precedent and could erode confidence in NIH. 
Therefore, the Committee has included sufficient funding to 
enable NIH to fully pay the committed levels on its grants. The 
Committee is also disappointed that the budget request's 
proposed average cost assumptions would keep NIH from buying 
the same amount of research as in fiscal year 2004 with its new 
research project grants [RPGs], when biomedical inflation, as 
measured by the Department of Commerce's Biomedical Research 
and Development Price Index [BRDPI], is taken into account. The 
funding level recommended by the Committee will permit the 
average cost of new and competing RPGs to rise by 2 percent 
instead of the 1 percent increase proposed in the budget 
request.
    Consulting Fees.--The Committee was extremely disappointed 
to learn the extent to which NIH scientists and administrators 
have been receiving monetary compensation from pharmaceutical 
and biotechnology companies. Some NIH employees have received 
hundreds of thousands of dollars for their outside work, none 
of which was publicly disclosed. Even more disturbing, some of 
these employees did not disclose their outside work to agency 
officials. These arrangements raise questions about potential 
conflicts of interest, the influence that these monetary 
compensations could have on the outcome of scientific research, 
and whether these employees are more interested in procuring 
lucrative consulting fees than in meeting the responsibilities 
of their full-time, taxpayer-funded jobs. The Committee finds 
it difficult to understand how the most prestigious biomedical 
research institution in the world could allow these questions 
to be raised. The Committee commends the NIH Director for 
convening a Blue Ribbon Panel to review and make 
recommendations regarding existing laws, regulations, policies 
and procedures governing consulting fees. The Committee was 
also pleased to learn that the NIH plans to implement new 
regulations to ensure the integrity of its scientific research. 
While the Committee strongly supports intramural and extramural 
research at the NIH, it must be sure of the integrity of that 
research; therefore, the Committee directs the NIH Director to 
immediately put in place safeguards that will insure that no 
conflicts of interest exist between scientists and 
pharmaceutical and biotechnology companies, or any other 
entity.
    Human Embryonic Stem Cell Research.--The Committee is very 
concerned that the current administration policy relating to 
human embryonic stem cell research is extremely limiting and is 
significantly slowing the pace of stem cell research. The 
Committee strongly believes that embryonic stem cells have the 
potential to be used to treat or cure the 100 million Americans 
who are afflicted with diseases such as cancer, heart disease, 
diabetes, Parkinson's, Alzheimer's, multiple sclerosis, spinal 
cord injury, and many others. While it originally appeared that 
78 embryonic stem cell lines would be available for research 
under the Federal policy, now, more than 2 years after the 
President's announcement on August 9, 2001, only 24 are 
available to researchers. Moreover, scientists have told the 
Committee that all available stem cell lines were grown with 
mouse feeder cells, making their therapeutic use for humans 
uncertain. The Committee strongly urges the administration to 
modify the current embryonic stem cell policy so that it 
provides this area of research the greatest opportunity to lead 
to the treatments and cures for which we are all hoping.
    The Committee is also deeply concerned with the slow pace 
of implementation of the current policy. The Committee was 
informed by NIH this year that anticipated spending on human 
embryonic stem cell research is just $24,800,000.

                       NATIONAL CANCER INSTITUTE

Appropriations, 2004....................................  $4,739,255,000
Budget estimate, 2005...................................   4,870,025,000
Committee recommendation................................   4,894,900,000

    The Committee recommends an appropriation of $4,894,900,000 
for the National Cancer Institute [NCI]. The budget request was 
$4,870,025,000. The fiscal year 2004 appropriation was 
$4,739,255,000. 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. The Institute 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.
    Anticancer compounds.--The Committee encourages the 
National Cancer Institute to increase research in the area of 
anticancer compounds. Sources of these compounds include marine 
invertebrates, terrestrial plants, and microorganisms that may 
be used to develop small molecule anticancer drugs. The 
Committee further understands that little research is conducted 
in this area and therefore urges the Institute to conduct 
appropriate research in this area.
    Behavioral Research.--The Committee recognizes the enormous 
progress NCI has made in the quality and breadth of cancer 
related behavioral science ranging from basic bio-behavioral 
research to health communication research and tobacco control 
research. Closing the gap between research and program delivery 
is both a challenge and a necessity if we are to ensure that 
all populations benefit from new scientific discoveries. 
Behavioral science can contribute to survival, reduced 
morbidity and increased quality of life, and the behavioral and 
cognitive sciences can be highly applicable in answering 
critical questions regarding patient care. The Committee sees 
NCI's behavioral science research program as a model for other 
institutes.
    Bladder and Renal Cancer.--The Committee is concerned about 
the poor implementation of the 2002 Progress Review Group 
Report on Bladder and Renal Cancers. The incidence and 
mortality of renal cancer has been steadily increasing over the 
past several decades. Renal cancers are silent killers; for 
many, renal cancers are not recognized until late in the 
disease, when cancer has already spread beyond the kidney. NCI 
is urged to expand studies to improve detection and diagnosis 
of renal cancer. For patients with metastatic renal cancer, 
survival is only 9 percent with a median survival time of 12 
months. There are very few effective treatments. Metastatic 
bladder cancer also responds poorly to treatment. The Committee 
urges NCI to develop a novel treatment network to rapidly 
identify and test for new therapies for renal and bladder 
cancer in human patients and to expand studies on mechanisms of 
metastasis in these patients.
    Blood Cancers.--The Committee is pleased that important new 
therapies have been developed for the blood cancers--leukemia, 
lymphoma, and multiple myeloma. It has been brought to the 
Committee's attention that the Leukemia, Lymphoma, and Myeloma 
Progress Review Group, a blue ribbon advisory panel of NCI 
recommended in May 2001 the establishment of new multi-
disciplinary and multi-institutional structures to shorten the 
timeline for new blood cancer drug development. The Committee 
encourages the NCI to develop new strategies to accelerate the 
development of new blood cancer therapies, which might include, 
among other options, public-private partnerships, multi-
disciplinary collaborations, and multi-institutional 
initiatives. The Committee further urges the NCI to consider 
flexible uses of current funding mechanisms in order to respond 
to the key recommendation of the blood cancer Progress Review 
Group.
    Bone Metastasis.--The NCI is encouraged to develop an 
integrated approach to study bone metastasis, leveraging the 
expertise of cancer and bone biologists, clinical oncologists 
and metastasis experts and representatives of the 
pharmaceutical industry. Key issues to address include the 
generation of novel models which mimic tumor/bone interaction 
and which delineate mechanisms to determine why tumor cells 
prefer bone for metastasis. It is clinically relevant to learn 
how to use information to change the bone microenvironment so 
that it is hostile to the invading tumor cells. The Committee 
also urges NCI to expand research on osteosarcoma to improve 
survival and quality of life and to prevent metastatic 
osteosarcoma in children and teenagers who develop this cancer.
    Brain Tumors.--The Committee is concerned that insufficient 
attention is being given by NCI and NINDS to brain tumor 
research. The Committee encourages NCI to fund at least five 
Specialized Programs of Research Excellence in Brain Tumors 
[SPORE] grants in the upcoming fiscal year, with particular 
emphasis on those proposals which include both basic research 
and clinical treatment applications.
    Cancer Centers and Minorities.--The Committee commends NCI 
on the success of its cancer centers program. Given that 
minority populations suffer disproportionately from virtually 
every form of cancer, the Committee encourages NCI to support 
the establishment of a comprehensive center at a minority 
institution focused on research, treatment, and prevention of 
cancer in African American and other minority communities.
    Cancer Genomics.--The Committee is pleased that the NCI has 
focused considerable attention on building innovative public/
private partnerships to accelerate the development and 
deployment of new technologies, which will facilitate the 
Institute's ambitious goal of dramatically altering the 
understanding and treatment of cancer by 2015. The Committee is 
also aware of the enormous potential for improved understanding 
and treatment of cancer presented by the use of microarray 
technology in both basic research and clinical setting. The 
Committee understands that the use of this technology can help 
accelerate the development of effective cancer drugs, the 
prediction of drug response, and ultimately the early detection 
and improved treatment of cancer. The Committee recommends that 
NCI continue to employ these enabling technologies to identify, 
characterize, and validate the gene pathways that cause cancer 
and that it continue to work cooperatively with public and 
private sector entities to do so.
    Cancer and Native Hawaiians.--The Committee remains 
concerned about the high incidence of breast, colon, and lung 
cancer among the native Hawaiian population. The Committee 
anticipates an update on the Director's task force to explore 
the continuing unique needs of the people of Hawaii and the 
Pacific Basin region.
    Chronic Lymphocytic Leukemia [CLL].--This incurable disease 
is the most common form of adult leukemia in the United States. 
The Committee once again urges the NCI to increase research 
into CLL, including improved therapies and their rapid movement 
from the laboratory to the bedside. The Committee is pleased to 
learn that the unique multidisciplinary and multi-institutional 
research consortium funded by the NCI for the past 5 years is 
proceeding with a competing renewal of its initial grant to 
permit coordinated continued study of CLL at the cellular and 
clinical levels. The Committee strongly urges the NCI to give 
favorable consideration to continuing and expanding the scope 
of research activities funded through the the CLL Research 
Consortium as it works to defeat this devastating blood 
disorder.
    Complementary and Alternative Cancer Therapies.--The 
Committee expects NCI to expand its work and its collaborative 
efforts with NCCAM to support research on promising 
complementary and alternative cancer therapies as well as on 
their integration with traditional therapies.
    Diethylstilbestrol [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]. The Committee 
expects NCI to continue its support of research in this area, 
and to continue to consult with organizations representing 
individuals impacted by DES as they carry out DES research and 
education efforts.
    Gynecologic Cancers.--In the last 5 years, approximately 
130,000 women in the United States have lost their lives to 
gynecologic cancer. The Committee commends the NCI for creating 
a cervical cancer and endometrial cancer SPORE, bringing the 
total number of gynecologic cancers SPORES to six, and expects 
that the NCI will expand the number of centers in the future. 
Unfortunately, 70 percent of ovarian cancer patients continue 
to be diagnosed in advanced stages when 5-year survival rates 
remain less then 25 percent. The Committee encourages continued 
research by the four ovarian SPORES that will lead to a better 
understanding of prevention and the development of a screening 
tool offering women earlier diagnosis when this cancer is more 
curable. The Committee also supports the expansion of NCI's 
collaboration with the NICHD for faculty development of 
gynecologic oncologists.
    Health Care Decision-making.--The Committee applauds NCI's 
investment in staff and resources to help build the science of 
health care decision-making. Such research will improve 
understanding of human decision-making processes so that 
individuals can make more informed choices about their health, 
and so more useful decision support systems can be constructed. 
Efforts to integrate basic behavioral and social research in 
judgment and decision-making, and applied cancer decision 
making will serve to harness the work of basic researchers, who 
may not have previously applied their work to health settings.
    Imaging Systems Technologies.--The Committee is encouraged 
by progress made by the NCI following its August 1999 
conference on biomedical imaging, and urges the NCI to continue 
to take a leadership role with the Centers for Medicare and 
Medicaid Services [CMS] and the Food and Drug 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 
continues to support the NCI's increased emphasis on examining 
the molecular basis of disease through imaging technologies 
such as PET and MicroPET. The Committee continues to encourage 
the large-scale testing of women for breast cancer and men for 
prostate cancer to demonstrate and quantify the increased 
diagnostic and staging capabilities of PET relative to 
conventional diagnostic and staging technologies, including 
mammography.
    Liver Cancer.--The Committee notes that in contrast to many 
other cancers, the number of people who develop and die from 
liver cancer has increased 24 percent since the year 2000. As 
the symptoms of liver cancer often do not appear until the 
disease is advanced, only a small number of liver cancer cases 
are found in the early stages of the disease, when it can be 
easily treated. The Committee is aware that the NCI, in 
collaboration with NIDDK, convened an Experts Conference that 
will help define the most urgent areas requiring additional 
research, professional education and public awareness 
initiatives. The Committee urges NCI to issue a Request for 
Applications based on the findings of this conference.
    Lung Cancer.--Lung cancer remains a major public health 
issue and is the leading cause of cancer death among women and 
minority populations. The death rate is expected to escalate as 
the population ages. Treatment and research now require an 
interdisciplinary approach and thoracic surgeons play an 
important role in both. The Committee encourages the Institute 
to work with the thoracic surgical community to identify 
priority areas for new clinical and translational studies and 
to ensure their participation in any interdisciplinary research 
efforts. Thoracic surgeons should be included in all relevant 
review and advisory committees and councils.
    Molecular Cancer Diagnostics.--The Committee understands 
that the NCI is aware of the potential for molecular cancer 
diagnostics using circulating nucleic acids, including in 
particular extracellular RNA in plasma. The Committee believes 
that this technology could have enormous potential for the 
early detection, monitoring, and selection of more effective 
treatment of a broad array of cancers and therefore encourages 
the NCI to explore the use and clinical application of this 
technology.
    Multidisciplinary Research.--NCI is commended for its 
innovative support of multidisciplinary training programs to 
enhance the scientific workforce. The Committee encourages NCI 
to explore new opportunities with the Office of Behavioral and 
Social Sciences Research to increase the number of scientists 
who can bridge the realms of behavioral and social science 
research and public health or biomedical research.
    Myelodysplasia and Myeloproliferative Disorders.--The 
Committee recognizes NCI's support for a new research 
initiative in Myeloproliferative Disorders [MPDs), which 
evolved from a recent conference involving the Institute and 
NHLBI. MPDs and Myelodysplasia [MDS] are chronic diseases of 
bone marrow cells that can develop into acute leukemia. The 
Committee encourages NCI and NHLBI to bring together scientific 
and clinical experts in these fields to explore collaborative 
and crosscutting research mechanisms to further this research 
agenda. The Committee also urges NCI to utilize the 
Surveillance, Epidemiology, and End Results [SEER] Program to 
collect data on the incidence and distribution of these 
diseases.
    Nanosystems Biology.--The Committee encourages NCI and the 
Office of the NIH Director to support a collaborative effort to 
bringing together nanotechnology, systems biology and molecular 
imaging to examine the molecular basis of cancer. Initial 
efforts have shown that cancers such as breast cancer are not a 
single disease, but may encompass many different diseases, when 
examined at the molecular level. Many clinical trials of new 
drugs are now considered a failure if only 10 percent of 
patients benefit, yet the 10 percent may represent a specific 
type of the disease, where the drug may be 100 percent 
effective. Bringing these three disciplines together may allow 
researchers to identify specific sub-types of cancer and to 
better target new interventions. Successful results of such an 
effort could lead to a molecular classification of many types 
of cancer and to targeted molecular treatments for molecular-
specific diseases.
    Neurofibromatosis.--The Committee commends NCI for 
conducting phase II clinical trials of NF1 patients with 
plexiform neurofibromas. The Committee is concerned about 
recent large drops in funding for NF research, and recognizing 
NF's connection to many of the most common forms of human 
cancer, the Committee encourages NCI to substantially increase 
its NF research portfolio in such areas as further development 
of animal models, natural history studies, therapeutic 
experimentation, and clinical trials. The Committee is mindful 
of NF's rapid movement toward clinical research and encourages 
NCI to aggressively pursue clinical/translational research 
while still maintaining a solid basic research portfolio.
    Pancreatic Cancer.--The Committee remains concerned about 
the lack of scientists researching pancreatic cancer, the 
Nation's fourth-leading cause of cancer death. The NCI's recent 
policy of offering a 50 percent extended payline for grants 
that are 100 percent related to pancreatic cancer was viewed as 
a critically important effort to encourage both young and 
experienced investigators to develop careers in this research 
field. Thus, the Committee is disappointed that the NCI plans 
to weaken that policy and adopt a new strategy consisting of 
identifying grants that are 50 percent directed to pancreatic 
cancer and then bringing them to the attention of the NCI 
Executive Committee. The Committee notes that this special 
consideration will not necessarily result in actual funding. 
Therefore, the Committee urges the NCI to maintain the 50 
percent extended payline for 100 percent relevant pancreatic 
cancer research grants as the best way to attract a critical 
mass of scientists to this field.
    Prostate Cancer.--The Committee commends the NCI for the 
considerable investment in prostate cancer, the leading cause 
of non-cutaneous cancer death among men, and encourages NCI to 
continue to support research to improve the accuracy of 
screening and early detection of prostate cancer.
    Psychoneuroimmunology and Cancer.--The Committee is 
interested in NCI's initiative to evaluate the complex 
interrelationships among emotional, behavioral, neural and 
immunological processes and how they may affect the etiology 
and progression of cancer. NCI's BiMPED initiative is a good 
example of leveraging the institute's resources to seed new 
research across NIH on fundamental mechanisms and processes 
that may affect multiple diseases and conditions.
    Radio Waves.--It has been brought to the Committee's 
attention that radio waves may prove promising in reducing 
cancerous tumors. While current radio frequency ablation 
requires placing electrodes directly into the tumor, this new 
non-invasive technique would target only the cancer cells while 
avoiding healthy tissue. The Committee urges the NCI to support 
research using this non-invasive cancer-targeting technique.
    Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or 
TSC, is a genetic disorder that triggers uncontrollable tumor 
growth in multiple organs of the body, including the brain, 
heart, kidneys, lungs, liver, eyes or skin. In light of its 
similarities to the uncontrolled growth of cancer cells, many 
scientists believe that determining the cause of tumor growth 
in TSC could open the way for cures and treatments for cancer 
as well. To those ends, the Committee strongly encourages NCI 
to support programs examining the molecular and cellular basis 
of TSC, and the role of TSC in tumor development.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2004....................................  $2,878,691,000
Budget estimate, 2005...................................   2,963,953,000
Committee recommendation................................   2,985,900,000

    The Committee recommendation includes $2,985,900,000 for 
the National Heart, Lung, and Blood Institute [NHLBI]. The 
fiscal year 2004 appropriation was $2,878,691,000 and the 
budget request was $2,963,953,000. 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 basic, 
clinical, population-based, and health education research.
    Advanced Imaging Technology for Heart Disease and Stroke.--
The Committee is aware that heart perfusion PET scans using 
Rubidium-82 are considered the ``gold standard'' for 
determining the extent of muscle damage to the heart following 
a heart attack. The Committee encourages the NHLBI to expand 
its research efforts into the role of biological imaging and 
PET in delivering more accurate information to determine 
appropriate treatment for heart disease patients.
    Allied Health Personnel.--Given the existing and growing 
shortages of qualified allied health professions who serve as 
laboratory personnel, NHLBI is encouraged to enhance program 
activity at research institutions training these individuals, 
as one step to alleviate this problem. This shortage is of 
particular concern since laboratory personnel are critical to 
identifying biological agents and, therefore, to any state or 
national plan for combating bioterrorism.
    American Indians and Alaskan Natives Community-Responsive 
Interventions to Reduce Cardiovascular Risk.--The Committee is 
aware that American Indian and Alaska Native communities bear a 
heavy burden of heart disease, stroke and other cardiovascular 
diseases. But, few preventive interventions have been tested. 
Tribal leaders have urged that research in their communities 
focus on finding solutions for the most serious issues these 
populations face, including heart disease, stroke and other 
cardiovascular diseases. To address the concerns of the tribal 
leaders, the Committee strongly urges the NHLBI to start a 
planned initiative to evaluate approaches to reducing 
behavioral cardiovascular disease risk factors such as obesity, 
diet, smoking, sleep restriction, stress, and sedentary 
lifestyle in the American Indian and Alaskan Native 
populations. A central part of this research will be the 
development of interventions that can be incorporated into 
community patient care programs or delivered through other 
public health avenues in native communities.
    Behavioral Research on Long-term Exercise Benefits.--The 
Committee encourages NHLBI to continue its research program on 
longterm behavior change, particularly as it concerns physical 
activity. NHLBI-funded research showed that moderate-intensity 
exercise was as effective in a long-term program as high-
intensity exercise in enabling patients to maintain weight loss 
for over a year. NHLBI is encouraged to continue its focus on 
the role of exercise in health, and factors that increase the 
likelihood that sedentary adults and youth can initiate and 
maintain programs of physical activity to prevent obesity.
    Cardio-thoracic Surgery.--The Committee commends the 
Institute for its efforts to increase research in the role of 
cardio-thoracic surgery in the treatment and management of 
heart and lung diseases. Reestablishing the cardio-thoracic 
intramural program is an important component of this effort. To 
support this renewed activity, the Committee encourages the 
Institute to increase the representation of cardiovascular and 
thoracic surgeons at all levels, including the advisory 
council.
    Cardiovascular Diseases.--The Committee continues to regard 
research into the causes, cure, prevention and treatment of 
heart disease, stroke and other cardiovascular diseases as a 
major concern for our Nation and urges the NIH and the NHLBI to 
make these diseases a top priority. Cardiovascular diseases 
remain the leading cause of death in the United States and a 
major cause of permanent disability. The Committee continues to 
strongly support increased efforts to study heart disease, 
stroke and other cardiovascular diseases. The Committee is very 
concerned that funding over the years for cardiovascular 
disease research has not kept pace with the scientific 
opportunities, the number of Americans afflicted with 
cardiovascular diseases and the economic toll these diseases 
impose on our Nation. Concerned that cardiovascular disease 
research still receives disproportionately low funding, the 
Committee urges the Institute to aggressively expand its 
research portfolio and dramatically increase its resources 
dedicated to cardiovascular disease research through all 
available mechanisms.
    Cardiovascular Health Study.--The Committee is aware that 
the Cardiovascular Health Study, initiated in 1987 to determine 
risk factors for development and progression of heart disease, 
stroke and other cardiovascular diseases in nearly 6,000 
Americans age 65 and older, is scheduled to end in 2005. The 
wide variety and complexity of data and samples collected in 
the Cardiovascular Health Study represent an unique national 
research resource. The Committee urges the NHLBI to initiate a 
planned proposal to stimulate innovative use of Cardiovascular 
Health Study data and material, provide opportunities for open, 
efficient use of the information for the entire scientific 
community, and continue follow-up of study participants.
    Chronic Obstsructive Pulmonary Disease [COPD] Education and 
Prevention Program.--The Committee urges the NHLBI to implement 
an education and prevention program for Chronic Obstructive 
Pulmonary Disease [COPD]. To enhance the proper diagnosis and 
early detection of COPD, NHLBI is urged to launch an effort to 
reach out to the more than 13.3 million Americans living with 
COPD and the 24 million individuals yet to be diagnosed. In 
developing such an education and prevention program, the NHLBI 
is encouraged to work closely with patient and physician 
organizations and existing coalitions to coordinate with on-
going activities in the community.
    Early identification of those at-risk for or who have COPD 
is essential in the effort to stem the growth of this segment 
of population. The Committee encourages NHLBI to enhance its 
efforts in this area, through all available mechanisms, as 
appropriate, including working with national lung 
organizations, such as the American Thoracic Society and the 
American Lung Association to develop epidemiological studies of 
patients who are at-risk for or who have this disease as well 
on a national education campaign for providers and the public 
about COPD.
    Cooley's Anemia.--The Committee remains strongly supportive 
of the focused research effort that is being undertaken by the 
Thalassemia Clinical Research Network, which is comprised the 
leading research institutions in the field of thalassemia, or 
Cooley's anemia. The Committee believes that this network is 
just beginning to meet its promise and urges the institute to 
continue its support. In addition, the Committee believes that, 
where appropriate, consideration should be given to including 
patients with related hemoglobinopathies whenever such 
inclusion will enhance the scientific validity of the research 
being conducted.
    Cystic Fibrosis.--The Committee understands that cystic 
fibrosis researchers are evaluating a number of compounds as 
possible therapies for CF. This will require the completion of 
clinical trials enrolling a significant number of participants. 
The Committee encourages NHLBI, which has a long and successful 
record in supporting trials on therapies for chronic disease, 
to expand its involvement in trials to demonstrate the 
effective use of approved therapies in CF patients and 
especially trials to examine the use of approved products in 
pediatric patients with CF.
    Diamond-Blackfan Anemia.--The Committee is pleased that 
NHLBI is working to develop a comprehensive research initiative 
to investigate the rare bone marrow deficiency disorder, 
Diamond Blackfan Anemia [DBA]. The Committee understands that 
breakthroughs in this disorder may lead to important strides in 
research especially relating to blood cell formation (recovery 
from cancer chemotherapy), cancer predisposition, gene 
discovery, and the effectiveness of steroids and blood 
transfusions as treatment options for all bone marrow failure 
syndromes and that the detailed evaluation of DBA patients will 
also serve as an important model for understanding the genetics 
of birth defects. The Committee commends NHLBI for their 
attention to this disorder.
    Duchenne Muscular Dystrophy.--The Committee encourages 
NHLBI, in collaboration with the Office of Rare Diseases, to 
enhance the research and related activities surrounding 
pulmonary and cardiac complications associated with Duchenne 
muscular dystrophy. The NHLBI is expected to report to the 
Committee on its approach to this issue not later than January 
15, 2005.
    Heart Failure Management.--The Committee is concerned that 
heart failure is a major cause of hospitalization and 
readmission. Medicare recipients represent about 65 percent of 
repeat hospitalizations within 1 year. Yet, perhaps 50 percent 
of these hospitalizations are avoidable. The Committee urges 
NHLBI to initiate a planned multi-center, randomized trial to 
evaluate management strategies for heart failure patients in 
terms of their ability to prevent death or hospital 
readmission. Costs, quality of life, physician compliance, and 
patient adherence to prescribed treatment will also be 
assessed. This clinical trial will identify and disseminate 
useful and effective tools for translation of proven heart 
failure therapies into patient care.
    Hemophilia.--The Committee commends NHLBI for its 
leadership in advancing research on bleeding disorders and the 
complications of these disorders. The Committee applauds NHLBI 
for its efforts, working with the National Hemophilia 
Foundation, to support research on improved and novel therapies 
for bleeding disorders.
    Marfan Syndrome.--The Committee commends NHLBI for its 
support of research opportunities to study this life-
threatening, degenerative genetic disorder. Marfan syndrome is 
characterized by cardiovascular, skeletal and ocular 
manifestations, and its cardiovascular complications result in 
premature death. Insights gained from research in this area can 
have implications for the understanding of other connective 
tissue disorders, other genetically mediated diseases, and the 
larger population of aging adults with thoracic aneurysms. The 
Committee urges NHLBI to expand its collaborative efforts with 
other institutes to support research, awareness of aortic 
dissection and help reduce the number of premature 
cardiovascular deaths resulting from undiagnosed genetic 
conditions.
    Minority Health.--The Committee notes lung disease 
disproportionately affects many minority groups. The Committee 
urges NHLBI to work with other Institutes and Centers to 
develop an epidemiologic approach to determine the 
disproportionate impact of airway disease on minority 
populations.
    Myelodysplasia and Myeloproliferative Disorders.--The 
Committee commends NHLBI for its new research initiatives in 
Myelodysplasia [MDS] and Myeloproliferative Disorders [MPDs), 
which resulted from a recent conference involving the Institute 
and NCI. MPDs and MDS are chronic diseases of bone marrow cells 
that can develop into acute leukemia. The Committee encourages 
NHLBI and NCI to bring together scientific and clinical experts 
in this field to explore collaborative research and 
crosscutting mechanisms to further this research agenda.
    National Asthma Education and Prevention Program [NAEPP].--
The Committee commends the 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. The Children's Health Act of 2000 
included provisions for NAEPP to develop, in conjunction with 
other Federal agencies and voluntary and professional health 
organizations, a Federal plan to respond to asthma. This plan 
will include the roles and responsibilities of several Federal 
agencies in combating asthma. The Committee would like to be 
kept apprised on the progress of NAEPP's planning efforts, and 
urges NHLBI to move forward as early as possible.
    Neurofibromatosis.--Significant advances continue to be 
made in research on NF's implications with heart disease and in 
particular, its involvement with hypertension and congenital 
heart disease which together affect over 50 million Americans. 
The Committee applauds NHLBI for its involvement with NF 
research and encourages it to continue to expand its NF 
research portfolio.
    Obstructive Sleep Apnea.--The Committee commends the 
Institute for its work on obstructive sleep apnea, a disorder 
that affects approximately 80 percent of the elderly, and which 
if left untreated significantly increases risk for 
hypertension, coronary artery disease, heart failure and 
stroke. The Institute is encouraged to include surgical 
treatments in its search for useful treatments for this 
disorder.
    Pediatric Asthma Network.--The Committee recognizes that 
little is known about the optimal treatment for asthma in 
infants and young children. 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.
    Primary Immunodeficiency Diseases.--The Committee 
understands that NHLBI has begun to work with the Jeffrey 
Modell Foundation as part of its national physician education 
and public awareness campaign for primary immunodeficiency 
diseases, including co-sponsorship of physician conferences at 
the NIH. The Committee encourages NHLBI to take further action 
in this regard and to be an active participant in the 
development of educational materials and future conferences, as 
appropriate.
    Pulmonary Hypertension.--Pulmonary Hypertension [PH] is a 
rare, progressive and fatal disease that predominantly affects 
women, regardless of age or race. PH causes deadly 
deterioration of the heart and lungs and is a secondary 
condition in many other serious disorders such as scleroderma 
and lupus. The Committee continues to view research in this 
area as a high priority and commends NHLBI's efforts to promote 
PH related research. For fiscal year 2005, the Committee 
encourages 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.
    Scleroderma.--The Committee is encouraged by NHLBI's 
growing interest in scleroderma, a chronic and progressive 
disease that predominantly strikes women. Scleroderma is 
disfiguring and can be life-threatening, affecting multiple 
systems including the heart and lungs. More research is 
critically needed in order to develop safe, effective 
treatments and to identify the cause or causes of the 
complications of scleroderma that include pulmonary fibrosis, 
pulmonary hypertension, myocardial fibrosis, cardiac 
arrhythmias, pericarditis, and Raynaud's Phenomenon.
    Sleep Disorders.--The Committee commends the National 
Center on Sleep Disorders Research for its progress and is 
pleased that the Center has sponsored the translational 
conference Frontiers of Knowledge in Sleep and Sleep Disorders. 
The Committee urges the Center to partner with other Federal 
agencies, such as the Centers for Disease Control and 
Prevention, as well as voluntary health organizations such as 
the National Sleep Foundation, to develop a sleep education and 
public awareness initiative that will provide a forum for 
dissemination of the outcomes of the sleep translational 
conference, and serve as an ongoing, inclusive mechanism for 
public and professional awareness on sleep and sleep disorders. 
Several institutes and public health service agencies have had 
success with these collaborative models.
    Thrombosis and Thrombophilia.--The Committee is concerned 
that too little is known about the basic science of thrombosis 
and thrombophilia, major causes of death and disability in this 
country. The Committee strongly urges the Institute to expand 
its support for basic research into their underlying causes in 
order to improve diagnosis and treatment for these conditions. 
The Committee also strongly urges the Institute to use all 
available mechanisms to support this research and urges 
collaboration with the thrombophilia centers funded by CDC.
    Tissue Engineered Blood Vessel Replacement and Repair.--The 
Committee is aware that a need exists to develop alternatives 
to natural blood vessels for the adults who endure heart artery 
bypass surgery and for the children born with complex heart 
defects who need multiple blood vessel grafts. The Committee 
encourages the NHLBI to initiate a planned initiative to 
complement existing tissue engineered research programs to 
stimulate efforts to ``grow'' small-diameter, functional blood 
vessels.
    Tuberculosis and AIDS.--The Committee supports the 
important research on the interaction of tuberculosis and AIDS 
conducted by the NHLBI AIDS research program and encourages 
NHLBI to strengthen its research in this important area.
    Von Willebrand Disease.--The Committee encourages NHLBI to 
establish a universal treatment algorithm (after consultation 
with established medical associations such as the American 
Society of Hematology) for the treatment of Von Willebrand 
disease. At present there is no accepted treatment algorithm in 
the United States for this condition. The Committee also 
recognizes that Von Willebrand disease is an under-recognized 
and under-diagnosed disease. The Committee believes that there 
are instances where women who are suffering from idiopathic 
menorrhagia are needlessly subjected to invasive procedures 
such as hysterectomies. The Committee encourages NHLBI to 
launch a pilot program among obstetricians and gynecologists 
treating patients, especially young women, with idiopathic 
menorrhagia to provide a blood test for Von Willebrand Disease. 
Such a program would act to confirm if a link exists between 
menorrhagia and Von Willebrand Disease in additional to 
providing the benefits of early detection and treatment.

         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2004....................................    $383,282,000
Budget estimate, 2005...................................     394,080,000
Committee recommendation................................     399,200,000

    The Committee recommendation includes $399,200,000 for the 
National Institute of Dental and Craniofacial Research [NIDCR]. 
The fiscal year 2004 appropriation was $383,282,000 and the 
budget requested $394,080,000. 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 Americans. The Institute 
emphasizes ways to prevent disease in high-risk groups, 
including the elderly, minority populations, and individuals 
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.
    Saliva as a Diagnostic Tool.--In recent years dental 
scientists have learned that the oral fluids in the mouth 
contain a cornucopia of information about the condition of the 
various systems of the body. Of particular interest is the 
potential to develop a diagnostic test for early detection of 
breast cancer. The Committee recognizes that considerable 
clinical research must be done before a test can be approved 
for use by health care professionals so that the women of this 
country will have a simple non-invasive, inexpensive procedure 
to alert them to the risk of breast cancer. The Committee urges 
the Institute to advance the field of salivary diagnostics.
    Scleroderma.--The Committee is encouraged by NIDCR's 
interest in scleroderma, a chronic and progressive disease that 
predominantly strikes women. Scleroderma is disfiguring and 
life-threatening; and effective treatments are lacking. 
Scleroderma is often associated with a number of dental and 
craniofacial complications. The most major and common problems 
are xerostomia and microstomia. Additional concerns are 
increased frequency of caries, periodontal disease, fibrotic 
changes, fungal infections, telangectasia and bone resorption 
of the mandible. Additional research is needed to develop safe 
and effective treatments and to identify the cause or causes of 
the serious complications of scleroderma.
    Skeletal Disorders.--The Committee encourages NIDCR to 
continue to conduct research into the basic biology of bone 
cells and bone matrix and their roles in bone turnover and 
regeneration. The Committee also urges NIDCR to pursue research 
into the role of genes and other agents in restoring skeletal 
tissue, and skeletal disorders--including fibrous dysplasia and 
dental abnormalities in Paget's disease patients.
    Systemic Health Risks and Oral Health.--The association 
between oral health and systemic health has been a topic of 
NIDCR funded research projects for many years. Early results 
from several studies indicate that there is a link between oral 
bacterium and preterm births. Still another report has shown a 
connection between gum disease and heart attacks, regardless of 
whether the patient uses tobacco. The Committee encourages 
further research to identify the connection between oral 
disease and systemic disorders.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 2004....................................  $1,671,803,000
Budget estimate, 2005...................................   1,726,196,000
Committee recommendation................................   1,739,100,000

    The Committee recommends an appropriation of $1,739,100,000 
for the National Institute of Diabetes and Digestive and Kidney 
Diseases [NIDDK]. The fiscal year 2004 appropriation was 
$1,671,803,000 and the administration's request is 
$1,726,196,000. The comparable amounts for the budget estimates 
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.
    Acute Liver Failure.--The Committee is pleased that the 
NIDDK has funded an Acute Liver Failure Study Group [ALFSG] 
that will improve medical knowledge necessary to prevent and 
treat acute liver failure. The Committee is pleased with the 
progress of the ALFSG, but notes that funding for the pediatric 
component of this initiative is limited. The Committee 
therefore urges increased funding for the ALFSG, particularly 
to permit a focus on pediatric issues.
    Auto-Immune Liver Diseases.--These diseases are the primary 
indication for liver transplantation in adolescents. The 
Committee urges additional research to improve the prevention 
and treatment of auto-immune liver diseases in children.
    Behavioral Research.--The Committee encourages NIDDK's 
initiative to expand research on childhood obesity, 
particularly behavioral research on physical activity in 
children in various site-specific settings (schools, after-
school care, or other community venues). The goal of such 
research would be to explore methods in pediatric populations 
for the prevention of inappropriate weight gain among those not 
overweight; to prevent further weight gain among those already 
overweight or obese; or treatment of overweight or obesity to 
prevent the complications of associated co-morbidities. The 
Committee applauds NIDDK's proposed long-term effort to address 
the relative contributions of the environmental and behavioral 
factors that lead to excessive weight gain and obesity among 
children.
    Cooley's Anemia.--The Committee continues to support the 
high quality research being conducted by the NIDDK on such 
issues as iron chelation, non-invasive iron measurement, fetal 
hemoglobin, and other topics critical the improving the lives 
of Cooley's anemia patients. The development of a less 
burdensome means of iron chelation is urgently needed. In 
addition, the Committee encourages NIDDK to continue to work 
closely with NIBIB to develop and perfect non-invasive means of 
iron measurement.
    Cystic Fibrosis.--Over the last three decades, advances in 
the treatment of cystic fibrosis have resulted in improvements 
in the life expectancy of individuals with CF. However, much 
more remains to be done to find new treatments for CF. One 
promising area of research is proteomics, which is focused on 
the CF Transmembrane conductance Regulator and its 
abnormalities, the many proteins that interact with CFTR, and 
the identification of novel targets for new CF drugs. The 
Committee encourages NIDDK to expand its support for basic and 
clinical CF research and to place a special emphasis on 
proteomics in CF.
    Diabetes in Native Hawaiians.--The Committee recommends 
investigating the incidence of diabetes in Native American, 
Hawaiian and Alaskan populations, as well as the Mississippi 
Band of the Choctaw Indians and the Eastern Band of the 
Cherokee Indians.
    Digestive Diseases.--The Committee commends NIDDK on the 
success of its Digestive Disease Centers program in addressing 
a wide range of disorders that result in tremendous human 
suffering and economic cost. The Committee continues to 
encourage NIDDK to expand this important program with an 
increased emphasis on irritable bowel syndrome.
    Fatty Liver Disease.--The Committee notes that there is an 
emerging obesity-related chronic liver disease, nonalcoholic 
fatty liver disease, which may affect as many as 1 in every 4 
adults over the age of 18. This diagnosis encompasses a 
spectrum of severity with many cases evolving into non-
alcoholic steatohepatitis [NASH] and, ultimately, cirrhosis. 
NASH-related liver disease has already become an important 
indicator for liver transplantation, and, in the absence of 
better treatments, the need for NASH-related liver 
transplantation will increase significantly over time. The 
Committee appreciates NIDDK's existing programs in this area 
but urges expanded basic and clinical research focused both on 
interventions needed to prevent the onset of NASH and improved 
protocols for treatment of established cases. The Committee 
also urges the Institute to review opportunities to expand 
current clinical programs, where appropriate, to permit the 
enrollment and follow up of larger numbers of patients. 
Finally, the Committee urges a public awareness campaign with a 
national voluntary health agency with State and local 
affiliates to reverse this growing and preventable public 
health epidemic linked to the broader issue of obesity.
    Fragile X.--Fragile X mental retardation is one of the most 
common single gene disorders, and yet there exists almost no 
research on its effects outside the central nervous system. 
Fragile X causes a broad range of symptoms including premature 
ovarian failure, macroorchidism (large testicles), and 
malformations in the urogenital track, digestive problems 
including excessive vomiting and increased motility. The fact 
that these diverse symptoms arise from one gene mutation offers 
an invaluable opportunity to understand and develop treatments 
for these disorders. The Committee urges NIDDK to expand its 
research activities on Fragile X and to coordinate these 
efforts with other Institutes working on related activities, 
including NIMH and NICHD.
    Glomerular Injury Research.--The Committee is pleased with 
NIDDK's glomerular injury research initiatives, including a 
clinical trial for patients with focal segmental 
glomerulosclerosis. The Committee understands that in addition 
to the clinical trial, the NIDDK is collaborating on a joint 
research program with a voluntary foundation to include basic 
and genetic studies. Further the Committee is pleased that 
NIDDK is sponsoring a scientific conference on glomerular 
injury research, and is hopeful that this important workshop 
will lead to a broader scope of activities and initiatives on 
glomerular disease research.
    Hepatitis B Conference.--Hepatitis B remains a common cause 
of acute hepatitis affecting 1,250,000 Americans. Among the 
Asian and Pacific Island populations the rate of infection rate 
is even higher, affecting up to 15 percent of individuals. In 
order to address this health issue, the Committee urges NIDDK 
to convene an Expert Conference in fiscal year 2005 to reach 
consensus on the best treatment protocols.
    Hepatitis C in Children.--The Committee is pleased that the 
NIDDK has launched a pediatric hepatitis C trial that will 
permit long-term follow up of children enrolled in treatment 
protocols, particularly as these treatment regimens impact the 
growth and development of the children. The Committee looks 
forward to being informed on the progress of this trial during 
the fiscal year 2006 appropriations hearings.
    Incontinence.--Fecal incontinence, also called bowel 
incontinence, affects people of all ages and is associated with 
a wide variety of causes. The Committee encourages NIDDK to 
develop a standardization of scales to measure incontinence 
severity and quality of life, and to develop strategies for 
primary prevention of fecal incontinence associated with 
childbirth.
    Inflammatory Bowel Disease.--The Committee has been 
encouraged in recent years by the 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 from 
intestinal illness. The Committee commends the NIDDK for its 
strong leadership in this area and encourages the Institute to 
increase funding for research focused on: the cellular, 
molecular, and genetic structure of IBD; identification of the 
genes that determine susceptibility or resistance to IBD in 
various patient subgroups; and translation of basic research 
findings into patient clinical trials as outlined in the 
research agenda developed by the scientific community titled, 
``Challenges in Inflammatory Bowel Disease''. The Committee 
also encourages NIDDK to continue to strengthen its partnership 
with the IBD community and increase funding for its successful 
digestive disease centers program with an emphasis on IBD.
    Interstitial Cystitis.--The Committee is pleased by recent 
advances in the area of interstitial cystitis research, 
particularly in the area of urinary markers. The Committee 
urges the NIDDK to continue to aggressively support IC-specific 
basic science initiatives, particularly through program 
announcements. The Committee also encourages the NIDDK to work 
closely with the IC patient community on developing and funding 
an IC awareness campaign for both the public and professional 
communities, and to host a consensus conference on the 
definition of IC. The absence of a uniform definition that 
accurately captures the condition and the affected population 
is negatively impacting patients in terms of diagnosis and 
treatment as well as researchers in terms of literature review 
and their research activities. The Committee was very 
encouraged by the progress reported at the 2003 NIDDK-sponsored 
scientific symposium on IC, and it urges the NIDDK to further 
this scientific momentum by hosting the next international 
symposium on IC in 2005.
    Irritable Bowel Syndrome.--The Committee encourages NIDDK 
to provide adequate funding for irritable bowel syndrome/
functional bowel disorders research and to give priority 
consideration to funding grants that will continue to increase 
the IBS portfolio. The Committee requests that NIDDK actively 
pursue the development of a strategic plan for IBS research.
    Mucopolysaccharidosis [MPS].--The Committee recognizes the 
efforts of the NIDDK to enhance research efforts to achieve a 
greater understanding and pursue development of effective 
therapies for MPS disorders. In addition to the general overall 
support of broad based MPS research, the Committee supports 
studying bone and joint disease in MPS disorders. Research into 
the underlying pathophysiology of bone and joint lesions, the 
gene mutations and substrates that are stored and potential 
therapeutic approaches are of interest to the Committee. The 
Committee encourages NIDDK's continued efforts to collaborate 
with NIAMS on bone and joint research in Lysosomal Storage 
Disorders and commends the NIDDK on its performance in 
collaborating with NINDS, NICHD, NCRR, and ORD in advancing 
MPS-related research.
    Osteoporosis.--The Committee encourages NIDDK, in concert 
with other NIH institutes, to increase research into disease-
related osteoporosis and/or bone disorders. This research 
should include studies of the role of genetics, the effects of 
these diseases on bone turnover and altered bone metabolism, 
the impact of environmental and lifestyle factors, their 
effects on bone quality and fracture incidence, the role of 
bone marrow changes, the use of agents to increase bone mass, 
and the therapeutic use of new technologies to combat 
osteoporosis.
    Pediatric Kidney Disease.--Chronic kidney disease is the 
ninth leading cause of death and one of the costliest illnesses 
in the U.S. Although significant strides have been made in 
understanding kidney disease in adults, much less is known 
about its manifestations in children. This breach has taken on 
greater significance in recent years as the number of children 
who are overweight and obese has skyrocketed, giving rise to an 
increased incidence of type 2 diabetes, hypertension and 
chronic kidney disease in this population. Given the long-term 
implications of diabetes-related kidney problems initiating in 
childhood, NIDDK is encouraged to undertake longitudinal 
studies of the natural history, prevention and treatment of 
kidney disease in type 2 diabetes and its antecedents in 
children and adolescents. The Committee is pleased that NIDDK 
has assigned priority to clinical studies related to the 
treatment of FSGS, the most common acquired cause of kidney 
disease in children, and to longitudinal epidemiological 
studies of children. In both instances, NIDDK is encouraged to 
support ancillary studies aimed at discovering new prevention 
and treatment strategies for children.
    Pediatric Liver Transplant National Database and 
Registry.--The Committee is pleased that NIDDK has funded the 
Studies in Pediatric Liver Transplantation Registry. This 
database and registry follows the natural history of infants 
and children who receive liver transplants until they are 18 
years of age. This National Database and Registry will permit 
more hypothesis testing and outcomes research to determine both 
the health and financial impact of liver transplants on the 
child and the child's family.
    Pediatric Urology.--The Committee remains concerned with 
the lack of research dedicated to pediatric urologic 
conditions. According to the NIDDK Bladder Research Review 
Group document ``Overcoming Bladder Disorders: A Strategic Plan 
for Research,'' the gaps and requirements for pediatric disease 
research remain substantial, particularly for conditions such 
as vesicoureteral reflux and bladder dysfunction. The Committee 
urges NIDDK to commit the necessary resources to expand 
research on pediatric urologic conditions, which may in turn 
provide additional insight into adult urologic problems.
    Polycystic Kidney Disease [PKD].--Recent breakthroughs in 
PKD research have culminated in the development of therapies to 
potentially halt disease progression for the 600,000 Americans 
who suffer from PKD. Key to such therapies is the discovery 
that an existing drug controlling other abnormal fluid-
retention diseases in humans also retards the production of 
cysts and disease progression in all forms of PKD in the 
laboratory. Also, the NIDDK-funded CRISP study for PKD proves 
the value of innovative imaging methods to measure disease 
progression, thus reducing by forty-fold the number of patients 
needed to adequately assess clinical research outcomes. 
Moreover, the possibility that future PKD clinical trials can 
be conducted simultaneously with other research protocols under 
the NIDDK-funded Halt-PKD Interventional Trials infrastructure 
is also encouraging. The Committee urges the NIDDK to pursue 
clinical trials regarding these recent breakthroughs and to 
expand its infrastructure for PKD clinical research, while 
expeditiously implementing the new PKD Strategic Plan it 
recently developed.
    Prostate Diseases.--Prostate diseases are highly prevalent 
and poorly understood. While progress has been made, the 
Committee encourages the Institute to develop a comprehensive 
initiative on basic prostate biology that can lead to improved 
diagnosis and treatment of diseases such as prostatitis and 
BPH. In particular, the current efforts to develop biomarkers 
for benign prostate diseases should be expanded.
    Prostatitis.--The Committee encourages the Institute to 
provide more diverse medical specialties to supplement and 
build upon the insufficient treatment options and the 
background of basic information now available. The genetic and 
molecular epidemiology, the management of pelvic pain, the 
infectious origins and the symptoms of prostatitis that are 
identical to symptoms of prostate cancer need special 
attention.
    Scleroderma.--The Committee encourages the NIDDK to support 
scleroderma relevant research. Scleroderma is a chronic and 
progressive disease that predominantly strikes women. It is 
estimated that 90 percent of patients with systemic sclerosis 
have gastrointestinal [GI] involvement and of that number 50 
percent have clinically significant manifestations. GI 
involvement can manifest as gastroesophageal reflux disease, 
dysphagia, Barrett's esophagus, gastroparesis, ``watermelon 
stomach'', malabsorption, and fibrosis of the small and large 
intestines. Renal crisis affects 20 percent of those with 
systemic sclerosis often within the first 5 years after 
diagnosis. More research is urgently needed in order to develop 
safe and effective treatments and to identify the cause or 
causes of the complications of scleroderma.
    Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or 
TSC, is a genetic disorder that triggers uncontrollable tumor 
growth in multiple organs of the body including the kidneys, 
where patients are at risk for polycystic kidney disease, 
cancer or, most commonly, benign growths known as 
angiomyolipoma that can result in kidney failure. The Committee 
strongly urges NIDDK to support studies examining the molecular 
and cellular basis of these manifestations of TSC as well as 
pre-clinical and clinical studies.
    Urogynecology Program.--The Committee is pleased that the 
NIDDK has supported the Urinary Incontinence Treatment Network 
and urges increased funding and expansion for this important 
and productive clinical network. While recent studies have 
yielded gains in understanding these conditions, the Committee 
is equally concerned that more needs to be done with basic and 
translational research in order to create better foundations 
for clinical care. The Committee supports the NIDDK in the 
creation of a team focused on urogynecology and encourages a 
dedicated study section in this area.
    Urology Research.--The Committee commends NIDDK's release 
of the first report on the burden of urologic disease through 
its ``Urologic Diseases in America'' project, with a final 
compendium due out in 2006. The Committee urges NIDDK to 
allocate resources to ensure that updated reports are sustained 
in the future and to provide a report on the plan for this 
activity. The Committee is pleased that NIDDK has recognized 
the interconnection between obesity and diabetes and urologic 
disorders as shown by the December 2003 NIDDK meeting 
``Urologic Complications of Diabetes'' and the NIDDK Bladder 
Research Review Group document ``Overcoming Bladder Disorders: 
A Strategic Plan for Research'' that dedicated an entire 
section to the urologic problems associated with diabetes and 
obesity. The Review Group specifically addressed research goals 
including programs to assess the effect of obesity on 
genitourinary tract function and to clarify the biologic 
mechanisms for bladder and urethral dysfunction in diabetes. 
The Committee encourages NIDDK to ensure that the NIH Obesity 
Research Task Force includes adequate resources for research 
addressing often-overlooked urologic problems associated with 
diabetes and obesity. In particular, the Committee recommends 
that the Urinary Incontinence Treatment Network continue 
observational and interventional trials in the area of 
incontinence associated with obesity and diabetes.
    The Committee urges the NIDDK to provide to the Committee 
the reports for the urology Interagency Coordinating Committee 
meetings for the past 5 years and the collaborative initiatives 
that have resulted from these meetings, and to provide the plan 
for the next year on collaborative Interagency and 
Interinstitute urology research. In particular, treatment for 
prostate cancer is associated with significant incidence of 
urinary incontinence and erectile dysfunction that severely 
affect quality of life. NIDDK is urged to cooperate with the 
National Cancer Institute on studies of the cause, prevention, 
and treatment of urinary incontinence and erectile dysfunction 
after treatment for prostate cancers. Incidence of urologic 
disorders increases with aging; for example, urinary 
incontinence is one of the leading causes of admission to 
nursing homes. NIDDK is urged to work with the National 
Institute on Aging to develop a comprehensive cooperative 
program to address these costly and pervasive urology health 
issues related to aging. In this regard, the Committee is 
pleased to learn that NIDDK leadership has taken steps to 
enhance integration of urologic diseases in initiatives within 
NIDDK and between and across the NIH, and urges continuation of 
these activities. A recently-appointed NIDDK Senior Advisor for 
Urology is working to coordinate urology research activities 
across the NIH.
    The Committee is impressed with the results produced by the 
George M. O'Brien urology research centers that bring together 
a critical mass of scientists who focus on urologic disease. 
The Committee recommends that NIDDK ensure adequate support to 
enhance the successes and to provide for collaboration among 
these centers.
    Prostate diseases are highly prevalent and poorly 
understood. While progress has been made, the Committee 
encourages the Institute to develop a comprehensive initiative 
on basic prostate biology that can lead to improved diagnosis 
and treatment of diseases such as prostatitis and BPH. In 
particular, the current efforts to develop biomarkers for 
benign prostate diseases should be expanded.
    The Committee is concerned about the continuing world-wide 
HIV epidemic. HIV is readily transmitted through sexual 
contact, yet little work is being done to examine the specific 
role of semen in this transmission. The Committee believes that 
a better understanding of these fundamental issues will 
contribute significantly to research for a vaccine and more 
effective treatments, and is pleased with the NIDDK's recent 
initiative to encourage basic and clinical research studies 
that will elucidate the factors that determine HIV release in 
the male genital tract. The Committee urges the Institute to 
continue enhancing its grant portfolio on the role of semen in 
HIV transmission.
    The Committee remains concerned with the lack of research 
dedicated to pediatric urologic conditions. According to the 
NIDDK Bladder Research Review Group document ``Overcoming 
Bladder Disorders: A Strategic Plan for Research,'' the gaps 
and requirements for pediatric disease research remain 
substantial, particularly for conditions such as vesicoureteral 
reflux and bladder dysfunction. The Committee urges NIDDK to 
commit the necessary resources to expand research on pediatric 
urologic conditions, which may in turn provide additional 
insight into adult urologic problems.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2004....................................  $1,501,207,000
Budget estimate, 2005...................................   1,545,623,000
Committee recommendation................................   1,569,100,000

    The Committee recommends an appropriation of $1,569,100,000 
for the National Institute of Neurological Disorders and Stroke 
[NINDS]. The fiscal year 2004 appropriation was $1,501,207,000 
and the budget request is $1,545,623,000. The comparable 
amounts for the budget estimates 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.--NINDS continues to play an integral 
role in widening the scientific base of knowledge about 
Alzheimer's disease. One emerging theme in the study of 
Alzheimer's disease and other neurodegenerative diseases such 
as Parkinson's and Huntington's disease, is the overlap 
researchers have observed in the pathology underlying these 
conditions. Scientific reports are showing evidence that these 
disorders may be caused by similar abnormalities in protein 
folding and accumulation, making support for Alzheimer's 
disease research more relevant than ever. On another front, 
working with NIA in the area of immunotherapy for Alzheimer's 
disease, NINDS has funded a collaborative group of Alzheimer's 
disease centers that will investigate the differences which can 
involve the production of antibodies that reduce the cellular 
and behavioral effects of the disease. The Committee encourages 
NINDS to continue to assign a high priority to its Alzheimer's 
research portfolio, and to work closely with NIA and other 
institutes. The Committee also encourages NINDS to conduct 
large scale clinical trials that will identify therapies and 
treatments capable of slowing or halting the onset and 
progression of Alzheimer's.
    Alzheimer's Disease and Early Diagnosis.--The Committee 
urges the NINDS, in collaboration with the NIA and NIMH, to 
expand its research into early diagnosis of Alzheimer's using 
PET imaging of the brain, and to share its results with the 
Centers for Medicare and Medicaid Services.
    Ataxia Telangiectasia [A-T].--A-T is a genetic disease that 
attacks in early childhood. It progressively affects 
coordination and severely compromises the immune system. 
Children with A-T are highly likely to develop cancer, and 
rarely live beyond their teens. The Committee encourages the 
NINDS to work with the NCI and other appropriate Institutes to 
support research aimed at understanding the underlying causes 
of A-T with the goal of translating this basic research into 
treatments for the disease.
    Batten Disease.--The Committee is once again disappointed 
with the pace of research regarding Batten disease. The 
Committee strongly urges the Institute to increase funding for 
such research by actively soliciting grant applications for 
Batten disease and taking aggressive steps to assure that a 
vigorous research program is established. The Committee expects 
to be informed of the steps taken to increase research on 
Batten disease.
    Behavioral Research and Measurement of Cognitive 
Function.--The Committee applauds the efforts of NINDS to 
understand the mechanisms of executive function and ways to 
enhance cognitive rehabilitation for neurological disease. The 
Committee commends NINDS for its leadership in research to 
develop and validate neuropsychological test batteries and 
other instruments needed to measure executive function, 
including higher level cognitive processes such as working 
memory, decision-making, anticipation, and planning. Such tests 
are critical measurement tools for establishing the efficacy of 
interventions in NINDS clinical trials.
    Brain Tumors.--The Committee continues to be concerned that 
not enough attention and resources are devoted to identifying 
causes of and treatments for brain tumors and encourages NINDS 
to continue working with NCI to carry out the recommendations 
of the Report of the Brain Tumor Progress Review Group.
    Charcot-Marie-Tooth Disorder.--Charcot-Marie-Tooth Disorder 
[CMT] is one of the most common inherited neurological 
disorders, affecting approximately 1 in 2,500 people in the 
United States. The Committee is concerned abut the prevalence 
of this disease and its effect on people across the age 
spectrum and recognizes the value of CMT research for advancing 
understanding into other neuromuscular disorders. The Committee 
urges the Institutes to identify new research opportunities on 
CMT that could lead to a relevant program announcement or 
request for applications. The Committee requests a report on 
NIH efforts and research on CMT and CMT-related disorders by 
April 1, 2005.
    Down Syndrome.--Recently Down syndrome research has begun 
to focus more on understanding the effect the disorder has on 
gene expression, cell function, neurons and neural systems. The 
Committee strongly encourages NINDS to expand its research on 
Down syndrome, particularly as it relates to gene expression in 
the brain and the development of possible biomedical 
interventions to improve cognition, memory, speech, behavior, 
and prevent early dementia. The Committee further encourages 
NINDS to assume a leadership role in coordinating this research 
among the Institutes and to work closely with NICHD to address 
the serious shortage of mice used for Down syndrome research.
    Duchenne Muscular Dystrophy.--The Committee urges NINDS, in 
collaboration with NIAMS and NICHD, to dedicate additional 
resources to develop a standard of care and improve treatments, 
accelerate clinical trials and translational research for 
patients with DMD. The Committee strongly encourages the 
funding of three additional Centers of Excellence and doubling 
of the funding for existing Centers of Excellence by the end of 
fiscal year 2005. In addition, the Committee notes that the NIH 
Interagency Coordinating Committee for muscular dystrophy has 
missed its 1-year deadline to submit a plan for conducting and 
supporting research and education on muscular dystrophy through 
NIH in accordance with the MD CARE Act of 2001. The Committee 
strongly urges the Coordinating Committee to finalize and 
submit this plan, as well as include representation from the 
Department of Defense on the panel, as soon as possible.
    The Committee was disappointed with the July 2004 
``Muscular Dystrophy Research and Education Plan for the 
National Institutes of Health''. The Plan developed by the MD 
Interagency Coordinating Committee, provides a summary of 
research goals, but lacks sufficient detail into baseline 
research efforts, funding, and technical progress. In 
compliance with the provision of the Muscular Dystrophy Care 
Act of 2001 (Public Law 107-84, ``MD Care Act''), the report 
from the Coordinating Committee should be sufficient to support 
science and research objectives; thus providing an investment 
strategy and technical roadmap. In addition, the Committee 
notes that in accordance with the MD Care Act, the Department 
of Health and Human Services was to establish an Interagency 
Coordinating Committee whose responsibility was the development 
a plan on research and education on Muscular Dystrophy. The 
Committee is also disappointed with the speed at which the Act 
is being implemented. The Act became law in 2001 and the 
coordinating Committee did not convene until July 2003. 
Therefore, the Committee requests that, not later than February 
1, 2005, the NIH shall provide an submit an additional report 
which should contain a plan which establishes research goals; 
the Institute or Center responsible for that research, the 
amount of funding spent in fiscal year 2000 through fiscal year 
2004 and the amount of funds that NIH will devote to this 
research in fiscal year 2005 and 2006; key technical risk 
areas; integration efforts between NIH Institutes and Centers; 
and all opportunities for transition of technology to industry; 
translational research; major milestones and clinical trial 
opportunities.
    Duchene Muscular Dystrophy Translational Research.--The 
Committee commends the Institute for its enhanced efficiency in 
the grant review cycle to fund translational research for 
Spinal Muscular Atrophy [SMA]. The Committee strongly endorses 
this accelerated research approach and urges the Institute to 
evaluate the merits of this review model to fund translational 
research for Duchenne Muscular Dystrophy and report back to 
Congress no later than April 2005. The Committee believes the 
SMA model enhances the dialogue between reviewers and 
scientists, facilitating modifications of grant proposals that 
are in the best interest of the patients. In addition, the 
Committee strongly urges the Institute to increase funding for 
basic and translation DMD research by aggressively soliciting 
grant applications. The Committee encourages the Institute to 
employ existing mechanisms such as a standing program 
announcement, websites, publications, workshops and conferences 
to promote awareness of funding opportunities. In addition, the 
Committee encourages the NIH to further develop opportunities 
for upcoming clinical trials and to help make available all 
ongoing patient care options. The NIH is encouraged to 
collaborate with other Departments, Federal agencies and 
Patient Groups to develop formal programs that increase public 
and professional awareness of the disease. The Committee 
requests that NIH report back to the Committee, no later than 
April 2005 with a progress report on all aspects of DMD 
translational research.
    Dystonia.--The Committee continues to support the expansion 
of research and treatment developments regarding the 
neurological movement disorder dystonia, given that dystonia is 
the third most common movement disorder after tremor and 
Parkinson's disease. The Committee encouragaes NINDS to support 
additional research on both focal and generalized dystonia, and 
commends NINDS for its study of the DYT1 gene and encourages 
expansion in this area of research. The Committee also commends 
NINDS for the release of the joint dystonia research program 
announcement with other NIH Institutes and requests a 
comprehensive report on the results of this important mechanism 
for the fiscal year 2006 hearings. The Committee encourages the 
Institute to continue its collaboration with the dystonia 
research community in supporting epidemiological studies on 
dystonia and in increasing public and professional awareness of 
this disorder.
    Epilepsy.--The Committee strongly encourages the Institute 
to expand its efforts to find breakthroughs in the prevention, 
treatment, and eventual cure of epilepsy. The Committee 
applauds the development of benchmarks for epilepsy research 
resulting from the ``Curing Epilepsy: Focus on the Future'' 
conference held in March 2000. The Committee expects that NINDS 
will continue to update Congress and the public on progress in 
reaching these goals. The Committee further encourages the 
Institute to address critical research issues raised at the 
Living Well With Epilepsy II conference held in July 2003. 
These investments in our Nation's health examine how epilepsy 
begins, ways of identifying people at risk and how to develop 
treatments that will prevent epilepsy in those people, as well 
as continuing the search for new therapies, free of side 
effects, to prevent seizures. In addition, the Committee urges 
the NINDS to focus on the critical research issues relating to 
the over 30 percent of patients with intractable epilepsy, to 
the life-long impact of seizures on young children, and to the 
growing incidence of epilepsy in the elderly. The Committee 
encourages the Institute to continue its anti-epileptic drug 
development program to discover therapies that may provide 
answers for the large number of people who do not respond to 
current treatments. The Institute is expected to update the 
Committee on its plans to advance these critical areas of 
research at the fiscal year 2006 appropriations hearing.
    Fragile X.--Fragile X is a single-gene disorder, but both 
its symptoms and its cellular mechanisms suggest involvement of 
multiple genes and specific brain pathways which are associated 
with other neurological disorders, such as autism and seizures. 
Furthermore, recent research offers clear evidence for 
disruption of fundamental brain circuitry in Fragile X. 
Research on Fragile X has the potential to contribute to 
understanding of multiple disorders. The Committee urges NINDS 
to expand its research activities on Fragile X and to 
coordinate these efforts with other Institutes working on 
related activities, including NIMH and NICHD.
    FXTAS.--Fragile X-associated tremor/ataxia syndrome, or 
FXTAS, is a newly discovered, progressive neurological disorder 
that affects older men who are carriers of a premutation in the 
same gene that causes Fragile X syndrome, the most common cause 
of inherited mental retardation. Nearly 1 in 800 men in the 
general population carries this premutation in the Fragile X 
gene, and as many as 30 percent of these carriers--roughly 1 in 
3,000 men--may develop FXTAS later in life. NINDS, in 
collaboration with the National Institute on Aging, is urged to 
commit additional resources and expand research into FXTAS, as 
identification of older male carriers will lead to a better 
understanding of the true incidence of Fragile X syndrome and 
afford at-risk families of child-bearing age the opportunity to 
pursue genetic counseling.
    Interdisciplinary Research.--The Committee encourages NINDS 
to continue exploring novel pathways by which cognitive 
neuroscientists and rehabilitation clinicians can apply new 
findings of central nervous system plasticity towards optimal 
treatment outcomes for patients with disorders of the brain 
affecting higher thought processes. The Committee applauds 
NINDS for promoting the establishment of multidisciplinary 
teams of scientists including neurologists, cognitive 
functional imaging experts and computational modelers in order 
to accelerate progress in the field of cognitive 
rehabilitation. By focusing on the limited set of neurological 
conditions (stroke, traumatic brain injury, and brain tumor) 
where these partnerships are likely to produce realistic gains 
in higher level functioning, NINDS may provide a model for 
interdisciplinary approaches to a range of conditions in which 
residual capacity is more difficult to measure.
    Juvenile Diabetes.--The Committee commends the NINDS for 
its efforts to prevent and treat hypoglycemia and neuropathy, 
both of which are serious complications of juvenile diabetes. 
The Committee encourages the NINDS to continue to expand its 
research into neuropathy and hypoglycemia unawareness and to 
consider establishing centers focused specifically on diabetic 
neuropathy. The Committee requests an update during the fiscal 
year 2006 hearings on the current status of diabetes-related 
research programs being carried out by the Institute and also 
urges NINDS to organize a workshop focusing on diabetic 
neuropathy. Such a workshop would provide the research 
community with an opportunity to identify common goals toward 
the development of novel clinical treatments for diabetic 
peripheral and autonomic neuropathies.
    Mucopolysaccharidosis [MPS].--The Committee is gratified at 
the release of the August 2003 PAS titled ``Neuroprotective CNS 
Barriers in Neurological Diseases'' and the stated interest in 
Lysosomal Storage Disorders [LSD] research in this initiative. 
The Committee is pleased to learn NINDS has chosen to work with 
the National MPS Society and other LSD groups in implementation 
of a new PAS initiative focused on therapeutic Central Nervous 
System research in Lysosomal Storage Disorders. The Committee 
continues to encourage NINDS to collaborate with all 
appropriate Institutes and Centers to support current MPS 
research, study the blood brain barrier as an impediment to 
treatment, and use all available mechanisms to further 
stimulate and enhance efforts to better understand and treat 
MPS disorders.
    Multiple Sclerosis [MS].--The Committee recognizes that 
more than 350,000 people in the United States currently suffer 
from multiple sclerosis and that approximately 200 new cases 
are diagnosed each week. The cause of MS remains unknown and no 
cure exists. The Committee urges NINDS to coordinate with 
private organizations that are working to discover effective 
treatment targets for MS.
    Neurofibromatosis.--Advances in NF research have linked NF 
to cancer, brain tumors, learning disabilities and heart 
disease affecting over 150 million Americans. Because NF plays 
a pivotal role both in disorders of the brain and in cancer and 
the enormous promise of NF research is now reaching fruition in 
the testing of potential therapies, the Committee encourages 
NINDS to aggressively expand its NF clinical and basic research 
portfolios. The Committee commends NINDS for its leadership 
role in NF research and in coordinating efforts with other 
Institutes engaged in NF research. The Committee applauds NINDS 
and the Office of Rare Diseases for convening a major 
conference on NF in December 2003. The Committee also applauds 
NINDS on issuing major program announcements in fiscal year 
2004, pursuing the creation of NF research centers and NF 
translational research. The Committee encourages NINDS to 
follow through with the creation of these centers.
    Neuroprosthetics.--The Committee urges the Institute to 
expand research on neuroprosthetics, such as the Brain Machine 
Interface (or Human Assisted Neurological Device) project. This 
research offers great promise in restoring movement in 
individuals suffering from a variety of neurological disorders 
including paralysis, stroke and wound-related trauma.
    Parkinson's Disease.--The Committee urges NINDS, in 
addition to pursuing all promising therapeutic avenues, such as 
gene therapy, stem cells, surgical approaches, non-human 
models, and biomarkers, to continue to identify and study 
neuroprotectant compounds, such as Coenzyme Q10, creatine, and 
minocycline.
    Furthermore, the Committee encourages NINDS to work with 
NIBIB to discover a biomarker (particularly a molecular one) 
for Parkinson's. Investment by NIBIB in clinical trials could 
greatly enhance the value of these trials, as imaging 
technology facilitates a better understanding of the physical 
effects of tested drugs.
    Finally, the Committee commends NINDS for committing to set 
aside funds within its budget to fund the Udall Centers. The 
Morris K. Udall Parkinson's Disease Research Centers of 
Excellence support additional research opportunities and 
discoveries that will lead to improved diagnosis and treatment 
of patients with Parkinson's disease. The Centers vary in their 
basic and clinical objectives, but together they foster an 
environment that enhances research effectiveness in a 
multidisciplinary setting.
    Pick's Disease.--The Committee requests the NINDS, in 
conjunction with NIA and NIMH, to provide a report to the 
Committee by March 31, 2005, on grant funding and research 
expenditures for Pick's disease and other frontotemporal 
dementias. The Committee further requests that the NINDS 
conduct an epidemiology study of frontotemporal dementias and 
hold a workshop for researchers, clinicians, and advocates to 
assess the current state of frontotemporal dementia research, 
treatment, and needs.
    Peripheral Neuropathy.--The Committee is aware that an 
estimated 20 million Americans suffer from peripheral 
neuropathy, a neurological disorder that causes debilitating 
pain, weakness in the arms and legs, and difficulty walking. 
Peripheral neuropathy affects approximately one-third of 
diabetics, or about 5.1 million persons. Other forms of 
neuropathy are inherited; associated with cancer, kidney 
disease or infections like hepatitis, HIV/AIDS or Lyme disease; 
or caused by autoimmunity, traumatic injuries, poor nutrition, 
toxins and certain medications. For most of its victims, the 
only recourse is pain medication, physical therapy or assistive 
devices to help maintain strength and improve mobility. In 
light of the large number of individuals affected, and the 
attendant costs of this disease to society, the Committee is 
concerned that insufficient resources are being devoted to 
finding ways to cure, prevent and more effectively treat 
peripheral neuropathy. To that end, the Committee strongly 
urges NINDS to (1) determine how much NIH is devoting to 
research in this area, and (2) develop a research agenda that 
is coordinated with work being done through other institutes. 
The Committee expects to receive a report on this effort at 
next year's hearings.
    Spina Bifida.--The Committee strongly encourages NINDS to 
enhance research to address issues relating the outcomes of the 
conference and urges significant expansion of prevention and 
treatment of Spina Bifida and associated secondary conditions. 
The Director should be prepared to testify on efforts to 
advance these areas of research at the fiscal year 2006 
appropriations hearing.
    Spinal Muscular Atrophy.--SMA is the leading genetic killer 
of infants and toddlers. The Committee understands that the 
severity of the disease, its relatively high incidence, and the 
possibility of imminent treatments have led NINDS to initiate 
the SMA Therapeutics Development Program. The Committee is 
pleased that initial work has begun on the program and strongly 
urges NIH/NINDS to commit the resources required to ensure a 
timely completion of the project mission--a treatment for SMA 
ready for clinical trails for current and future therapies. To 
maximize program efficiency, it is also critical that NINDS 
integrate Therapeutics Development efforts with the biotech and 
pharmaceuticals industry, academic medical centers and 
collaborations with voluntary health organizations. The 
Committee encourages NINDS to aggressively expand its SMA 
basic, translational and clinical research portfolio. The 
Committee understands that the strategy for developing a 
treatment for SMA will guide therapeutics development for other 
diseases including: Duchenne Muscular Dystrophy, ALS, 
Huntington's and Alzheimer's. The Committee strongly urges 
NINDS to successfully and expeditiously execute the SMA 
Therapeutics Development Program for the benefit of patients of 
SMA and countless other diseases. The Committee requests that 
NIH report back to the committee, no later than April 2005 with 
a progress report on all aspects of SMA research.
    Stroke.--The Committee continues to regard research into 
the causes, cure, prevention, treatment and rehabilitation of 
stroke as a major concern for our Nation and urges the NIH and 
the NINDS to make stroke a top priority. Stroke remains 
America's third most common killer, a major contributor to 
late-life dementia, and a major cause of permanent disability. 
The Committee continues to strongly support increased efforts 
on stroke research. The Committee is very concerned that 
funding for stroke research over the years has not kept pace 
with the scientific opportunities, the number of Americans 
afflicted with stroke, and the economic toll this disease 
imposes on our Nation. The Committee urges the NINDS to 
aggressively expand its research portfolio and dramatically 
increase resources dedicated to stroke research through all 
available mechanisms. The Institute is urged to expand its 
stroke education program, to continue to implement the long-
range strategic plan for stroke research and to continue and 
expand innovative approaches to improve stroke diagnosis, 
treatment, rehabilitation, and prevention.
    Stroke Professional Judgment Budget.--The Committee 
commends the NINDS for convening a Stroke Progress Review Group 
which subsequently developed and released a 2002 report 
identifying critical gaps in stroke knowledge and outlining 
research priorities and resource priorities. The Committee is 
concerned that the report did not include a professional 
judgment budget and therefore requests that the NINDS submit to 
the Committee by April 2005 a professional judgment budget for 
each year of the plan. The Committee encourages the Institute 
to continue to implement and fully fund the priorities in the 
Report and requests an implementation report by April 2005.
    Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or 
TSC, is a genetic disorder that triggers uncontrollable tumor 
growth in multiple organs of the body, including the brain, 
heart, kidneys, lungs, liver, eyes or skin. Its victims--many 
of whom are infants and young children--face a lifetime of 
suffering with kidney failure, seizures, behavioral disorders, 
autism and mental retardation. Because of the effects of TSC on 
multiple organ systems, the Committee last year called upon the 
NIH Director to formulate an NIH-wide research agenda. The 
Committee understands that NINDS is assigned to implement and 
coordinate that effort, and looks forward to a yearly report on 
that effort. In the meantime, NINDS is strongly urged to 
support research examining the molecular and cellular basis of 
central nervous system manifestations in TSC, including studies 
examining TSC-associated epilepsy and brain tumor formation, 
and the effect of tubers and seizures on cognition and 
behavior. The Committee also looks forward to a report on 
NINDS's coordinating activities and progress towards 
implementing the research agenda prior to the fiscal year 2006 
hearings.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2004....................................  $4,155,447,000
Budget estimate, 2005...................................   4,325,507,000
Committee recommendation................................   4,307,185,000

    The Committee recommends an appropriation of $4,307,185,000 
for the National Institute of Allergy and Infectious Diseases 
[NIAID]. The budget request was $4,325,507,000. The fiscal year 
2004 appropriation was $4,155,447,000. Included in these funds 
is $149,115,000 to be transferred to the Global Fund to Fight 
HIV/AIDS, Malaria, and Tuberculosis. The comparable amounts for 
the budget estimate include funds to be transferred from the 
Office of AIDS Research.
    Mission.--The NIAID is the lead NIH Institute charged with 
developing vaccines and supporting research on allergies, 
acquired immunodeficiency syndrome [AIDS], sexually transmitted 
diseases, turberculosis, tropical diseases, and other 
infectious diseases--including those likely to be used as 
agents of bioterrorism. To accomplish this mission, the NIAID 
supports and conducts basic and clinical research and research 
training programs in infectious diseases, whether they are 
naturally occurring or the result of a bioterrorist attack, and 
in diseases caused by, or associated with, disorders of the 
immune system.
    Arthritis.--The Committee encourages the NIAID to 
coordinate its research efforts with other NIH institutes to 
find a cure for arthritis and related diseases.
    Asthma.--The Committee is pleased with NIAID's leadership 
regarding asthma research and management. The Committee urges 
NIAID to continue to improve its focus and effort on asthma 
management, especially as it relates to children. The Committee 
also urges the NIAID to collaborate more aggressively with 
voluntary health organizations to support asthma prevention, 
treatment, and research activities. Additionally, recent 
studies suggest that a variety of viral and bacterial agents, 
including agents used for immunization may play a role in the 
development of asthma. The Committee urges the Institute to 
expand research into the role that infections and vaccines play 
in the development of asthma.
    Atopic Dermatitis.--Atopic dermatitis [AD] is one of the 
most common skin disorders experienced by infants and children. 
Patients with AD suffer with chronic skin inflammation and 
itching that disrupt sleep and reduce quality of life. Of 
additional concern, individuals who have active or dormant AD 
are at high risk for serious adverse reaction to the smallpox 
vaccine. The Committee encourages NIAID to work with NIAMS to 
spearhead a multidisciplinary, multi-institute initiative to 
encourage investigator-initiated research on AD as it relates 
to smallpox vaccination as well as the progression to asthma 
and other allergic diseases.
    Genomics.--The Committee is pleased that the NIAID has 
focused its attention on research efforts associated with 
multiple categories of pathogens. The Committee understands 
that commercially available research tools, such as microarray 
technology, can enhance the progress of pathogen-related 
research. The Committee urges the NIAID to utilize this 
technology to further support an aggressive agenda of pathogen 
research activities.
    Hemophilia.--The Committee appreciates NIAID's efforts to 
improve HIV and hepatitis C virus [HCV] treatment for persons 
with hemophilia or other bleeding disorders. The Committee 
encourages NIAID to work with the National Hemophilia 
Foundation in strengthening its support for research on liver 
disease progression to improve HIV and HCV treatment among 
persons with bleeding disorders.
    Hepatitis.--The Committee continues to be concerned about 
the prevalence of hepatitis and urges NIAID to work with public 
health organizations to promote liver wellness, education, and 
prevention of hepatitis.
    Hepatitis C Vaccine.--The Committee is encouraged to learn 
that a small hepatitis C vaccine human trial has been launched 
and urges the consideration of other creative approaches and 
new paradigms including the development of DNA vaccines.
    Inflammatory Bowel Disease.--Recent research identifies 
strong linkages between Crohn's disease and ulcerative colitis 
(collectively known as inflammatory bowel disease) and the 
functions of the immune system. The Committee encourages the 
Institute to expand its research partnerships with the IBD 
community, and to increase funding for research focused on the 
immunology of IBD and the interaction of genetics and 
environmental factors in the development of the disease.
    Juvenile Diabetes.--The Committee is encouraged by the 
Institute's efforts regarding the Autoimmune Prevention 
Centers, and it encourages the Institute to develop pilot 
projects, initiated with the support of the Prevention Centers 
of Autoimmunity, into full research proposals with special 
emphasis on pre-clinical studies related to juvenile diabetes.
    Nontuberculous Mycobacteria [NTM].--Mycobacteria are 
environmental organisms found in both water and soil that can 
cause significant respiratory damage. The Committee is aware of 
the increasing incidence of nontuberculous mycobacteria [NTM] 
pulmonary infections in women, particularly involving rapidly 
growing mycobacteria, an inherently resistant subspecies. The 
Committee encourages NIAID to advance diagnostic and treatment 
protocols for patients suffering from NTM diseases.
    Primary Immunodeficiency Diseases.--The Committee notes 
that more than 150 primary immune deficiency diseases have been 
identified to date. These diseases, which impair the body's 
immune system, strike more severely in children, many of whom 
do not survive beyond their teens or early twenties. Primary 
immune deficiencies afflict more than 50,000 Americans, 
regardless of age, race, or gender. The Committee believes that 
NIAID should play a significant role in addressing this 
seriously under-diagnosed class of diseases. Research is being 
funded at many institutions, including several of the twelve 
Jeffrey Modell Diagnostic and Research Centers, as part of a 
consortium created to expand and enhance the research in this 
group of diseases. However, that research only helps people if 
physicians know to look for the disease; the public is aware of 
it; and, patients are diagnosed early and accurately. For this 
reason, the Committee encourages NIAID to increase its support 
for the public outreach campaign principally funded by the CDC, 
while maintaining its research portfolio. The Committee 
commends NIAID for the establishment of its primary 
immunodeficiency disease research consortium (USIDNet) in 
partnership with the Immune Deficiency Foundation and 
encourages continued support for this program.
    Psoriasis.--Psoriasis is a chronic, immune-mediated disease 
that affects more than 5 million Americans. A 1999 NIMH-
supported study found that patients with psoriasis reported 
reduction in physical and mental functioning comparable to that 
seen in cancer, arthritis, hypertension, heart disease, 
diabetes, and depression. The Committee considers research on 
psoriasis and psoriatic arthritis very important, and is 
pleased that NIAMS helped create a psoriasis tissue bank from 
which the first several psoriasis genes have been identified. 
The Committee urges NIAMS to support additional research into 
the identification of other genes expected to play a role in 
psoriasis pathogenesis, and also to support additional clinical 
research on current and potential therapies for psoriasis and 
psoriatic arthritis.
    Scleroderma.--The Committee encourages NIAID to undertake 
research to study the cause and treatment of scleroderma, a 
chronic progressive disease that predominantly strikes women. 
Scleroderma is disfiguring and can be life-threatening, 
affecting multiple systems. More research is critically needed 
in order to develop safe, effective treatments and to identify 
the cause or causes of scleroderma and its complications. 
Therefore, the Committee urges NIAID to include scleroderma 
research in the portfolio of the Autoimmune Centers of 
Excellence.
    Transplantation Research.--The Committee urges NIAID to 
convene an expert conference during fiscal year 2005 to develop 
a Transplantation Research Action Plan identifying the most 
urgently needed research to facilitate an increase in the 
success of organ transplantation. The Committee requests a 
report on the results of this conference including a breakdown 
of resources committed to this category of research.
    Tuberculosis.--The World Health Organization estimates that 
nearly 1 billion people will become infected with tuberculosis 
[TB], 200 million will become sick, and 70 million will die 
worldwide between now and 2020. The Committee is pleased with 
NIAID's efforts to develop an effective TB vaccine and 
encourages the Institute to continue its TB vaccine development 
work and to expand efforts to develop new drugs to treat TB.

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2004....................................  $1,904,838,000
Budget estimate, 2005...................................   1,959,810,000
Committee recommendation................................   1,975,500,000

    The Committee recommendation includes $1,975,500,000 for 
the National Institute of General Medical Sciences [NIGMS]. The 
fiscal year 2004 appropriation was $1,904,838,000 and the 
administration's request is $1,959,810,000. 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, biological 
chemistry, bioinformatics, and computational biology, 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 United States leadership in biomedical science.
    Basic Behavioral Science.--The legislative mandate for 
NIGMS specifically includes behavioral science research, 
although NIGMS does not now support behavioral science research 
or training. Given the wide range of fundamental behavioral 
topics with relevance to a variety of diseases and health 
conditions, the Committee encourages NIGMS to incorporate basic 
behavioral research as part of its portfolio, especially in the 
areas of cognition, behavioral neuroscience, behavioral 
genetics, psychophysiology, methodology and evaluation, and 
experimental psychology
    Basic Research on Pre-Disease Pathways.--As the NIH 
institute most concerned with basic research, NIGMS has 
provided leadership in research on physiological and biological 
structures and functions that may play roles in numerous health 
conditions. The Committee encourages NIGMS to collaborate with 
other institutes including NCI, NIMH and the Office of 
Behavioral and Social Sciences Research to fund research to 
integrate physiological knowledge of pre-disease pathways with 
behavioral studies.

        NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

Appropriations, 2004....................................  $1,242,361,000
Budget estimate, 2005...................................   1,280,915,000
Committee recommendation................................   1,288,900,000

    The Committee recommends an appropriation of $1,288,900,000 
for the National Institute of Child Health and Human 
Development [NICHD]. The fiscal year 2004 appropriation was 
$1,242,361,000 and the administration's request is 
$1,280,915,000. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The NICHD is that component of the NIH 
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; gynecological health and 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.
    Behavioral Science.--The Committee emphasizes its strong 
support for the broad portfolio of behavioral research at 
NICHD, and supports NICHD's efforts to determine the 
biological, behavioral, and social factors that affect 
cognitive, social, and personality development of children in a 
variety of settings. The Committee encourages research on 
effective ways to promote and sustain healthy family formations 
for low-income families, including families of color. The 
Committee is particularly concerned about rising rates of 
childhood obesity and supports continued initiatives to promote 
healthy behaviors in children and adolescents and research to 
prevent health risk behaviors.
    Demographic Research.--The Committee commends NICHD for its 
strong support of demographic research. This research has 
consistently provided critical scientific knowledge on issues 
of greatest consequence for American families: work-family 
conflicts, family formation and structure, childcare, 
adolescent health and wellness, and family and household 
behavior. Recent findings have provided invaluable insights 
into timely issues such as the role of maternal employment and 
parental involvement on child development. The Committee 
applauds NICHD for its ongoing support of the Fragile Families, 
Three Cities Study of Welfare, and National Longitudinal Study 
of Adolescent Health studies in particular. The Committee 
encourages the Institute to ensure adequate funding for the 
large databases such as these that make advances in population 
research possible. Further, the Committee urges NICHD to 
maintain stable funding for the Population Research 
Infrastructure program. The recent retooling of this program 
has enhanced its ability to support vital interdisciplinary 
collaboration and innovation in population research at academic 
and research institutions nationwide. The diverse exceptional 
research supported by this program has yielded key findings in 
areas such as fertility, health disparities, immigration and 
migration trends, and family dynamics. Given the importance of 
these issues to policymakers and the public, demographic 
research at the NICHD must continue to thrive.
    Down Syndrome.--The Committee encourages NICHD to increase 
funding for Down syndrome research as relates to gene 
expression of chromosome 21, the effects on cell function and 
cognition, and possible medical treatments to eliminate or 
reduce the cognitive abnormalities associated with the 
disorder. The Committee is aware of a serious shortage of mice 
used in the research of Down Syndrome and strongly encourages 
NICHD to increase funding for greater production of the Ts65Dn 
mouse model and for the research and development of other mouse 
models. The Committee also urges NICHD to work closely with 
NINDS, NIA, NIMH and NHGRI to establish a new, multi-year 
research initiative to fund Down syndrome biomedical research 
on cognition, behavior and early dementia.
    Drug Safety for Children.--The Committee recognizes the 
importance of ensuring that drugs are safe and effective for 
use by children and are appropriately labeled for pediatric 
use. The Committee strongly supports continued implementation 
of the Research Fund within the National Institutes of Health, 
as established in the Best Pharmaceuticals for Children Act of 
2003 (Public Law 107-109) within section 409I of the Public 
Health Service Act, which supports the pediatric testing of 
off-patent drugs, as well as on-patent drugs not being studied 
through existing mechanism. The Committee urges NICHD to act as 
the coordinating Institute for other Institutes within NIH for 
which pediatric pharmacological drug research may have 
therapeutic relevance, and urges consultation with the Food and 
Drug Administration to ensure that the studies conducted 
through the Fund are designed to yield improved pediatric 
labeling. The Committee expects an update prior to the fiscal 
year 2006 hearings, including information on the number of 
studies supported through the Research Fund; the estimated cost 
of each study undertaken; the nature and type of studies 
undertaken; the number of label changes resulting from 
completed studies; the patent status of the drugs studied; and 
the number of drugs remaining on the priority list established 
through section 409I.
    Fragile X.--Title II of the Children's Health Act of 2000 
authorized the establishment of at least three Fragile X 
research centers. The Committee is pleased that the NICHD has 
funded three Centers on a first-year basis, and urges the NICHD 
to issue an RFP with the goal of enhancing the Centers and 
recruiting new researchers to the Fragile X field. The 
Committee also encourages the NICHD to coordinate its Fragile X 
research efforts internally, by partnering with others, and by 
relating Fragile X research with that in other developmental 
disorders, and with autism research.
    Infertility and Contraceptive Research.--The Committee 
continues to place high priority on research to combat 
infertility and speed the development of improved 
contraceptives. NICHD is urged to continue aggressive 
activities in this area, including individual research grants 
and those of the infertility and contraceptive research 
centers.
    Learning and School Readiness.--The Committee commends 
NICHD on its commitment to research in reading, learning 
disabilities, and math and science cognition. NICHD is 
encouraged to support additional research on developing 
comprehensive, culturally neutral and developmentally 
appropriate assessments and instruments to measure cognitive, 
social and emotional skills for pre-school-aged children that 
are necessary for school readiness.
    Maternal Fetal Medicine Units Network [MFMU].--The 
Committee was extremely encouraged by the research results from 
NICHD's Maternal Fetal Medicine Units Network on the 
identification of a therapy, progesterone, that prevents 
recurrent preterm birth in high-risk women. The Committee 
understands that this is one of the first advances in this 
area, despite extensive efforts over decades, and urges the 
NICHD to build on this finding and to fully support the MFMU 
Network.
    National Children's Study.--The Committee strongly supports 
full and timely implementation of the National Children's 
Study. This study aims to quantify the impacts of a broad range 
of environment influences, including physical, chemical, 
biological and social influences, on child health and 
development. The Committee urges the NICHD to coordinate the 
involvement of the Department, the lead Federal partners--CDC, 
EPA, and NIEHS--and other interested institutes, agencies, and 
non-Federal partners conducting research on children's 
environmental health and development, such that this study is 
ready for the field no later than 2006.
    The Committee is pleased that the National Children's Study 
Advisory Committee is planning to utilize probability sampling 
in its design and is undertaking a strategic planning process 
that emphasizes collaboration between the biomedical and 
behavioral sciences.
    Neurofibromatosis.--Learning disabilities occur with high 
frequency (30-65 percent) in children with NF and in 
approximately 5 percent of the entire world's population. 
Enormous advances have been made in NF research in just the 
past year, regarding the mysteries of how the NF gene is 
related to learning disabilities, raising hopes of finding a 
treatment for learning disabilities not only in children with 
NF but in the general population as well.
    Obesity in Children.--The Committee strongly urges the 
NICHD, in collaboration with other relevant Institutes, to 
support the initiation of a study on the metabolic, 
psychological, and genetic causes of obesity in children. The 
Committee requests the Institute be prepared to report on the 
progress being made in the development of such study during the 
fiscal year 2006 appropriation hearings.
    Pediatric AIDS.--The Committee urges the Institute to 
increase support for AIDS research, especially pediatric HIV/
AIDS research. HIV/AIDS affects children differently than it 
does adults, and it is essential to do specific research for 
pediatric populations in order to continue making significant 
strides in treating children with HIV/AIDS.
    Pediatric Liver Disease.--The Committee urges the Institute 
to aggressively pursue and fund ancillary studies associated 
with the recently awarded NIDDK pediatric hepatitis C clinical 
trial. This clinical trial will provide long term follow up for 
children treated for hepatitis C, permitting growth and 
development issues to be more fully explored. The Committee 
also notes that the Institute has provided only limited support 
for pediatric liver disease research and urges support to 
expand ongoing efforts to study biliary atresia and to provide 
expanded support for the Biliary Atresia Clinical Research 
Consortium.
    Prader-Willi Syndrome.--Prader-Willi Syndrome is the most 
common known genetic cause of life threatening obesity in 
children. The Committee strongly encourages the NICHD to place 
a high priority on Prader-Willi Syndrome research to study 
childhood obesity. Furthermore, the NICHD is urged to 
incorporate Prader-Willi Syndrome into the planning process for 
The National Children's Study.
    Prematurity.--The Committee encourages NICHD to support a 
major initiative in the area of prematurity. The rates of 
premature birth have increased 29 percent since 1981 to over 
480,000 babies in 2002. African-American infants are nearly 
twice as likely as non-Hispanic white infants to be born 
prematurely. Premature birth is the leading cause of death in 
the first month of life and most recent data indicate the first 
rise in infant mortality rates since 1958. Premature birth can 
occur in any pregnancy; the causes of nearly half of all 
preterm births are unknown. The Committee commends NICHD for 
its work on preterm birth and strongly urges the allocation of 
more funds to reveal the underlying cause of preterm delivery, 
to identify prevention strategies and improve the treatment of 
outcomes for infants born preterm.
    In addition, the Committee is aware that genomic and 
proteomic strategies are widely used and have had a major 
impact on medicine. The Committee believes it is imperative 
that these techniques also be used to understand prematurity, 
and strongly encourages NICHD to support an initiative to 
hasten a better understanding of the pathophsiology of 
premature birth, discover novel diagnostic biomarkers, and 
ultimately aid in formulating more effective interventional 
strategies to prevent premature birth.
    Primary Immunodeficiency Diseases.--The Committee continues 
to be impressed with the dedication of financial and personnel 
resources by NICHD to address the research and awareness issues 
that surround this class of more than 100 diseases. The 
Committee is particularly encouraged by the institute's 
research commitment to develop newborn screening procedures for 
PI through microarray technologies and urges the NICHD to press 
ahead aggressively with this initiative.
    Skeletal Development.--The Committee urges NICHD to focus 
on the effects of a wide variety of drugs on the growing 
skeleton and how to minimize these effects by working to ensure 
that the impact on the growing skeleton is investigated for all 
therapeutic agents in the implementation of the Better 
Pharmaceuticals for Children Act. The Committee also encourages 
NICHD to engage in trans-NIH research into other factors--
including genetic, diet and exercise--affecting the 
determination of peak bone mass in children with and without 
the metabolic bone diseases of osteoporosis and osteogenesis 
imperfecta. In addition, the Committee urges support for basic 
research on the pathophysiology, genetics and treatment of 
osteopetrosis.
    Spina Bifida.--The Committee is pleased that the Institute 
cosponsored the Spina Bifida Research Conference in May 2003. 
However the Committee has concerns that without adequate 
follow-up the conference findings and recommendations will not 
come to fruition. The Committee strongly encourages NICHD to 
enhance research to address issues related to the outcome of 
the conference and urges the Institute to significantly expand 
its research efforts in the prevention and treatment of Spina 
Bifida and associated secondary conditions. The Director should 
be prepared to report on efforts to advance these areas of 
research at the fiscal year 2006 appropriations hearing.
    Spinal Muscular Atrophy [SMA].--SMA is the leading genetic 
killer of infants and toddlers, and is the most prevalent 
genetic motor neuron disease. The severity of the disease, its 
relatively high incidence, and the possibility of imminent 
treatments have led NINDS to initiate the SMA Project. The 
Committee believes that the treatment of SMA, and the SMA 
Project at NINDS, is strategically consistent with the mission 
the NICHD. The Committee strongly urges the NICHD to work 
closely with NINDS to develop collaborations and programs which 
will support and expand the SMA Project. The Committee strongly 
urges NICHD to expand the scope and level of SMA research by 
aggressively soliciting grant applications on an expedited 
basis. Lastly, the Committee strongly urges the NICHD to 
develop formal programs that increase public and professional 
awareness of SMA. The Committee requests that the NICHD report 
back to the Committee during the fiscal year 2006 
appropriations hearings.
    Stillbirth.--The Committee applauds NICHD's efforts in 
addressing stillbirth, a major public health issue with 
morbidity equal to that of all infant deaths. The Committee 
understands that NICHD has established a cooperative network of 
clinical centers and a data center to address this issue with a 
standard protocol, and strongly encourages the NICHD to fully 
fund this effort.
    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. Now that NICHD is focusing 
more globally on infant mortality, the Committee urges the 
Institute to transition from its successful SIDS 5-year 
research plan to a more comprehensive plan focusing on SIDS, 
stillbirth, and miscarriage. The Committee requests that NICHD 
determine an appropriate means of including research on these 
causes of infant mortality into one inclusive plan.
    Urinary Incontinence.--Urinary incontinence is one of the 
most prevalent chronic diseases in women affecting 30 percent 
of females; these and other pelvic floor disorders serve as 
obstructions to healthy living and contribute to depression and 
obesity. The Committee commends the NICHD for establishing the 
Pelvic Floor Disorder Network [PFDN] and expects additional 
resources will enable the network to expand the quality and 
integrity of clinical and basic scientific research in the 
field of urogynecology. The Committee is pleased that the NICHD 
continues to collaborate with the NIDDK in developing research 
in urinary incontinence. Recent studies have yielded gains in 
understanding these conditions but the Committee is equally 
concerned that more needs to be done with basic, clinical and 
translational research in order to create better foundations 
for clinical care. The Committee encourages the Institute to 
provide expanded research for investigator-initiated 
applications to ensure a self-sustaining base of ongoing 
research and encourages a dedicated study section in this area. 
The Committee also encourages the NICHD to include the effects 
of pregnancy on a woman's chance for incontinence and pelvic 
floor disorders in the future National Children's Study.
    Vulvodynia.--Millions of American women suffer from 
vulvodynia, a painful and often debilitating disorder of the 
female reproductive system. Despite its prevalence, inadequate 
attention has been paid to the disorder by health professionals 
or researchers. Since fiscal year 1998, the Committee has 
called on the NICHD to support research on the prevalence, 
causes and treatment of vulvodynia. While some initial steps 
have been taken, more must be done. The Committee urges the 
Institute to fund a collaborative research network to expedite 
the collection of data on the efficacy of current and future 
treatments. In addition, the Committee notes that, on average, 
women with vulvodynia consult five physicians before receiving 
a correct diagnosis. Therefore, the Committee urges the NICHD 
to work with the National Vulvodynia Association to implement a 
national education program for primary care health 
professionals, patients and the general public to reduce this 
delay.

                         NATIONAL EYE INSTITUTE

Appropriations, 2004....................................    $653,052,000
Budget estimate, 2005...................................     671,578,000
Committee recommendation................................     680,300,000

    The Committee recommends an appropriation of $680,300,000 
for the National Eye Institute [NEI]. The budget request was 
$671,578,000 and the fiscal year 2004 appropriation was 
$653,052,000. 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 laboratory 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.
    Diabetic Retinopathy.--The Committee commends NEI for 
establishing the Diabetic Retinopathy Clinical Research 
Network, which serves to expedite the evaluation of new 
approaches to address vision-related complications of diabetes. 
The Committee encourages NEI to continue to expand upon its 
efforts to detect, prevent and treat diabetic retinopathy by 
collaborating with NIBIB on the development and application of 
scanning technologies that will be highly affordable and widely 
accessible to allow for early detection.
    Gene Therapy.--The Committee is aware of progress made in 
demonstrating the effectiveness of gene therapy to reverse and 
cure several retinal diseases, including diabetic retinopathy, 
macular degeneration, and retinopathy of prematurity. diabetic 
retinopathy and macular degeneration are leading causes of 
blindness and visual disability in the United States, with an 
additional 165,000 people losing their vision each year due to 
these disorders. Additionally, each year more than 500 infants 
are blinded by retinopathy of prematurity. Since gene therapy 
intervention has been successfully demonstrated in laboratory 
animals, the Committee urges the Institute to facilitate 
clinical trials in primates and humans to further validate gene 
therapy interventions to reverse and cure retinal diseases.
    Juvenile Diabetes.--The Committee is aware of the serious 
problem of retinopathy in individuals with juvenile diabetes, 
and it encourages the NEI to continue to collaborate with other 
institutes on efforts to identify the genes for diabetic 
retinopathy by collecting and analyzing human samples and by 
developing animal models of diabetic retinopathy.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2004....................................    $632,392,000
Budget estimate, 2005...................................     650,027,000
Committee recommendation................................     655,100,000

    The Committee recommends an appropriation of $655,100,000 
for the National Institute of Environmental Health Sciences 
[NIEHS]. The budget request was $650,027,000 and the fiscal 
year 2004 appropriation was $632,392,000. 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.
    Breastfeeding and Toxins.--Recent reports on the presence 
of flame retardants and other environmental toxins in human 
breastmilk have given rise to concerns about the safety of 
breastfeeding. Recognizing that these reports may offer mixed 
messages about this public health concern, the Committee 
reaffirms the goal of Healthy People 2010 of ``[I]ncreasing the 
proportion of mothers who breastfeed their babies.'' The 
Committee also strongly urges the National Institute of 
Children's Health and Human Development, the National Institute 
of Nursing Research, the National Institute of Environmental 
Health Sciences, the Centers for Disease Control and 
Prevention, Department of Health and Human Services' Office of 
Women's Health to hold a consensus meeting with health 
professionals, to include nursing and breastfeeding and 
lactation professionals. The consensus meeting should focus on 
environmental toxins and breastfeeding and appropriate public 
risk communication.
    Environmental Health and Nursing.--According to the final 
report of the Nursing and Environmental Health Roundtable, held 
in the fall of 2002, there is a significant need to build a 
cadre of registered nurse researchers specializing in 
environmental health. During the last decade, increased 
emphasis has been placed on the impact of environment on human 
health and the need for nurses to engage in research to advance 
knowledge in this field. Several nurse researchers received 
funding for environmental health projects focused on prevention 
of lead exposures, environmental factors and asthma, pesticide 
exposures among workers and their families, environmental 
awareness, and occupational health. Despite these efforts, 
significant needs still exist. Environmental health nurse 
researchers bring knowledge in nursing research methods as well 
as more traditional areas of environmental health research, 
such as human disease manifestation, risk assessment, and risk 
management. Many of the priority areas of environmental health 
nursing research rely on methods of exposure assessment, risk 
assessment, and risk communication. This Committee urges the 
National Institute of Environmental Health Sciences to create 
specific nurse research fellowships with the goal of increasing 
the number of registered nurse researchers specializing in the 
area of environmental health.
    Pacific Center for Environmental Health.--The Committee 
encourages NIEHS to establish a Pacific Center for 
Environmental Health to further study the short-term and long-
term health effects of volcanic emissions as well as other 
environmental issues. Such environmental concerns should 
include food and waterborne illness, fish contamination by 
pesticides and heavy metals, and pesticide residue in food and 
water.
    Parkinson's Disease.--The Committee urges NIEHS in 
collaboration with NINDS to gain a greater understanding of the 
environmental underpinnings of Parkinson's disease. The 
Committee also strongly urges NIEHS to intensify its efforts in 
the Collaborative Centers for Parkinson's Disease Research 
Program--as this initiative facilitates significant 
collaboration among genetics, clinical medicine, epidemiology, 
and basic science so that the most promising leads may be 
investigated more quickly in pursuit of a cure or to reduce the 
incidence of harmful toxins.

                      NATIONAL INSTITUTE ON AGING

Appropriations, 2004....................................  $1,024,754,000
Budget estimate, 2005...................................   1,055,666,000
Committee recommendation................................   1,094,500,000

    The Committee recommendation includes $1,094,500,000 for 
the National Institute on Aging [NIA]. The budget request was 
$1,055,666,000 and the fiscal year 2004 appropriation was 
$1,024,754,000. 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.--The number of Americans with 
Alzheimer's--4.5 million today--will increase to between 11.2 
million and 16 million by 2050. Within a decade, total annual 
Medicare costs for people with Alzheimer's will increase by 
almost 55 percent to nearly $50,000,000,000. Medicaid health 
and long-term care expenditures will rise by 80 percent, to 
$33,000,000,000 annually. Alzheimer's is also having a 
corrosive effect in the private sector, costing U.S. businesses 
$61,000,000,000 in 2002, an amount equivalent to the net 
profits of the top 10 Fortune 500 companies. The Committee 
notes, however, that rapid advances in basic science are 
helping to identify multiple targets for therapies that may 
help slow or halt the progression of Alzheimer's disease. 
Before these promising advances can be put to use preventing or 
treating the disease, they must be tested and validated in 
controlled clinical trials. Given the tremendous toll 
Alzheimer's disease exacts in human suffering, health care 
costs and economic loss, the Committee strongly urges NIA to 
launch simultaneous clinical trials on therapies it determines 
to be most promising. The Committee also encourages NIA to work 
collaboratively with other institutes and the CDC to educate 
Americans about the ways they can maintain their brain as they 
age.
    Alzheimer's Research Caregiver, Education, and Training.--
The Committee recommends that the NIA establish cooperative 
working relationships with non-profit organizations dedicated 
to new approaches to care-giving for patients with Alzheimer's 
disease, and to expand the level of resources made available 
for Alzheimer's disease caregiver education, research, and 
training.
    Behavioral Research and Older Workers.--The Committee 
encourages NIA to expand research on the needs of older 
workers. Since more baby boomers will be working well beyond 
the traditional age of retirement, more information is needed 
about the ways in which workplaces and workplace technology can 
be better designed to accommodate the needs of older workers.
    Bone Diseases.--The Committee encourages NIA to increase 
research into the pathophysiology of osteoporosis, Paget's 
disease and osteogenesis imperfecta. This research should 
include: genetics, the role of cell aging and altered 
metabolism, environmental and lifestyle factors, bone 
responsiveness to weight bearing, bone quality and fracture 
incidence, bone marrow changes, new agents to increase bone 
mass, the therapeutic use of new technology, and the 
comorbidity of metabolic bone diseases with chronic diseases of 
aging.
    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 a critical role in developing top-level 
experts in geriatrics. The Committee again urges NIA to make 
all possible efforts to expand these centers to include a 
school of nursing.
    Cognitive Research.--The Committee has noted the results of 
the NIA-funded clinical trial, ACTIV, in which interventions to 
improve various aspects of cognition in older people were found 
to be effective, but did not generalize to improved cognitive 
performance overall. Understanding that changes in memory and 
cognition are troubling to older people and threaten their 
independence, the Committee encourages NIA to consider next 
steps in research to develop cognition-enhancing interventions 
and report back on additional efforts.
    Demographic and Economic Research.--The Committee once 
again commends the NIA for supporting demographic and economic 
research and, in particular, the NIA Demography of Aging 
Centers program. Since its inception 10 years ago, the program 
has supported invaluable research to enhance knowledge about 
the well being of older Americans--especially information about 
their health and socioeconomic status, including their income, 
savings, work, and retirement decisions. Researchers at these 
Centers have initiated critical surveys, such as the Health and 
Retirement Survey and the National Long-Term Care Survey, which 
have, for example, identified social and economic consequences 
of retirement and the decline in disability among older 
Americans, respectively. After a decade, the Centers are poised 
to make significant contributions on numerous policy issues 
confronting an aging society. The Demography Centers are also 
now in a unique position to collaborate with several of the NIA 
Roybal Centers program to help translate findings into 
interventions and improve quality of life for older people. 
Therefore, the Committee urges NIA to continue its strong 
support of the demography centers program.
    Down Syndrome.--Research has shown that all persons with 
Down syndrome develop the neuropathological findings of 
Alzheimer's disease, and that many go on in later life to show 
cognitive decline. The Committee strongly urges NIA to increase 
funding to study the connection between Alzheimer's disease and 
Down syndrome and to work closely with NINDS, NICHD, NIMH and 
NHGRI to establish a new, multi-year research initiative to 
fund Down syndrome research on improving cognition and 
preventing early dementia through biomedical treatments.
    Hematology Research.--The Committee remains interested in 
advancing research opportunities into blood disorders in the 
elderly population. The Committee is particularly concerned 
that the incidence and prevalence of anemia increases with age; 
after age 85, one quarter of the population is anemic. Research 
is needed to better understand the basic biology and adverse 
quality of life complications of anemia and other blood 
diseases in the elderly. The Committee is supportive of the 
ongoing collaboration between the American Society of 
Hematology and NIA, with the participation of NHLBI, NCI, and 
NIDDK, to develop a research agenda in this field.
    Parkinson's Disease.--The Committee encourages NIA to 
collaborate with NINDS to determine the overlap in benefits 
that current research could provide to understanding both 
Alzheimer's and Parkinson's disease. The Committee 
congratulates the significant investment by NIA in 
understanding the role of genes, including alpha-synuclein, in 
the causation and manifestation of Parkinson's. Work of this 
nature is critical for better comprehension of the disease 
process, identification of potential pharmaceutical agents, 
improved diagnostic ability--especially during the early stages 
of the disease, and the development of accurate animal models.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 2004....................................    $501,066,000
Budget estimate, 2005...................................     515,378,000
Committee recommendation................................     520,900,000

    The Committee recommends an appropriation of $520,900,000 
for the National Institute of Arthritis and Musculoskeletal and 
Skin Diseases [NIAMS]. The budget requested $515,378,000 and 
the fiscal year 2004 appropriation was $501,066,000. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--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 
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 expenditures and lost 
productivity. The research activities of this Institute serve 
the concerns of many different special populations, including 
women, minorities, children, and the elderly.
    Arthritis.--Arthritis is the leading cause of disability in 
the United States, with 70 million Americans living with some 
form of the disease of chronic joint symptoms. The NIAMS is a 
leader in the field of arthritis research. The committee urges 
NIAMS to collaborate with other NIH Institutes toward a cure 
for arthritis and related diseases.
    Bone and Cartilage Diseases.--The Committee urges NIAMS to 
explore new avenues for cell and gene-based therapies for the 
treatment of bone and cartilage diseases, such as osteoporosis, 
Paget's disease, and osteogenesis imperfecta. Identifying new 
targets for enhancing bone formation and blocking bone 
destruction should be a major focus, with studies that 
integrate basic and clinical approaches regarding bone forming 
cell development.
    Duchenne Muscular Dystrophy [DMD].--The Committee urges 
NIAMS, in collaboration with NINDS, to dedicate additional 
resources to improve treatments for patients with DMD.
    Juvenile Arthritis.--The Committee urges the NIAMS, in 
collaboration with NICHD and NIAID, to strengthen its 
investment in, and commit additional resources to, basic, 
clinical, and translational research efforts and related 
activities specific to juvenile arthritis, as authorized by the 
Children's Health Act. The Committee expects the NIH to provide 
Congress with a report on efforts underway and progress made in 
achieving this goal by February 2005.
    Lupus.--The Committee is aware of the importance of lupus 
susceptibility genes. Voluntary health organizations have 
established a collaboration among many individual research 
teams throughout the country to accelerate the search for these 
genes. The Committee urges the Institute to pursue this 
collaboration and to provide increased funding so that 
sufficiently large patient cohorts can be developed that will 
facilitate research in this area. Because lupus is disorder 
that disproportionately affects women of African American, 
Hispanic and Asian ancestry, appropriate numbers of samples 
from these populations should be included in these cohorts. The 
Committee also urges the Institute to consider the importance 
of creating repositories that might aid research into the 
genetic aspects of lupus.
    Marfan Syndrome.--The Committee commends NIAMS and its 
collaborative efforts with other institutes to provide vital 
support for research on Marfan syndrome, a life-threatening, 
progressive and degenerative genetic disorder. The Committee 
urges NIAMS to focus on research opportunities that have the 
potential to advance non-surgical treatment options, through 
all available mechanisms, as appropriate.
    Metabolic Bone Diseases.--The Committee urges NIAMS to 
support trans-NIH research into all aspects of genetics and 
gene therapies for the treatment of metabolic bone diseases, 
the role of environmental and lifestyle factors in bone 
disease, the effects of depression and cardiovascular disease 
on bone disease, the impact of mechanical loading of bone, 
translational research to bring the recent exciting basic 
discoveries about bone in to clinical practice, and research on 
bone health and osteoporosis in special groups, such as non-
Caucasian ethnic groups.
    Mucopolysaccharidosis [MPS].--The Committee is aware of 
recent efforts with NIDDK to facilitate communication between 
MPS and Lysosomal Storage Disorder investigators with bone 
pathology and connective tissue scientists to examine 
problematic issues in this area of study. Research in the 
underlying pathophysiology of bone and joint lesions, the gene 
mutations and substrates that are stored and potential 
therapeutic approaches are of interest to the Committee. The 
Committee encourages NIAMS to enhance its efforts to directly 
support and collaborate with NIDDK on bone and joint diseases 
in MPS disorders.
    Scleroderma.--The Committee is encouraged by NIAMS's 
growing interest in scleroderma, a chronic and progressive 
disease that predominantly strikes women. Scleroderma is 
disfiguring and can be life-threatening and effective 
treatments are lacking. The Committee encourages NIAMS to 
collaborate with other institutes, including NHLBI, NIDDK, 
NIAID, and NIDCR to generate additional research opportunities 
for scleroderma to identify genetic risk factors and safe and 
effective treatments.
    Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or 
TSC, is a genetic disorder that triggers uncontrollable tumor 
growth in multiple organs of the body, including the skin. The 
Committee strongly encourages NIAMS to support programs 
examining the molecular and cellular basis of dermatological 
lesions in TSC as well as the development of non-surgical 
treatments for skin manifestations.

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 2004....................................    $382,053,000
Budget estimate, 2005...................................     393,507,000
Committee recommendation................................     399,000,000

    The Committee recommends an appropriation of $399,000,000 
for the National Institute on Deafness and Other Communication 
Disorders [NIDCD]. The budget requested $393,507,000 and the 
fiscal year 2004 appropriation was $382,053,000. 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; contributes to health promotion and disease 
prevention; and supports efforts to create devices that 
substitute for lost and impaired sensory and communication 
functions.
    Animal Models of Hearing Loss.--It is now clear that 
peripheral hearing loss leads to profound changes in the 
central nervous system, including cell death and loss of 
synapse function. The Committee encourages research to focus on 
animal models of conductive and senorineural hearing loss, 
particularly the induced changes in brain physiology that 
result from deafness during development. Understanding the 
brain structure and function of deaf individuals is essential 
to proper implementation of ameliorative strategies such as 
hearing aid and cochlear implants.
    Behavioral Research.--The Committee recognizes that many 
behavioral problems afflict those who suffer from communication 
disorders, and that NIDCD research in behavioral and 
communication science is key to alleviating these conditions. 
Unwanted behaviors, as a result of autism or other disorders, 
can interfere with the development of communication skills, and 
research has shown that highly structured behavioral programs 
are effective in some cases. Research in cognitive processing 
combines behavioral and biological approaches to help 
understand the normal mechanisms of sensory processing, 
cognition and perception. This is an excellent example of the 
interdisciplinary research that should be supported at NIH.
    Clinical Evaluation of Hearing Loss.--The Committee 
encourages NIDCD to partner with other Institutes at NIH to 
support the development of functional neuroimaging technology 
with more precise spatial and temporal resolution, as well as 
better molecular probes to monitor brain activity.
    Deafness Research.--The Committee urges the NIDCD to 
continue to support research in the areas of inner ear 
protection, rescue, and regeneration, such as noise-induced 
hearing loss, ototoxicity and hair cell regeneration, as well 
as research on the central auditory system. In addition, NIDCD 
should continue research on rehabilitative technologies and 
strategies, leading to improved prevention, treatment and 
management of hearing loss, tinnitus and dizziness. The 
Committee strongly urges the NIDCD to continue to support the 
translation of basic research discoveries into better clinical 
diagnostic techniques and treatments.
    Early Detection and Intervention.--It is now clear that 
early treatment of hearing loss is essential for normal 
language acquisition. However, the Committee notes that there 
are many children with late onset and progressive hearing loss 
who are not identified by Universal Neonatal Hearing Screening 
[UNHS], so parents and clinicians should be made aware of this 
in NIDCD newsletters and on the NIDCD website. The Committee 
supports expanded research on the early detection, diagnosis, 
and intervention of infants with deafness and other 
communication disorders. This should include exploring the role 
of intrauterine exposure to cytomegalovirus [CMV] in 
progressive hearing impairment. It is also critical to 
recognize that otitis media, or middle ear infection, is among 
the most frequent reasons for a sick child to visit the doctor 
within the first few years of life. The use of antibiotics to 
treat this disorder is resulting in more strains of bacteria 
that cause otitis media to be resistant to first and second 
line antibiotics. The Committee encourages NIDCD to explore 
alternative ways to either treat or prevent otitis media, which 
exacts an estimated public health burden of about 
$5,000,000,000 a year in the United States.
    Environmentally-induced Hearing Loss.--The Committee 
continues to be concerned by the number of Americans who suffer 
from chemical-and noise-induced hearing loss. The NIDCD's Wise 
Ears Campaign is making significant inroads towards educating 
Americans of all ages, and the Committee strongly supports its 
expansion to school-age children. The Committee also supports 
expanded research on prosthetic and pharmacological therapies 
for hearing loss from noise stress, ototoxic drugs and other 
environmental traumas.
    Hair Cell Regeneration.--The Committee urges NIDCD to 
continue to assign a high priority to new and important 
directions for inner ear hair cell regeneration in mammals, 
specifically in the use of gene therapy to restore hair cells 
in the cochlea with adenovirus vectors, and in the development 
of stem cells to re-grow hair cells of the inner ear.
    Hearing Devices.--The Committee encourages the NIDCD to 
expand research that would improve the benefits of cochlear 
prostheses and improve remediation of less-than-profound 
hearing loss through hearing aids and/or new prostheses and 
drug-delivery systems. Building on the successful clinical 
implementation of the cochlear implant, the Committee 
encourages NIDCD to explore the feasibility of electrical 
stimulation applied to the vestibular system to treat balance 
disorders.
    Hereditary Hearing Loss.--The Committee applauds the 
remarkable progress towards understanding the molecular basis 
for hereditary hearing impairment. The Committee encourages a 
sustained effort to screen for the single and multigenetic 
bases of hearing loss through contemporary techniques, 
including the development of diagnostic gene chips for auditory 
dysfunction. The Committee also encourages the development of 
animal models to better assess at the level of structure and 
function how gene mutation results in impaired central auditory 
function.
    Language Acquisition.--The Committee encourages the NIDCD 
to explore the biological bases of infant speech perception and 
language acquisition. This should include studies on the impact 
of partial or profound hearing loss.
    Neurofibromatosis.--NF2 accounts for approximately 5 
percent of genetic forms of deafness. Unlike other genetic 
forms of deafness, NF2-associated deafness is potentially 
preventable or curable if tumor growth is halted before damage 
has been done to the adjacent nerve. Research is now being 
conducted to cure deafness in NF2 mice through gene therapy, 
with enormous implications for gene therapy in general and for 
patients suffering from meningiomas and other tumors in 
particular. The Committee therefore encourages NIDCD to expand 
its NF2 research portfolio through all suitable mechanisms 
including RFAs and clinical trials.
    Presbycusis.--Presbycusis, the gradual loss of hearing from 
aging, is the third leading chronic disease, following 
hypertension and arthritis, in individuals over age 65. It will 
become more common as the Nation's population grows older. The 
Committee encourages research on the central and peripheral 
mechanisms leading to presbycustic hearing loss and on 
strategies that would prevent hearing loss in our senior 
population. NIDCD is urged to undertake research on the 
mechanism underlying the premature cell death that results in 
many forms of presbycusis so as to develop prevention and cure 
strategies.
    Stuttering.--The Committee received testimony concerning 
stuttering which affects approximately 3 million people in this 
country. It was learned that healthy individuals who stutter 
are often labeled as unintelligent, eccentric, mentally ill 
and/or emotionally disturbed. NIDCD is encouraged to conduct a 
workshop in fiscal year 2005 on stuttering, which will examine 
the current state of the science as well as to identify future 
research opportunities in the field of stuttering and to report 
to the Committee on the plans for the workshop at next year's 
hearings.
    Tinnitus.--The Committee encourages the Institute to expand 
its research into mechanisms underlying peripheral and central 
tinnitus.
    Translational Research.--The Committee encourages NIDCD to 
support research activities aimed at accelerating the 
translations of new findings from the laboratory bench to the 
bedside. With the exciting new insights and findings of our 
molecular and basic sciences in understanding the mechanisms of 
cell death and disease processes, it is important to provide 
support for those activities that will translate these findings 
into new interventions and technologies to better prevent and 
treat deafness and other communication disorders.

                 NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2004....................................    $134,724,000
Budget estimate, 2005...................................     139,198,000
Committee recommendation................................     140,200,000

    The Committee recommends an appropriation of $140,200,000 
for the National Institute of Nursing Research [NINR]. The 
budget request was $139,198,000 and the fiscal year 2004 
appropriation was $134,724,000. 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.
    Alzheimer's Disease.--The Committee is pleased that NINR 
has stepped up its research both on Alzheimer's patients and 
those who care for them. For example, a nursing research study 
is now underway comparing four interventions designed for 
families coping with the effects of Alzheimer's disease and 
related disorders. Two home-based and two community-based 
interventions are being assessed according to the physical and 
psychological well-being of the caregiver and the cognitive/
behavioral functioning and well-being of the person receiving 
the care. Future findings promise valuable information for 
nursing, social work and other health disciplines about each 
intervention's usefulness for particular situations.
    Adolescent Risk Behavior.--The Committee commends NINR's 
research in risk behavior. Increased understanding of factors 
that facilitate healthy lifestyle behaviors, as well as the 
modification of risky behaviors, will reduce the consequences 
associated with these risks. Recognizing that many adolescent 
risk behaviors are intertwined, the focus of NINR's initiative 
is on developing interventions that target several risk 
behaviors simultaneously. The Committee hopes this research 
will continue to bear positive results.
    End of Life Research.--The Committee continues to strongly 
support NINR's leadership in coordinating end-of-life research 
at NIH. Expansion of the NINR research portfolio to include 
children at the end-of-life is a groundbreaking research 
initiative in an area that has not received the attention that 
it should. By focusing on such behavioral issues as stress and 
decision-making, as well as end-of-life care for children, the 
institute will continue to make strides that will alleviate the 
burdens involved with caring for those with terminal 
conditions.
    Genetics.--The Committee is pleased with NINR's efforts in 
genetics and emphasis on the integration of genetics into 
nursing research, practice, and education. The NINR Summer 
Genetics Institute, which provides an 8-week intensive genetics 
research training program each year, is a key component of the 
effort to increase genetics expertise within the nursing 
knowledge base and healthcare practice.
    Minority Health and Disparities.--The Committee commends 
NINR for its support of research to reduce disparities in the 
health of minority populations and is pleased that this will 
receive continued emphasis. It is important to reduce low 
birth-weight rates for minority women, which can be 50 percent 
higher than for white women. NINR's focus on early 
identification of risk factors and chronic diseases during 
pregnancy and on health promotion for pregnant minority women 
will be important to lower the unacceptably high number of low 
birth-weight babies in the country. NINR is also urged to 
continue its successful research in promoting the health of 
minority men who have a reduced life expectancy compared to 
women. Research of effective health promotion strategies such 
as smoking cessation, nutrition, physical activity, and 
increased management of stress are critical to improving and 
extending the life cycle of minority men.
    Nurse-managed Health Centers.--The Committee urges the NINR 
to increase funding for nurse-managed health centers and 
advanced practice nurses in research and demonstration 
projects.
    Nursing Shortage.--NINR is to be commended for its forward-
thinking investment in research training as a way to address 
the nursing shortage. Training support for fast-track 
baccalaureate-to-doctoral program participants is one important 
initiative. The 17 recently funded Nursing Partnership Centers 
to Reduce Health Disparities is another initiative that helps 
produce an adequate number of nurse researchers. Not only will 
these partnerships between research-intensive schools of 
nursing and minority serving university schools of nursing 
train more minority nurses, but they also expand health 
disparities research.
    Self-Management.--Increasingly, self-management is becoming 
a significant approach to living with illness because it 
enhances the ability to retain the highest quality of life 
possible. The Committee is pleased that NINR is taking new 
approaches in its research on self-management of chronic 
illnesses that tailors interventions to diverse and vulnerable 
populations. Results from studies of technological advances 
that aid self-management, such as technologies that allow 
monitoring indices of illness at home, are an important adjunct 
to self-management strategies.

           NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM

Appropriations, 2004....................................    $428,669,000
Budget estimate, 2005...................................     441,911,000
Committee recommendation................................     444,900,000

    The Committee recommends an appropriation of $444,900,000 
for the National Institute on Alcohol Abuse and Alcoholism 
[NIAAA]. The budget request was $441,911,000 and the fiscal 
year 2004 appropriation was $428,669,000. 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, genetics, neuroscience, and moderate 
drinking.
    Alcohol Policy Information System.--The Committee supports 
the Alcohol Policy Information System [APIS]. This 
clearinghouse provides users with access to the latest and most 
comprehensive information to develop and implement effective 
policies and practices to combat underage drinking and other 
alcohol problems. The Committee strongly encourages the NIAAA 
to increase funding in this area and to report on its efforts 
to maintain the APIS, and to develop a plan to increase public 
awareness and use of this information clearinghouse.
    Alaska Alcohol and Substance Abuse.--The Committee is aware 
of serious problems with alcohol and substance abuse in Alaska, 
especially among its Alaska Native population and of the need 
for translating research into clinical applications for this 
population. The Committee urges NIAAA to sponsor a Research to 
Practice Forum with the Substance Abuse and Mental Health 
Services Administration to focus on bridging the gap between 
researchers and practitioners and translating scientific 
research into clinical applications, and encourages NIAAA to 
support the implementation of any recommendations developed at 
the forum.
    Co-occuring Substance Abuse Disorders.--The Committee notes 
that the Report to Congress on the Prevention and Treatment of 
Co-occurring Substance Abuse Disorders and Mental Health 
Disorders found that a ``significant lack of prevalence data on 
co-occurring disorders exist.'' The Committee encourages NIMH, 
NIAAA and NIDA to collaborate with States to develop more 
recent and accurate data on persons with co-occurring mental 
health and substance use disoders--with an emphasis on 
individuals with mild to moderate mental health disorders.
    Drinking as a Development Disorder.--The Committee 
understand that new NIAAA research has shown serious drinking 
problems previously associated with middle adulthood often 
begin to emerge during adolescence and young adulthood. The 
Committee encourages NIAAA to continue researching alcohol-
related problems in a developmental context and recognizes that 
alcohol abuse and dependence are best characterized as 
developmental disorders that become manifest throughout the 
lifespan.
    Knowledge Transfer.--The Committee urges NIAAA to redouble 
its efforts to transfer new knowledge to communities and to 
primary care health providers who can apply it to prevention 
and treatment. Recognizing the developmental nature of alcohol-
related problems, NIAAA should continue to focus intensively on 
the transition from childhood into adolescence, adolescence 
itself, and the transition from adolescence into young 
adulthood. The Committee looks forward to research findings 
that will reduce the risk to future generations of Americans 
and will spare countless additional parents from suffering the 
consequences of problem drinking in their children.
    Nonalcoholic Steatohepatitis [NASH].--The Committee notes 
that the mechanisms that cause NASH and the treatment protocols 
that are effective with regard to NASH also offer promise for 
treating alcoholic liver disease [ALD]. The Committee urges 
additional research focused on NASH and ALD to address both 
these diseases as well as to further test the hypothesis that 
the mechanisms causing these diseases are similar and new 
research findings may address both diseases.
    Underage Drinking.--The Committee acknowledges that alcohol 
is, by far, the psychoactive substance most often used by 
youth, leading to numerous problems for themselves such as 
lower grades or school failure, social problems, physical 
problems, such as hangovers or medical illnesses, unwanted or 
unintended sexual activity, physical and sexual assault, memory 
problems, increased risk for suicide and homicide, alcohol-
related car crashes and death from alcohol poisoning. The 
Committee recognizes that alcohol consumption represents one of 
the most important public health problems among youth today.
    Using an Integrative Approach.--The Committee encourages 
NIAAA to continued directing substantial effort and resources 
toward the achievement of a more fully integrated and 
comprehensive scientific understanding of the environmental, 
behavioral, biological, and genetic factors that promote the 
initiation, maintenance, and acceleration of alcohol use, and 
that influence the transition into harmful alcohol use, 
including abuse and dependence.

                    NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2004....................................    $990,953,000
Budget estimate, 2005...................................   1,019,060,000
Committee recommendation................................   1,026,200,000

    The Committee recommends an appropriation of $1,026,200,000 
for the National Institute on Drug Abuse [NIDA]. The budget 
request was $1,019,060,000. The fiscal year 2004 appropriation 
was $990,953,000. 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 
that 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 and to assure 
dissemination of information with respect to prevention of drug 
abuse and treatment of drug abusers.
    Adolescent Drug Use.--The Committee is pleased with the 
Institute's focus on adolescents. The Committee notes that if 
drug use is to be reduced, there must be a better understanding 
of the adolescent decision-making process so that more 
effective prevention programs can be developed. NIDA is urged 
to increase its research to better understand the mechanisms 
underlying adolescent judgment, decision-making, impulsivity 
and risk-taking.
    Collaboration With SAMHSA.--The Committee commends NIDA for 
its outreach and work with State substance abuse authorities to 
reduce the current 15- to 20-year lag between the discovery of 
an effective treatment of intervention and its availability at 
the community. In particular, the Committee applauds NIDA for 
working with SAMHSA on a recent RFA designed to strengthen 
State agencies' capacity to support and engage in research that 
will foster statewide adoption of meritorious science-based 
policies and practices. The Committee also encourages NIDA to 
continue collaborative work with States to ensure that research 
findings are relevant and adaptable by State Substance Abuse 
systems. In addition, the Committee encourages NIDA to work 
with SAMHSA, NIAAA and NIMH to develop more recent and accurate 
data on persons with co-occurring mental health and substance 
use disorders, with an emphasis on individuals with mild to 
moderate mental health disorders.
    Co-morbidity.--Co-mortidity between drug abuse and mental 
illness is common and may reflect common contributing factors. 
The Committee urges NIDA to expand research efforts to better 
understand the neurobiological underpinnings of these co-
occurring disorders; to elucidate risk and protective factors 
for development of mental health and substance abuse problems; 
and more specifically to explore the impact of stimulant 
therapies for mental disorders such as ADHD on later drug use 
disorders. The Committee also encourages NIDA to examine how 
treatment services can best accommodate the co-morbid nature of 
these disorders.
    Drug Abuse and HIV/AIDS.--The Committee understands HIV/
AIDS continues to disproportionately affect vulnerable 
populations in the United States (e.g. criminal justice 
populations, pregnant women, minorities and youth) and that 
drug abuse is often a factor in transmission of HIV/AIDS. 
Therefore, the Committee urges NIDA to continue its support of 
research that is focused on the development and testing of 
drug-abuse related interventions designed to reduce the spread 
of HIV/AIDS in these populations.
    Emerging Drugs.--The Committee is concerned regarding the 
abuse of over-the-counter medications, including 
dextromethorphan [DMS] and steroids. Recognizing the 
significant role that NIDA has played in monitoring drug trends 
and responding to emerging drug problems like methamphetamine 
and prescription drugs, the Institute is encouraged to continue 
to increase its research and dissemination efforts on emerging 
drug problems.
    Long-Term Consequences of Marijuana Use.--The Committee is 
concerned with the continuing widespread use of marijuana. 
Research shows that marijuana can be detrimental to educational 
attainment, work performance, and cognitive function. However, 
more information is needed in order to assess the full impact 
of long-term marijuana use. The Committee urges NIDA to support 
increased efforts to assess the long-term consequences of 
marijuana use on cognitive abilities, achievement, and mental 
and physical health.
    Medical Consequences.--The Committee recognizes that 
addiction is a disorder that affects the course of other 
diseases such as cancer, cardiovascular and infectious 
diseases. Therefore, the Committee urges the NIDA to continue 
to support research on the medical consequences associated with 
drug abuse and addiction.
    Medications Development.--The Committee applauds NIDA for 
over a decade of leadership in working with private industry to 
develop anti-addiction medications and is pleased this 
collaboration has resulted in a new medication for opiate 
addiction. The Committee encourages NIDA to continue its work 
with the private sector to develop anti-addiction medications, 
particularly for cocaine, methamphetamine, and marijuana.
    Methamphetamine Abuse.--The Committee continues to be 
concerned with the rate of methamphetamine abuse across the 
Nation. The problem is especially acute in Midwestern States. 
The Committee again urges NIDA to expand its research on 
improved methods of prevention and treatment of methamphetamine 
abuse.
    Outreach.--The Committee commends NIDA for its outreach and 
work with State substance abuse authorities to reduce the 
current 10- to 20-year lag between the discovery of an 
effective treatment of intervention and its availability at the 
community level. The Committee is pleased with NIDA's 
collaboration with SAMHSA on strengthening State agencies' 
capacity to support and engage in research that will foster 
statewide adoption of science-based policies and practices. The 
Committee also encourages NIDA to continue collaborative work 
with States to ensure that research findings are relevant and 
adaptable by State Substance Abuse systems.
    Primary Care Settings and Youth.--Primary care settings, 
such as offices of pediatricians and general practitioners, are 
potential key points of access to prevent and treat problem 
drug use among young people; yet primary care and drug abuse 
services are commonly delivered through separate systems. The 
Committee encourages NIDA to expand support for health services 
research on effective ways to educate primary care providers 
about drug abuse; develop brief behavioral interventions for 
preventing and treating drug use and related health problems, 
particularly among adolescents; and develop methods to 
integrate drug abuse screening, assessment, prevention and 
treatment into primary health care settings.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2004....................................  $1,381,774,000
Budget estimate, 2005...................................   1,420,609,000
Committee recommendation................................   1,436,800,000

    The Committee recommends an appropriation of $1,436,800,000 
for the National Institute of Mental Health [NIMH]. The budget 
request was $1,420,609,000 and the fiscal year 2004 
appropriation was $1,381,774,000. The comparable amounts for 
the budget estimate include funds to be transferred from the 
Office of AIDS Research.
    Mission.--The mission of the NIMH is to reduce the burden 
of mental illness and behavioral disorders through research on 
mind, brain, and behavior. At the same time, NIMH maintains a 
clear focus on its ultimate goal: to pursue an understanding 
that will enable it to prevent mental illness, or to develop 
rational treatments that will actually cure them once they 
occur.
    As the leading Federal agency involved in research focused 
on mental disorders, NIMH and the scientists it supports seek 
to gain an understanding of the fundamental mechanisms 
underlying thought, emotion, and behavior--and an understanding 
of what goes wrong in the brain in mental illness. Equally 
important are the Institute's strong efforts to translate this 
basic knowledge into clinical research that will lead to better 
treatments and ultimately be effective in diverse populations 
and evolving health care systems.
    Aging and Mental Health.--The Committee continues to be 
concerned that NIMH has not provided substantial resources to 
promote aging research or provide data on existing funds 
targeted toward geriatric mental health research. Therefore, 
the Committee encourages NIMH to significantly expand research 
in this area extramurally through all available mechanisms to 
advance the geriatric mental health research agenda.
    Alzheimer's Disease.--Recently, NIMH launched a five-site 
trial of antidepressant medications designed to help identify 
the best medication regimen for treating the behavioral 
problems that often occur in Alzheimer patients. Initial 
results should be available in late 2004. In addition, NIMH 
intramural researchers identified a promising new method for 
early detection of Alzheimer's disease. Long-term studies now 
underway will determine whether this biomarker can be used as a 
predictive and diagnostic tool. The Committee encourages NIMH 
to continue to place significant priority on studies of 
Alzheimer's disease.
    Behavioral Science.--The Committee is aware that NIMH is 
reviewing its portfolio in basic behavioral science and 
encourages NIMH to continue its commitment to strengthen 
behavioral research that examines the basic psychological 
functions that promote mental health or become disturbed in 
mental disorders. The Committee further recognizes the 
potential contribution of research on cognitive, personality, 
emotional, and social processes that underlie behavioral 
functioning and urges their inclusion in inter-disciplinary 
research. The Committee is pleased that the National Mental 
Health Advisory Council has established a basic science working 
group and looks forward to receiving a report on the working 
group's conclusions regarding research opportunities in basic 
behavioral sciences relating to mental health.
    Down Syndrome.--The Committee encourages NIMH to research 
the mental health symptoms of persons with Down syndrome and to 
investigate risk factors and possible treatments for autism, 
obsessive-compulsive disorder, attention deficit disorder, 
anxiety, and depression. The Committee urges NIMH to include 
Down syndrome in its studies on related disorders and to 
coordinate its work with the National Center on Birth Defects 
and Developmental Disabilities at the Centers for Disease 
Control and Prevention. The Committee further urges NIMH to 
work closely with NINDS, NICHD, NIA and NHGRI to establish a 
new, multi-year research initiative to fund Down syndrome 
research relating to cognition and behavior through biomedical 
interventions.
    Fragile X.--Fragile X is the most common single-gene 
neuropsychiatric disease known. It causes cognitive impairment, 
mental disorders such as obsessive-compulsive disorder, and 
extreme anxiety. The Committee commends NIMH for working with 
FRAXA Research Foundation to spearhead three focused research 
meetings devoted to identifying critical research needs, in 
November 2001, January 2003, and a planned meeting in July 
2004. The Committee urges NIMH to pursue the most critical 
needs identified by the meeting panels. These include 
controlled studies of existing and new pharmacological 
treatments for Fragile X and identification of the key 
molecular targets which are likely candidates for designing 
drug treatments for Fragile X and related disorders such as 
autism. The Committee also urges NIMH to include Fragile X in 
its studies of related neuropsychiatric disorders and to work 
with other Institutes such as NICHD and NINDS to develop 
cooperative research support mechanisms in this area.
    Frontier Mental Health Needs.--The Committee commends NIMH 
on its outreach efforts to determine the differences in mental 
health needs which may exist in remote frontier communities. 
The Committee encourages NIMH to expand its research efforts 
into these communities, which are often ignored in research 
projects, but which continue to suffer from high incidences of 
mental health problems including depression, suicide and co-
occurring disorders with substance abuse.
    Major Depression and Bipolar Disorder.--The prevalence, 
economic consequences, and systemic nature of major depression 
is alarming. Depression is now recognized as a multisystem 
disorder affecting not only the brain, but the entire body. It 
has been associated with alterations in endocrine, 
cardiovascular, and immune systems as well as changes in bone 
metabolism. Researchers funded by NIMH found that the 
prevalence for major depression for lifetime was 16.2 percent; 
in any given year, more than 20 million children and adults in 
the Nation are affected by major depression or bipolar 
disorder. Depression has been shown to be a leading cause of 
disability worldwide. The Committee urges the NIMH to continue 
its efforts to understand depression, to develop new 
treatments, to decrease the impact of depression on comorbid 
illnesses, and--because depression and bipolar disorders are 
prominently associated with suicide--to reduce suicide. The 
Committee is pleased with NIMH's leadership in the public 
education campaign entitled ``Real Men. Real Depression'' and 
encourages the Institute to continue these education and 
information dissemination efforts.
    Outreach.--The Committee commends NIMH on its outreach 
efforts to determine the differences in mental health needs 
which may exist in remote rural communites. The Committee 
encourages NIMH to expand its research efforts toward the 
unique needs of the Native Hawaiian community.
    Parkinson's Disease.--The Committee encourages NIMH to 
increase its research on the role of depression in Parkinson's 
disease. Particularly, depression may be a very early symptom 
of Parkinson's, sometimes appearing before other traditional 
symptoms. NIMH should also continue its ongoing research into 
the proper treatment of depression and other serious mental 
disorders that often co-occur with Parkinson's, such as 
dementia and anxiety.
    Portfolio Review.--The Committee is pleased with recent 
NIMH efforts to set priorities with an eye toward achieving 
maximum impact against mental disorders. A balanced NIMH 
research portfolio ranges from the most basic molecular 
research to complex clinical and health services research--all 
of which contributes to the body of knowledge that will enable 
science to develop targeted and highly effective treatment 
interventions that can then be implemented through services 
that reach every individual who is in need. In this regard, the 
Committee understands that Working Groups of the National 
Advisory Mental Health Council [NAMHC], convened by the NIMH 
Director--including NAMHC members and outside scientific 
experts--have scrutinized the current NIMH portfolio related to 
clinical trials, to basic neurobiological research, and to 
basic behavioral research. The Committee favors these efforts 
at careful portfolio management, and looks forward to seeing 
the resulting recommendations of the Workgroups as to how the 
NIMH can best focus its efforts in areas that are relevant to 
the tremendous public health burden of mental disorders while 
at the same time promising the greatest opportunity for 
scientific advancement.
    Prader-Willi Syndrome.--The Committee commends the NIMH for 
its efforts to further the understanding and description of the 
mental health components of Prader-Willi Syndrome. The 
Committee recommends that NIMH expand its programs to develop 
practical treatment protocols, including pharmaceutical 
options, for the severe anxiety, obsessive-compulsive disorder, 
oppositional-defiant disorder and psychotic mental illness 
aspects of Prader-Willi Syndrome.
    Prevention Research.--The Committee places a high priority 
on prevention research, particularly with respect to mental 
disorders among children and adolescents, in identifying 
protective factors against the negative impacts of stress among 
young adults, and in developing strategies to strengthen the 
family.
    Psychological Impacts of Terrorism.--The Committee supports 
NIMH research related to the psychological impact of both acute 
and chronic exposure to threats of violence, including 
terrorism and war, with particular emphasis on vulnerable 
populations, such as trauma survivors, children and older 
adults. The Committee encourages NIMH to expand its research 
portfolio to include research related to factors that promote 
detection or prediction, prevention, and post-exposure recovery 
and resilience.
    Research Progress.--Research has led to breakthroughs in 
understanding the brain, how it is affected by environmental 
conditions, and how this in turn works to influence behavior. 
The Committee is pleased to see the success of research on the 
genetics of mental illness supported by NIMH, and progress made 
in identifying genes that increase one's risk of developing 
schizophrenia, depression and bipolar disorder, and unraveling 
how the genes work in the brain to influence vulnerability.
    The Committee notes recent findings from the NIMH 
intramural research program on brain development, particular 
its study of normal brain development in youth ages 4 to 21. 
These results have elucidated the processes involved in the 
development of the normal brain, thus allowing more precise 
interpretation of what goes awry in neurodevelopmental 
disorders such as autism and schizophrenia. These developments 
are a clear illustration of the critically important work that 
is supported at NIH.
    Schizophrenia.--The Committee supports NIMH's recent 
innovative steps to hasten understanding of schizophrenia, 
especially the emphasis on its highlight successful intramural 
program relating to schizophrenia, and on developing 
medications that will target cognitive symptoms associated with 
psychotic disorders.
    Post Traumatic Stress Disorder.--The Committee supports 
NIMH's leadership in working to address urgent public health 
problems. NIMH research has shown that, for some individuals, 
exposure to violent or traumatic events can result in 
significant mental health repercussions. For example, in the 
area of fear, a great deal has been learned about the 
neurobiology of ``extinction,'' which enables most individuals 
to recover from a traumatic experience. Those not able to do 
this develop Post Traumatic Stress Disorder [PTSD]. By studying 
fear learning and extinction in non-human animals, scientists 
now know that PTSD must involve a well-defined specific brain 
circuit. This information can be important given the need to 
address potential psychological repercussions of terrorism and 
terrorist acts. The Committee is aware of NIMH's leadership in 
seeking interagency coordination in addressing this urgent 
issue.
    Selective Serotonin Reuptake Inhibitors.--The Committee 
urges the NIMH, in collaboration with the NICHD and other 
appropriate Institutes, to develop and conduct studies to 
examine the safety and efficacy of selective serotonin reuptake 
inhibitors [SSRIs] in children and adolescents. SSRIs are 
prescribed to millions of American children each year, and that 
number continues to increase dramatically. Yet there is 
conflicting information about the benefits and possible risks 
of using SSRIs to treat youth suffering from depression. 
Therefore, the Committee recommends that studies be designed to 
conclusively answer questions about the safety and efficacy of 
SSRIs in youth suffering from depression. The Committee further 
recommends that these studies focus on original research to the 
extent that existing data prove insufficient to answer such 
questions.
    Social Work.--The Committee commends the NIH Office of 
Behavioral and Social Science Research for its leadership in 
working together with NIH Institutes and centers, especially 
NCI, NIAAA, NIA, NIDA, NIMH, NICHD, and social work 
organizations and academics to implement recommendations from 
the NIH Plan for Social Work Research, including expanded 
technical assistance and outreach and a summer 2004 training 
institute, and encourages continued implementation activities 
including working with appropriate social work practice, 
education, and research groups to host a trans-NIH conference 
on social work research.
    Suicide.--The Committee supports NIMH efforts to enhance 
suicide awareness and prevention, and encourages the Institute 
to continue its collaborative work with other NIH Institutes to 
address this painful yet all-to-real topic. In 2000, 30,000 
persons killed themselves in the United States. Suicide deaths 
outnumber homicide deaths by 5 to 3, and suicide was the third 
leading cause of death for 10- to 24-year-olds. The health 
conditions most consistently associated with suicide are mental 
illness and addictive disorders, affecting up to 90 percent of 
all people who die by suicide. The Committee is pleased with 
the program announcement sponsored by NIMH, NIAAA, NIDA, and 
others asking for grant applications for research that will 
reduce the burden of suicide. This multi-Institute initiative 
is meant to intensify investigator-initiated research on 
suicide and to attract new investigators to the field. This 
work is critical, and the Committee applauds this trans-NIH 
approach. Prescriptions for psychotropic medications for 
children and youth have clearly been increasing. While many 
children are immeasurably helped by these medications--so that 
they can lead satisfying social lives, perform well in school--
recent reports of a possible link between use of these 
medications and suicide have alarmed the Committee. NIMH is 
addressing this important public health issue through its 
support of the large-scale clinical trial to carefully evaluate 
safety and effectiveness of treatments for adolescents with 
depression. The Committee would like a brief report from NIMH 
after publication of the trial results. The Committee notes 
NIMH's web page essay on this topic, and urges NIMH to continue 
its vital research on the effects of these medication on 
children and on developing the brain when used long-term.
    Translating Behavioral Research.--The Committee recognizes 
and strongly supports NIMH's efforts to advance the application 
of behavioral research and interventions in clinical settings 
to address the public health burden of mental disorders. The 
Committee strongly supports translational research in the 
behavioral and social sciences to address how basic behavioral 
processes, such as cognition, emotion, motivation, development 
and social interaction, inform the diagnosis, treatment and 
delivery of services for mental disorders. Behavioral 
interventions are especially needed for children and 
adolescents with mental disorders.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2004....................................    $479,073,000
Budget estimate, 2005...................................     492,670,000
Committee recommendation................................     496,400,000

    The Committee recommendation includes $496,400,000 for the 
National Human Genome Research Institute [NHGRI]. The budget 
requested $492,670,000 and the fiscal year 2004 appropriation 
was $479,073,000. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The Human Genome Project was an effort to 
determine the location and sequence of the estimated 30,000 
genes that constitute the human genome. This historic 
achievement opens the genomic era of medicine. The Committee 
commends the NHGRI for developing this vision for the future of 
genomics.
    The NHGRI coordinates extramural and intramural research as 
well as research training in the area of genomics and genetics. 
The Division of Extramural Research supports research on 
genetic sequences of both human and non-human genomes, DNA 
sequencing technology development, database management and 
analysis, and studies of the ethical, legal, and social 
implications of human genome research. The Division of 
Intramural Research 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-based therapies. The intramural program has also 
developed a strong clinical research program in collaboration 
with several other NIH Institutes to study and better 
understand rare and complex genetic diseases such as diabetes, 
heart disease, breast cancer, colon cancer, and melanoma.
    Behavioral Research.--The Committee acknowledges NHGRI's 
leadership in establishing a social and behavioral intramural 
research branch within its intramural program. The new branch 
will work to translate the discoveries from the recently 
completed Human Genome Project into interventions for health 
promotion and disease prevention, and for counseling patients 
and families dealing with the impact of devastating genetic 
disorders. The SBRB also will investigate the complex social, 
ethical and public policy impact of genomic research.
    Gene-Environment Interactions.--NHGRI is commended for its 
partnerships with other Institutes and the Office of Behavioral 
and Social Sciences Research to push the frontier of genetics 
research forward by examining gene-environment interactions. 
Research on the environmental stimuli, such as behaviors, 
experience of stress, or exposure to certain physical 
conditions, that lead to the expression of genes is critical if 
science is to reap the benefits of the mapped genome. NHGRI is 
encouraged to work with OBSSR on multidisciplinary training 
programs to increase the number of skilled scientists who can 
bridge the behavioral and genetic realms.
    Targeting Disease Prevention.--The Committee commends NHGRI 
for creating the Encyclopedia of Data Elements [ENCODE] 
project, which has a long term goal of identifying and locating 
all protein-coding genes, non-protein coding genes and other 
sequence-based functional elements contained in human DNA 
sequence. However, other important research related to 
unveiling the secrets of the human genome should also be 
investigated. These include: the development of a comprehensive 
catalogue of the functional components encoded in the human and 
mouse genomes, a study of how microarray technology can play a 
role in the screening of newborn infants in conjunction with 
the NICHD, and the completion of the international haplotype 
mapping [HAPMAP] project. In each of these areas, the Committee 
recognizes that advances in the use of mircroarray technology 
can enhance NHGRI's global leadership in meeting these goals.

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2004....................................    $287,129,000
Budget estimate, 2005...................................     297,647,000
Committee recommendation................................     300,800,000

    The Committee recommends an appropriation of $300,800,000 
for the National Institute of Biomedical Imaging and 
Bioengineering [NIBIB]. The budget requested $297,647,000 and 
the fiscal year 2004 appropriation was $287,129,000. The 
comparable amounts for the budget estimate include funds to be 
transferred from the Office of AIDS Research.
    Mission.--The NIBIB improves health by promoting 
fundamental discoveries, design and development, and 
translation and assessment of technological capabilities in 
biomedical imaging and bioengineering, enabled by relevant 
areas of information science, physics, chemistry, mathematics, 
materials science, and computer sciences. The Institute plans, 
conducts, fosters, and supports an integrated and coordinated 
program of research and research training that can be applied 
to a broad spectrum of biological processes, disorders and 
diseases and across organ systems. The Institute coordinates 
with the biomedical imaging and bioengineering programs of 
other agencies and NIH Institutes to support imaging and 
engineering research with potential medical applications and 
facilitates the transfer of such technologies to medical 
applications.
    Artificial Tissues.--The Committee encourages the Institute 
to focus on improved tissue and organ imaging technologies and 
on the growth of artificial tissues. Progress in these fields 
will have multiple benefits including addressing issues such as 
invasive diagnostics tests now required for liver diseases and 
the need to address the shortage of livers and other organs 
available for transplantation.
    Cardio-vascular Surgery.--Cardio-vascular surgery depends 
on the development of new materials and tools that can be used 
in surgical management of heart and lung disease. The Committee 
is encouraged that the Institute has recognized the importance 
of this concept and implemented programs in advanced 
biomaterials and tissue engineering that have a direct bearing 
on these surgical fields.
    Imaging Techniques.--The Committee urges NIBIB to make new 
bone imaging techniques a primary focus, speeding the 
development of new imaging modalities that better capture bone 
quality, including bone micro- and macro-architecture, 
quantification of bone mass and crystalline composition. This 
is necessary to develop diagnostic and treatment therapies for 
patients with metabolic bone diseases. The Committee urges 
NIBIB to participate actively in trans-NIH initiatives that 
address these priorities.
    Pet MicroPET Scans.--The Committee continues to encourage 
this new Institute to devote significant resources to molecular 
imaging technologies such as positron emission tomography [PET] 
and microPET to take advantage of the capacities of molecular 
imaging to detect disease process at the molecular level and to 
monitor the effectiveness of targeted gene therapies now under 
development. The Committee also encourages the new Institute to 
develop its research agenda in close collaboration with other, 
disease-specific Institutes at NIH, so that new imaging 
technologies are closely tied to the research projects being 
undertaken by the various other Institutes of NIH.

                 NATIONAL CENTER FOR RESEARCH RESOURCES

Appropriations, 2004....................................  $1,179,058,000
Budget estimate, 2005...................................   1,094,141,000
Committee recommendation................................   1,213,400,000

    The Committee recommends an appropriation of $1,213,400,000 
for the National Center for Research Resources [NCRR]. The 
budget request was $1,094,141,000 and the fiscal year 2004 
appropriation was $1,179,058,000. 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 pre-college students and the general public.
    Animal Research.--The Committee encourages NCRR to support 
research and development focused on improving methods for 
recognizing, assessing, and alleviating pain and distress in 
research animals.
    Cystic Fibrosis.--The Committee commends NCRR for its 
support of clinical trials networks, including cystic fibrosis 
clinical trials networks. A number of research institutions and 
private organizations are engaged in efforts to initiate or 
provide ongoing support to biospecimen repositories or specimen 
banks. The Committee recognizes that NCRR has supported 
programs to provide biomaterials to researches and recommends 
that NCRR continue such efforts, including collaborative 
efforts with private sector entities. The Committee recommends 
that NCRR support a cystic fibrosis biospecimen repository, 
which would serve as an important resource to CF researchers 
and function as a model for other diseases.
    Extramural Construction.--The Committee has included bill 
language identifying $119,220,000 for extramural biomedical 
facility renovation and construction. This amount is the same 
as the fiscal year 2004 appropriation. The fiscal year 2005 
budget proposed to eliminate funding for the program. These 
funds are to be awarded competitively, consistent with the 
requirements of section 481A of the Public Health Service Act, 
which allocates 25 percent of the total funding to institutions 
of emerging excellence.
    Extramural Facilities Construction at Minority 
Institutions.--The Committee encourages NCRR to give priority 
consideration to supporting extramural facilities construction 
projects at historically minority institutions which have 
developed a comprehensive plan to address the disproportionate 
impact of cancer in minority communities.
    General Clinical Research Centers.--The 79 NCRR-funded 
General Clinical Research Centers across the country are 
critical to NIH efforts to translate basic science discoveries 
into vaccines, treatments, and cures for disease. Approximately 
10,000 researchers use GCRCs each year for patient-oriented 
research focused on a wide variety of diseases. A recent 
publication by the members of the Institute of Medicine 
Clinical Research Roundtable described the GCRCs as ``an 
extraordinarily important model for how clinical research can 
be done'' within academic health centers and recommended an 
expansion of the program. To enhance the capacity of these 
Centers to support patient-oriented research, the Committee has 
provided $300,000,000 for GCRC Grants (M01), an increase of 
$14,800,000 over fiscal year 2004. To clarify its intentions, 
the Committee emphasizes that this funding should be allocated 
directly to NCRR-funded GCRCs through or as a supplement to the 
M01 mechanism to support clinical research infrastructure such 
as inpatient and outpatient beds, laboratory services, research 
nutrition services, and statistical support for publicly and 
privately funded clinical investigators. The Committee asks to 
be informed in advance of any new initiatives within the GCRC 
program that entail expenditure or reallocation of funds.
    The Committee encourages the NCRR to upgrade GCRC 
facilities with the sophisticated technologies needed to apply 
the mapping of the human genome to the study of human disease 
and respond to the threat of bioterrorism; expand staffing as 
recently mandated by NCRR to assure patient safety; and support 
local GCRC pilot projects as approved by the NCRR Advisory 
Council.
    IDeA Grants.--The Committee has provided $224,000,000 for 
the Institutional Development Award [IDeA] Program authorized 
by section 402(g) of the Public Health Service Act. This is a 
$10,000,000 increase over fiscal year 2004 and the same as the 
fiscal year 2005 budget request. Within the total provided, 
$81,000,000 is for Idea Networks of Biomedical Research 
Excellence [INBRE] and $136,000,000 is for the Centers of 
Biomedical Research Excellence [COBRE] initiative.
    Positron Emission Tomography.--The Committee continues to 
urge 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.
    Plant-Based Medicinal Products.--The Committee continues 
its interest in accelerating the development and 
commercialization of plant-based medicinal products.
    Prader-Willi Syndrome.--The Committee recognizes the 
commitment to establish a Rare Diseases Clinical Research 
Center as part of the Rare Diseases Clinical Research Network 
for the study of Prader-Willi Syndrome and other rare 
disorders. The Committee recommends that the RDCRC program be 
expanded to increase the level of research being conducted.
    Research Resource Centers.--The Committee continues to urge 
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.

   NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE [NCCAM]

Appropriations, 2004....................................    $116,978,000
Budget estimate, 2005...................................     121,116,000
Committee recommendation................................     121,900,000

    The Committee has included $121,900,000 for the National 
Center for Complementary and Alternative Medicine. The budget 
request was $121,116,000 and the fiscal year 2004 appropriation 
was $116,978,000. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    The Committee strongly supports the work of the National 
Center for Complementary and Alternative Medicine. The Center 
is charged with assuring that complementary and alternative 
therapies be rigorously reviewed to provide consumers reliable 
information.
    The Committee expects that funding for existing and new 
centers supported by NCCAM will be maintained. The Committee 
further expects NCCAM to undertake field investigations and a 
program for the collection and evaluation of outcome data on 
promising alternative therapies. The Committee expects NCCAM to 
expand its support of CDC's field investigations program and of 
AHRQ's literature reviews and data-analysis efforts, and to 
develop and disseminate a comprehensive set of fact sheets on 
CAM therapies to inform the public and health professionals of 
the state of scientific knowledge about these therapies.
    The Committee once again calls upon NCCAM to increase the 
number of research grants and centers awarded to CAM 
institutions. The Committee believes that in order to assure an 
adequate CAM research infrastructure and to encourage quality 
research at these institutions, greater support and resources 
from NCCAM to these institutions are needed.
    Ameliorating Liver Disease.--The Committee notes that NIDDK 
has completed efforts to synthesize and calibrate the 
production of milk thistle, which will now make possible 
clinical trials to demonstrate its value in slowing the 
progression of nonalcoholic steatohepatitis and to reduce the 
side effects of hepatitis C interferon treatments. The 
Committee urges NCCAM to pursue research to demonstrate the 
value of milk thistle to ameliorate liver disease.
    Bone Health and Nutrition.--The Committee urges NCCAM to 
conduct research on women in their 30s and 40s with respect to 
bone health and nutrition, including the use of supplements and 
nutraceuticals, in an effort to determine whether such 
strategies can prevent osteoporosis and fractures later in 
life. In addition the Committee urges support for research on 
the effect of complementary and alternative medicine on bones 
and pain management in people with metabolic bone diseases.
    Native Hawaiian Healing.--The Committee encourages the 
preservation and documentation of Native Hawaiian traditional 
cultural healing practices.
    Parkinson's Disease.--The Committee encourages NCCAM to 
continue exploration of the neuroprotective qualities of B 
vitamins and antioxidant phytochemicals in berries via animal 
models. Research with animals has shown that diets containing 
berry fruits, such as blueberries, in addition to B vitamins 
may forestall and could reverse many of the neurological 
changes associated with age-related neurodegenerative 
conditions, such as Parkinson's and Alzheimer's disease.

       NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2004....................................    $191,471,000
Budget estimate, 2005...................................     196,780,000
Committee recommendation................................     197,900,000

    The Committee has included $197,900,000 for the National 
Center on Minority Health and Health Disparities. The budget 
request was $196,780,000 and the fiscal year 2004 appropriation 
was $191,471,000. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--The NCMHD advises the NIH Director and Institute 
and Center [IC] directors on the development of NIH-wide policy 
issues related to minority health disparities research, 
research on other health disparities, and related research 
training. Among other activities, the NCMHD develops, in 
consultation with the NIH Director, IC directors, and the 
advisory council, a comprehensive strategic plan that 
identifies and establishes objectives, priorities, budgets, and 
policy statements governing the conduct and support of all NIH 
minority health disparities research, research on other health 
disparities, and related research training activities. It also 
administers funds for the support of minority health 
disparities research and other health disparities research, by 
awarding grants and leveraging the programs of the ICs.
    Behavioral and Social Sciences Research.--The Committee is 
pleased with NCMHD's efforts to reach out to and coordinate 
with the Office of Behavioral and Social Sciences Research. 
Cooperative efforts to spur research on socioeconomic status 
and health, experience of racism, and effective health 
communications are encouraged.
    Community-Based Organization Partnership Prevention 
Centers.--The Committee recommends expansion of community-based 
partnerships to further respond to the Department's prevention 
initiatives. Efforts should be concentrated on the development 
of Community Prevention Partnership Centers whereby CBOs 
partner with targeted institutions of higher education. These 
institutions of higher education are HBCUs, HSIs, and API 
Serving Institutions. In American Indian, Alaska Native and 
Native Hawaiian communities, Tribal Colleges, Universities and 
health centers would serve as community prevention centers. All 
centers would provide cultural competent health promotion and 
disease prevention services and activities to promote healthy 
lifestyles and reduce risks for health problems ranging from 
diabetes, to cardiovascular disease, to substance abuse.
    Community Programs to Improve Minority Health Grants.--The 
Committee recommends funding additional minority community-
based grant projects that integrate community-based screening 
and outreach services, and include linkages for access and 
treatment to minorities in high risk or low-income communities, 
and address socio-cultural and linguistic barriers to health. 
The Committee notes that a number of meritorious grant 
applications in this important area are going unfunded.
    Cultural and Linguistic Best Practices Studies.--The 
Committee urges studies of best practices and effective 
approaches implemented by health care providers in addressing 
cultural and linguistic barriers that impact on diagnosis and 
treatment regimens, patient health outcomes, patient 
comprehension and compliance with care and treatment regimens, 
and patient safety and medical errors reduction.
    Hepatitis C.--The Committee notes that hepatitis C is twice 
as common in African Americans as it is in European Americans 
and standard hepatitis C treatments do not respond as well in 
African American populations. The Committee therefore urges the 
Center to initiate and participate with NIDDK in research 
focused on the Hepatitis C disparities that exist among 
minority populations.
    Liver Disease.--The Committee remains concerned about the 
disproportionate burden of liver disease among African 
Americans, Hispanics, Asians and Native Americans. Among 
younger Native Americans liver disease is the second major 
cause of death, and the sixth leading cause of death among all 
Native American age groups. Furthermore, among most Asian 
populations hepatitis B is a major cause of death. The 
Committee strongly encourages NCMHD, in collaboration with 
NIDDK, to expand research to improve liver disease treatment 
effectiveness among minority populations.
    Racial and Ethnic Disparities.--The Committee believes that 
implementation of recommendations stemming from the Institute 
of Medicine [IOM] ``Unequal Treatment: Confronting Racial and 
Ethnic Disparities in Health Care'', study offer significant 
opportunities for improving health across communities of color. 
NCMHD is urged to support minority organizations and minority 
community-based efforts to disseminate research based health 
information that highlights health disparities experienced by 
different racial and ethnic groups. NCMHD is expected to engage 
minority national organizations including minority community-
based organizations in educating diverse communities about 
recommendations of the Institute of Medicine report in an 
effort to improve health.
    Scleroderma.--The Committee encourages the Center to 
support research that furthers the understanding of causes and 
consequences of scleroderma, a chronic, degenerative disease of 
collagen production, prevalent among African Americans, 
Hispanic and Native American men and women as well as other 
populations. The Center is encouraged to establish 
epidemiological studies to address the prevalence of 
scleroderma among these populations, as statistics indicate 
that African Americans have a slightly higher incidence of 
scleroderma. This population is also likely to be diagnosed at 
a younger age and tend to be diagnosed more often with the 
diffuse form of scleroderma.

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

Appropriations, 2004....................................     $65,382,000
Budget estimate, 2005...................................      67,182,000
Committee recommendation................................      67,600,000

    The Committee recommends an appropriation of $67,600,000 
for the Fogarty International Center [FIC]. The budget request 
was $67,182,000 and the fiscal year 2004 appropriation was 
$65,382,000. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--Adapting research advances in biomedicine to 
populations at home and abroad requires a continuing commitment 
to basic science as well as rigorous clinical and applied 
(epidemiological) studies. Examples are vaccines, anti-
infective agents, drugs, and more efficient diagnostic tools, 
combinations of interventions, and health policies to reduce 
the risk of disease and its associated human, social, and 
economic consequences. These challenges will benefit from a 
more coordinated and multi-disciplinary approach to global 
health needs. It is the mission of the FIC to address these 
challenges by forging collaborations with a range of domestic 
and global partners in international research and training to 
pursue three core objectives: first, to accelerate the pace of 
discovery and its application by special projects enabling 
scientists worldwide to share conceptual insights, analytic 
methods, data sets, patient cohorts, or special environments; 
second, to engage and assist young as well as more established 
U.S. investigators to address scientific challenges related to 
global health; and third, to help develop a cadre of highly 
capable young foreign investigators positioned to cooperate 
with U.S. scientists in areas of the world that, due to 
geography, genetics, or disease burdens, provide unique 
opportunities to understand disease pathogenesis, anticipate 
disease trends, or develop interventions of relevance and 
priority for both the United States and the collaborating 
country.
    Chronic Obstructive Pulmonary Disease.--The Committee notes 
that Chronic Obstructive Pulmonary Disease [COPD] is the fourth 
leading cause of death worldwide, and encourages the Fogarty 
International Center to expand its COPD research and training 
activities.
    Tuberculosis Training.--The Committee is pleased with the 
Fogarty International Center's efforts to supplement grants in 
AIDS International Training and Research Program [AITRP] or 
International Training and Research Program in Emerging 
Infectious Diseases [ERID], which trains tuberculosis experts 
in the developing world. Given the magnitude of global 
tuberculosis, the Committee encourages FIC to develop a 
specific free-standing TB training program.

                      National Library of Medicine

Appropriations, 2004....................................    $317,245,000
Budget estimate, 2005...................................     325,147,000
Committee recommendation................................     325,100,000

    The Committee recommends an appropriation of $325,100,000 
for the National Library of Medicine [NLM]. The budget 
requested $325,147,000 and the fiscal year 2004 appropriation 
was $317,245,000. These amounts include $8,200,000 made 
available from program evaluation funds. The recommendation 
includes $4,000,000 for improvement of information systems. 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 5,000,000 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.
    Computational Science.--The Committee recognizes that 
advances in computer science and technology, and applications 
of those advances to biomedical research, underpin many of the 
remarkable advances in the life sciences that have been 
achieved during the last couple of decades. Biomedical research 
now involves not only experiment, but also extensive 
computation. Increasingly, shortcomings in the specific 
biomedical computing environment limit the rate of progress in 
biomedical research. Accordingly, the Committee believes that a 
major effort must be undertaken to improve the ability of 
computation to serve biomedical research. The Committee urges 
that NIH develop a plan for the near, intermediate, and long 
term, to improve the biomedical computing environment to the 
point that inefficiencies in the use of computer power and 
information technology no longer limit the rate of progress in 
biomedical research. The Committee recognizes that expertise 
relevant to the development and implementation of such a plan 
resides in other agencies as well as the NIH, such as the 
National Science Foundation, the Department of Energy, DARPA, 
and others, and thus encourages the NIH work with all such 
agencies in the development and implementation of such a plan.
    Home Medical Consultations.--The Committee continues to 
support an expansion of a model project on the use of state-of-
the-art telemedicine technology for home medical consultations. 
This innovative approach holds great promise for improving the 
care and lowering health care costs for home-bound individuals 
who require frequent monitoring.
    Native Hawaiian Healing.--The Committee encourages the 
preservation and documentation of Native Hawaiian traditional 
cultural healing practices.
    NLM Research Facility.--The Committee was pleased to learn 
that the design for the new research facility at the NLM has 
been completed and urges the NIH to assign a high priority to 
this construction project. The National Center for 
Biotechnology Information is the leveraging resource for much 
of the science that NIH supports. The information-handling 
capabilities of the Center are being jeopardized by a lack of 
adequate facilities, and for the good of biomedical research 
this expansion of NLM is needed as soon as possible.
    Senior Citizen Outreach.--The Committee is very pleased 
with the excellent work by NLM to expand access to NLM's 
databases by senior citizens, and it urges the Library to 
continue this worthwhile effort.

                         OFFICE OF THE DIRECTOR

Appropriations, 2004....................................    $327,504,000
Budget estimate, 2005...................................     359,645,000
Committee recommendation................................     364,100,000

    The Committee recommends an appropriation of $364,100,000 
for the Office of the Director [OD]. The budget request was 
$359,645,000 and amount appropriated in fiscal year 2004 was 
$327,504,000. 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.
    Amnion-derived Stem Cell [ASC].--The Committee understands 
that ASC technologies offers the potential to develop and 
produce an adequate supply of cells for therapeutic cellular 
transplantation based upon isolation from placental tissue. The 
Committee supports all avenues of stem cell research and 
strongly urges the NIH to explore research in this area and 
steps necessary for the clinical application of this 
technology.
    Autism Spectrum Disorders.--The Committee is encouraged by 
the NIH's autism research matrix and urges NIH to devote 
sufficient resources to this research agenda. The Committee 
urges the NIH when implementing the autism research matrix to 
coordinate with autism organizations already funding research 
initiatives to ensure the most efficient use of it resources. 
The Committee also notes the promise of particular areas cited 
in the matrix, including genetic and behavioral 
characterizations of the disorder and screening and early 
diagnosis.
    Autoimmune Diseases.--The Autoimmune Disease Coordinating 
Committee, with representation from each NIH Institute, Centers 
for Disease Control and Prevention, Food and Drug 
Administration, Veterans Administration, and patient advocacy 
organizations, has been effective in fostering collaborative, 
integrated multi-Institute research on issues affecting the 
entire genetically related family of autoimmune diseases, as 
recommended in the Autoimmune Diseases Research Plan. This 
collaboration has been a significant factor in achieving recent 
advances in the understanding, diagnosis and treatment of 
autoimmune diseases. Congress supports the committee's 
continued efforts in implementing the Autoimmune Diseases 
Research Plan.
    Basic Behavioral Research.--The Committee notes with 
interest that NIH has undertaken a review of basic behavioral 
and social sciences research funded by the National Institutes 
of Health. The working group, composed of outside scientists 
and chaired by a member of the Advisory Council to the NIH 
Director, is charged in part with reviewing NIH's portfolio and 
identifying areas of opportunity in basic behavioral and social 
sciences, consistent with NIH's mission, that NIH should 
consider supporting. Basic research in these sciences is 
fundamental to an understanding of the mechanisms of sensation 
and perception, development, learning and memory, and group 
dynamics and behavior, among other areas. The Committee 
reiterates its support for NIH's history of investment in basic 
behavioral and social sciences research and looks forward to 
reviewing the report of the working group.
    Center for Scientific Review [CSR].--The Committee 
recognizes that the reorganization of CSR offers the 
opportunity to enhance the quality of peer review for grant 
applications in the areas of cardiovascular, congenital and 
thoracic surgery. The Committee is encouraged by CSR's decision 
to restructure the peer review of these applications and to 
ensure that cardio-thoracic surgeons are full participants in 
the peer review process. The Committee will monitor this 
activity to ensure that proper support is given to the 
development of new surgical knowledge. This is especially 
important as biomedical research evolves into a more integrated 
model that cuts across existing boundaries to incorporate the 
expertise of different scientific disciplines including 
surgery.
    Childhood Obesity, Trans-NIH Obesity Research Initiative.--
The committee encourages the NIH to further expand the Trans-
NIH obesity research initiative to include a multi-center study 
of the metabolic, psychological, and genetic precursors of 
obesity in children.
    Chronic Fatigue Syndrome [CFS].--The Committee is 
disappointed that NIH funding for CFS has basically remained 
flat in recent years, despite repeated congressional requests 
for increases. In addition, several grants represented to be 
for CFS research have limited direct relevance to CFS. The 
Committee notes that the Office of Research on Women's Health, 
through the Trans-NIH Working Group for Research on Chronic 
Fatigue Syndrome, is working on a request for applications 
[RFA] based on the findings of a June 2003 scientific workshop 
on CFS. The Committee strongly urges the NIH to fund this RFA 
as soon as possible. The Committee also urges the NIH to expand 
the involvement of intramural researchers in the study of CFS.
    Clinical Investigators.--The Committee commends the Office 
of the Director for rapidly launching programs with loan 
repayment and for training clinical investigators and 
encourages NIH to maintain and expand these programs. These 
programs will be crucial for establishing the clinically 
trained work force that will translate the promising basic 
discoveries supported by NIH into clinical application to cure 
and prevent disease in American citizens.
    Clinical Practice Networks.--The Director of NIH is 
commended for his Roadmap efforts to re-engineer clinical 
research as currently supported by NIH. The Committee 
recognizes that it is essential that study results be rapidly 
disseminated into clinical practice. Therefore, the Director is 
encouraged to work directly with the medical community--
including the surgical community--in order to utilize existing 
networks as a way to accelerate the transfer of information for 
the treatment of patients. The Committee requests a report on 
this effort prior to next year's Appropriations hearing.
    Clinical Research.--The opportunities for substantial 
dividends on the Nation's investment in medical research have 
never been greater. The Human Genome Project is providing 
remarkable insights into diseases and disorders that have 
plagued society for centuries. Those insights, together with 
the infusion of resources during the 5-year doubling of NIH, 
are opening new pathways to discovery. Commensurately, public 
expectations are growing with the hope that past investments 
will hasten the translation of new scientific knowledge into 
better health and more effective treatment and prevention 
strategies. But clinical research, the staging ground that 
deploys the results of research to hospitals and health care 
providers, is increasingly emerging as a bottleneck in the 
scientific continuum. At a time when a cohesive and coherent 
national effort is vital, the academic health centers on whose 
shoulders this work rests face unfunded regulatory mandates, 
fragmented clinical research infrastructure, incompatible data 
bases, and a severe and growing shortage of qualified clinical 
investigators and willing participants. While the NIH Roadmap 
initiative is intended to address some of these obstacles, more 
must be done to help academic health centers defray the costs 
associated with unfunded mandates; support infrastructure 
grants to modernize information technology systems and 
databases; and help modernize clinical research facilities. The 
Committee requests a report on these and other steps taken to 
improve the clinical research enterprise prior to the fiscal 
year 2006 hearings.
    Clinical Research Loan Repayment Program.--The Committee is 
pleased that NIH has moved forward with the Clinical Research 
Loan Repayment Program. As the program completes its third 
year, the Committee would like to assess outcomes to date as 
well as areas for potential improvement. It is the Committee's 
understanding that the requirement that applicants have an 
institutional guarantee of 2 years of research support has 
proven an insurmountable hurdle for many potential applicants, 
particularly those at the end of a training grant or career 
award who have not yet obtained outside support for the next 
stage of their careers. The Committee requests a report within 
60 days after passage of this bill evaluating alternative 
strategies for assuring that recipients of loan repayment 
actually pursue careers in clinical research. Second, the 
Committee requests a report profiling award recipients 
including their training experience; degrees held; medical/
scientific disciplines; academic positions; and the funding 
support by which they were eligible to apply.
    Cystic Fibrosis.--The NIH Roadmap identifies the re-
engineering of the clinical research system as a top priority. 
One of the strategies that the Roadmap recommends to enhance 
clinical research is establishing clinical trials networks that 
share informatics and other technologies. These networks also 
should include a significant number of institutions, in order 
to facilitate efficient recruitment and rapid enrollment of 
trial participants. The Committee believes that there are 
important opportunities for collaboration between NIH and this 
existing clinical trials network and encourages NIH to pursue 
this potential collaboration.
    Digestive Disease Commission.--The Committee calls on the 
Director, in collaboration with the Secretary, to establish a 
national commission on digestive diseases composed of 
distinguished scientists and physicians who are experts in 
digestive diseases, digestive disease patient advocates and 
representatives of Federal departments, agencies or institutes 
providing support for research related to digestive diseases in 
order to (1) study the incidence, duration, and mortality rates 
of digestive diseases, as well as their social and economic 
impacts; (2) evaluate public and private facilities and 
resources, including trained personnel and research activities, 
for the diagnosis, prevention, and treatment of such diseases; 
(3) identify related disease management programs, including 
biological, behavioral, nutritional, environmental, and social 
programs; and (4) develop a long-range plan for the use and 
organization of national resources to effectively deal with 
digestive diseases.
    Duchenne Muscular Dystrophy.--The Committee strongly 
encourages the funding of three additional Centers of 
Excellence and to double the funding for existing centers of 
excellence by the end of fiscal year 2005. In addition, the 
Committee notes that the NIH Interagency Coordinating Committee 
for muscular dystrophy has missed its 1-year deadline to submit 
a plan for conducting and supporting research and education on 
muscular dystrophy through NIH in accordance with the MD CARE 
Act of 2001. The Committee strongly urges the Coordinating 
Committee to finalize and submit this plan, as well as include 
representation from the Department of Defense on the panel, as 
soon as possible.
    In addition, the Committee strongly urges the NIH's to 
devote additional resources to DMD translational research and 
clinical trials. This funding is to be separate from the 
Centers of Excellence program. Based on the severity of this 
disorder, its high incidence in children, and the prospect of 
important new treatments, the Committee strongly urges OD, 
through NIAMS and NINDS, to follow the accelerated model for 
funding DMD translational research that was used for motor 
neuron diseases, including ALS and SMA. The Committee strongly 
endorses that plan and urges the OD to equip the program and 
the personnel charged with executing the plan with appropriate 
authoritative and financial resources to maximize the chances 
of success.
    Finally, the Committee encourages the OD to further develop 
opportunities for upcoming clinical trials and to help make 
available all existing and emerging patient care options. The 
Institutes are encouraged to work with other Federal agencies 
to develop formal programs that increase public and 
professional awareness of the disease.
    Epilepsy.--The Committee recognizes that while the NINDS is 
the primary Institute for addressing epilepsy, several other 
Institutes are also involved in related research. They include 
the NICHD, the NHGRI, the NIMH, and the NIA. The Committee 
requests the Director to provide a report by April 1, 2005, on 
the progress made in the coordination of research efforts in 
epilepsy among these Institutes, and on the progress made in 
implementing the NINDS research benchmarks resulting from the 
March 2000 conference ``Curing Epilepsy: Focus on the Future.''
    Fragile X.--The Committee notes that in fiscal year 2003, 
75 grants were provided by 11 separate NIH Institutes, units, 
and its National Center for Research Resources to find a 
treatment and cure for Fragile X. In addition, privately-funded 
Fragile X research is rapidly expanding, often in partnership 
with NIH grants. The Committee commends the growing breadth and 
diversity of this research but strongly urges the Director to 
establish a coordinating mechanism to direct and coordinate 
these efforts in regularly-scheduled meetings. The Committee 
requests that the Director report to the Congress on the 
progress during the fiscal year 2006 appropriations hearings.
    Fragile X Pediatric Training.--The committee encourages the 
Director to increase the number and size of institutional 
training grants to institutions supporting pediatric training 
and the number of grants for career development clinical 
research.
    Gender-Based Biology.--The Institute of Medicine [IOM] has 
released a study that clearly demonstrates that all biological 
research--from bench to bedside--must be cognizant of the 
differences that result from the sex of the patient, tissue or 
cell. One of the areas where such differences are most 
pronounced is in the field of neuroscience. For this reason, 
the Committee believes it is entirely appropriate that the 
Director assure that the ten institutes involved in the trans-
institute initiative on brain research include gender-based 
biology as an integral part of the research conducted and that 
research results are analyzed and reported in this manner, when 
appropriate. The Committee would like a report from the 
Director on the progress of this effort prior to next year's 
hearings.
    General Clinical Research Centers.--The Committee has 
supported expansion of the General Clinical Research Centers 
program within the National Center for Research Resources. 
Wherever possible, the Committee encourages the Director to 
utilize the GCRCs as the foundation of NIH Roadmap activities 
related to clinical research. Rather than establishing programs 
in isolation, the Committee believes that it will be both 
synergistic and cost-effective for NIH Roadmap clinical 
research programs to be sited in the GCRCs as practicable.
    Genomics.--The Committee recognizes that while the NHGRI is 
the primary Institute for addressing the human genome sequence, 
other Institutes should also identify the role genomics and 
genetics play in the progression of specific diseases. For 
example, the Committee urges the Director to encourage the 
various Institutes, including the NIA, NIMH, and NINDS, to take 
advantage of advances in microarray technology. Utilization of 
this technology could lead to improved prevention and 
therapeutic intervention strategies for Alzheimer's and 
Parkinson's diseases, as well as autism, obsessive compulsive 
and bi-polar disorder.
    Graduate Training in Clinical Investigation Awards.--In an 
effort to reverse the shortage of well-trained clinical 
investigators, Congress authorized the Clinical Research 
Curriculum Awards and the Graduate Training in Clinical 
Investigation Awards. The Curriculum Awards were intended to 
support institutional training programs in clinical research, 
with the second award intended to provide tuition and stipend 
support for enrolling students. For 3 consecutive years, this 
Committee has expressed concern that NIH has not moved forward 
with implementation of the Graduate Training in Clinical 
Investigation Awards. The Committee believes that NIH is 
compromising the effectiveness of the training programs that 
have been established through the Curriculum Awards by failing 
to fund the complementary student stipend/tuition awards. The 
report of the General Accounting Office on NIH implementation 
of the clinical research legislation substantiated the 
Committee's concerns. The Committee urges the Director to 
consider including these awards in the NIH Roadmap activities 
related to enhancing the clinical research workforce and 
provide sufficient funds to support 200 students in fiscal year 
2005.
    Heart Disease, Stroke and Other Cardiovascular Diseases.--
The Committee recognizes that the problems associated with 
heart disease, stroke and other cardiovascular diseases involve 
many institutes and centers, including NHLBI, NINDS, NIA, 
NIDCR, and NCRR. The Committee strongly urges the Director to 
expand its research portfolio and increase its resources and 
better coordinate cross-cutting research on these diseases in 
all institutes, centers and divisions, as appropriate, and 
through all available mechanisms. The Committee requests the 
Director to be prepared to report on initiatives on these 
diseases begun in fiscal year 2004 or scheduled to begin in 
fiscal year 2005 at the fiscal year 2006 appropriations 
hearings.
    Hepatitis B.--The Committee is aware that although there 
has been tremendous success in the prevention and treatment of 
hepatitis B, this disease remains a serious concern. The large 
number of immigrants to the United States from countries where 
hepatitis B is endemic will keep the disease in the forefront 
of public health for years to come. The Director of NIH is 
urged to make hepatitis B a priority and to stimulate research 
to find complements for the current therapies; improvements in 
prevention, detection and treatment; and develop new vaccines 
and outreach programs.
    High-Risk Research.--As the NIH enters into a period of 
limited funding resources, the peer review system will 
naturally tend to reward conservative research proposals rather 
than bolder ideas that have a higher risk of succeeding. The 
Committee strongly urges the NIH to beware of this tendency, in 
terms of both the research grants that it awards and the types 
of researchers who receive them. Relying solely on tried-and-
true approaches to medical research, conducted solely by 
veteran, established researchers, will not result in quantum 
leaps in discovery. Despite the current decline in the growth 
rate of NIH's budget, the NIH must continue to fund high-risk 
research and young investigators who have innovative ideas.
    Hepatitis C Consensus Conference Implementation.--The 
Committee notes that the Hepatitis C Consensus Development 
Conference recommended the creation of a Hepatitis Clinical 
Research Network [HCRN] and commends NIDDK and NIAID for 
expanding Hepatitis C related clinical research studies. The 
Committee requests a report by April 2005 to incorporate the 
advice of NIH and biomedical community leaders to assess the 
adequacy of this arrangement along with alternative approaches 
to assure a complete response to the original recommendations 
of the Hepatitis C Consensus Conference regarding the creation 
of the Network.
    Human Tissue Supply.--The Committee remains interested in 
matching the increased needs of NIH grantees, intramural, and 
university-based researchers who rely upon human tissues and 
organs to study human diseases and search for cures, including 
for those researchers dedicated to the study and cure of rare 
diseases. The Committee is aware that one of the leaders in 
this competitive field, the National Disease Research 
Interchange [NDRI], is uniquely positioned to obtain this 
valuable and effective alternative research resource. More than 
500 peer-reviewed research advances made by NDRI-dependent 
researchers have been published during the past 4 years 
contributing to the research community's fund of knowledge. The 
Committee is encouraged by NDRI's role in these research 
advances and applauds the Director's expanded support for NDRI 
by bringing NEI, NIDDK, NIAID, NIAMS, and the Office of Rare 
Diseases into the multi-institute initiative. While this is 
promising, more needs to be done to match the demand for the 
use of human tissue in research. The Committee, therefore, 
strongly urges the Director to increase the core support NDRI 
receives from NCRR, and the Institute Directors to identify and 
implement program-specific initiatives intended to expand 
support for NDRI.
    Interdisciplinary Research and Training.--The committee 
notes OBSSR's efforts to develop new mechanisms for training 
scientists in more than one academic discipline to create a 
scientific workforce better prepared to research multi-faceted 
problems. OBSSR is directed to report back to the committee on 
interdisciplinary research issues such as cross-disciplinary 
support for the new mechanisms, numbers of applicants, and any 
barriers encountered in implementing the new program.
    Irritable Bowel Syndrome.--The Committee is pleased with 
the increased focus on irritable bowel syndrome [IBS] at the 
NIH's Office of Research on Women's Health. It is estimated 
that over 60,000,000 Americans, disproportionately women, 
suffer from IBS.
    Juvenile Arthritis.--The Committee urges the Director, in 
collaboration with NIAMS, NICHD and NIAID, to strengthen its 
investment in, and commit additional resources to, basic, 
clinical, and translational research efforts and related 
activities specific to juvenile arthritis as authorized by the 
Children's Health Act. The Committee requests the NIH to 
provide Congress with a report on efforts underway and progress 
made in achieving this goal by April 2005.
    Liver Disease and the Veterans Health Administration.--The 
Committee believes that closer collaboration with the Veterans 
Health Administration will significantly facilitate, 
accelerate, and leverage research to develop more effective 
treatments and cures for liver disease. The Committee notes 
that the Veterans Health Administration [VHA] has developed a 
significant database of veterans with hepatitis C that includes 
demographic, diagnostic, laboratory, drug treatment and co-
morbidity population statistics that could be used to support a 
large number of NIH funded research efforts. The Committee is 
pleased that NIDDK, as the lead NIH Institute, has begun 
efforts to develop a cooperative agreement with the Veterans 
Health Administration as a vehicle for cost-sharing 
collaborative efforts to facilitate liver disease research on a 
trans-NIH basis. The Committee requests the Institute be 
prepared to report at the fiscal year 2006 Appropriation the 
progress and status of cooperative research efforts with the 
VHA to address hepatitis C.
    Lymphatic System Research.--Despite the central role of the 
lymphatic system in human health and disease, this focus of 
research and medical care has, until recently, been relatively 
neglected. The lack of research has created barriers to 
effective delivery of health care and limited the interest of 
biomedical investigators to pursue prospective studies in this 
area. Therefore, the Committee urges the Trans-NIH Coordinating 
Committee for the Lymphatic System to work with its member ICs 
to implement a comprehensive lymphatic research awareness 
campaign that is designed to target academia, governmental 
agencies, industry, scientific and medical professional 
organizations, and the public at large.
    The Committee also urges the OD to consider targeted 
initiatives regarding the lymphatic system, such as: (a) the 
development of suitable reagents, including monoclonal 
antibodies, to facilitate lymphatic investigation in vitro and 
in vivo; (b) the development of transgenic and knockout animal 
models; (c) the functional imaging of the lymphatic system; (d) 
academic career development; and (e) a national patient 
registry and tissue bank for lymphatic diseases. Finally, the 
Committee encourages the Coordinating Committee to work with 
the Center for Scientific Review and ICs to ensure that experts 
in the lymphatic system are adequately represented on peer 
review panels.
    Microbicides for the Prevention of HIV.--Microbicides, a 
class of products that would be applied topically to prevent 
HIV, represent a promising prevention strategy, with the 
potential to be especially significant in preventing HIV in 
women, who now account for more than half of the individuals 
newly infected with HIV globally. Once developed, microbicides 
and vaccines would serve as complementary HIV prevention 
technologies.
    NIH, principally through NIAID, spends the majority of 
Federal dollars in this area. The Committee remains concerned 
that microbicide research at NIH is currently conducted with no 
single line of administrative accountability or specific 
funding coordination. The Director of NIH, in consultation with 
OAR and in coordination with NIAID, NICHD, NIDA, NIMH, and 
ORWH, is urged to establish a microbicides branch or comparable 
dedicated unit specifically for microbicides research and 
development, with appropriate staff and funding.
    Minority Health and Racial Disparities.--The Nation has 
invested greatly in the NIH providing tremendous opportunities 
for accelerated improvements in health and quality of life. 
Research advances must be applied more expeditiously to ensure 
greater improvements in health outcomes across all communities 
of color and the general public. The Committee strongly urges 
the NIH to improve, strengthen and expand its systems of 
information dissemination and outreach to health care 
providers, minority organizations, and the public. Knowing that 
one-size does not fit all as it relates to the public, 
communities, and the Institutes and Centers, the Committee 
strongly urges the Director of NIH, and the director of each of 
the Institutes and Centers to report on their respective 
improved systems across these areas during next year's 
appropriations hearings.
    Nanosystems Biology.--The Committee encourages the 
director, along with NCI, to support a collaborative effort to 
bring nanotechnology, systems biology and molecular imaging 
together to examine the molecular basis of cancer, consistent 
with the Director's Roadmap Initiative.
    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. Accordingly, the 
Committee has provided additional funds to expand this office's 
efforts. In particular, the Committee expects the ODS to speed 
up ongoing collaborative efforts to develop, validate and 
disseminate analytical methods and reference materials for the 
most commonly used botanicals and other dietary supplements. 
The Committee also expects the ODS to contract with industry 
non-profit associations or foundations which currently have and 
maintain a database of dietary supplement labels to develop, 
create, continually update, maintain and make available to 
Government and research entities a database of all supplement 
labels sold in the United States. The creation of this database 
would allow ODS to have access for research purposes of all 
known supplements manufactured in the United States and to 
allow access by other Federal agencies for ensuring safety to 
consumers, through the mandatory listing of ingredients in 
these products on the label, who purchase supplements 
manufactured and/or sold in the United States.
    Office of Science Education.--The Committee is pleased with 
the work of the Office of Science Education and encourages all 
of the NIH Institutes to work with the Office to support 
supplemental curricular and training project for K-12 science 
education. The support from the NIH Institutes and centers 
greatly enhance the capacity of this Office to provide the 
critical investment in science literacy among young people 
throughout the Nation.
    Office of Research on Women's Health.--The Committee 
recognizes the critical role played by the Specialized Centers 
of Research on Sex and Gender Factors Affecting Women's Health 
and encourages the Office to continue programmatic initiatives 
to further this work. The Committee also supports the 
development of an intramural women's health program at NIH.
    Parkinson's Disease.--The Committee commends the Director 
for his strong support and facilitation of collaboration with 
patient advocacy groups, health non-profits, and international 
organizations.
    The Committee is also aware that the Parkinson's Disease 
Research Agenda [PDRA] developed by NIH in 2000 included 
professional judgments funding projections that totaled an 
additional $1,000,000,000 over 5 years to achieve a cure. The 
Committee strongly urges NIH to come as close as possible to 
fulfilling that Agenda while maintaining the standards of peer 
review. Furthermore, the Committee is also aware that the 
Director has prepared his own ``matrix'' for Parkinson's which, 
while laudable, falls short of the ambitious goal of the 
Parkinson's Disease Research Agenda to find a cure for 
Parkinson's by developing a roadmap and projections of the 
resources needed to achieve that goal.
    The Committee strongly urges the NIH to devote additional 
resources to Parkinson's research, as recommended by the 
Parkinson's disease Research Agenda, using all available 
mechanisms, including RFAs.
    The Committee expects the NIH to report to Congress by 
April 2005, not only on the steps it is taking to fulfill the 
Parkinson's disease Research Agenda, but also its progress 
towards finding a cure for this devastating disease. 
Additionally, as 5 years have elapsed since the last NIH 
conference on Parkinson's disease, the Committee strongly urges 
the Director to hold another conference, similar to the one 
held in November 1999, to examine the path to a cure, working 
with patient advocacy, scientific, and non-profit communities. 
The results of the conference should produce a strategic plan 
setting forth the research funding and programs required to 
secure the earliest possible development of effective 
therapies, prevention, and a cure for Parkinson's disease.
    Pediatric Research Initiative.--The Committee urges the 
Office of the Director to expand the Pediatric Research 
Initiative, as authorized by the Children's Health Act of 2000. 
The Committee strongly supports the growth of support for 
pediatric research across Institutes and encourages activities 
which stimulate new and promising areas of pediatric research. 
Additionally, the Committee urges NIH to collaborate with the 
CDC and HRSA in research areas related to heritable and genetic 
disorders affecting children.
    Population-Based Prevention Research.--The Committee 
commends NIH for its efforts to support research in humans that 
examines factors associated with preventing disease and 
promoting health. The Committee urges the NIH to seek ways to 
remove barriers that prevent research findings from being 
translated into population-wide health improvements and to 
expand its support for studies that include examination in 
human populations of biological, behavioral and environmental 
factors associated with disease and means to ameliorate them. 
As part of these efforts, the Committee requests the NIH to 
submit a report by April 1, 2005, that indicates total funding 
by institute, and where applicable by disease, for prevention 
research among human populations that reduces disease risk 
through social, behavioral and environmental change.
    Prader-Willi Syndrome.--The Committee commends the NIH for 
creation of an Obesity Research Task Force and for NIH's 
recognition of the need to prevent and treat obesity beginning 
in childhood. However, the committee strongly urges the Task 
Force to explicitly include, across the six proposed trans-NIH 
obesity initiatives, investigations into the genetic causes of 
obesity beginning with study of Prader-Willi Syndrome. 
Furthermore, the Committee urges the Director of NIH to conduct 
outreach to the Prader-Willi Syndrome community to participate 
in research at the proposed ``Obesity Clinical Research 
Center.'' The NIH should be prepared to report on the progress 
made by the Obesity Research Task Force, and the trans-NIH 
research efforts to appropriately incorporate both children and 
genetics into the overall obesity research agenda during the 
fiscal year 2006 appropriations hearings.
    Public Health Relevance of Research Awards.--The Committee 
is encouraged by steps the National Institutes of Health [NIH] 
is taking to improve communications regarding the public health 
relevance of its research awards. Specifically, the Committee 
is pleased NIH has proposed a modification to its standard 
grant application, PHS Form 398, requiring all grantees to 
include a statement of public health significance. The 
Committee urges the Department of Health and Human Services and 
the Office of Management and Budget to approve the proposed 
revision and support the agency in its efforts to implement 
this important change in the grant application form.
    Rare Liver Diseases.--The Committee is pleased that the 
Office of Rare Diseases has provided significant co-funding, 
along with NIDDK, for the Biliary Atresia Research Network. The 
Committee urges ORD to continue to address rare liver diseases 
including primary biliary cirrhosis, primary sclerosing 
cholangitis, and auto-immune hepatitis.
    Saliva Research.--The Committee has learned that saliva is 
gaining value as a diagnostic tool and potential monitor of 
disease progression in systemic disorders, including 
Alzheimer's disease, Sjogren's syndrome, cystic fibrosis, and 
diabetes; moreover, studies have uncovered the presence of a 
cancer-related protein whose concentration increases in the 
presence of breast cancer--thus, having the potential as a 
diagnostic marker for the early detection of breast cancer. The 
Director of NIH is urged, working with the NIDCR, to find ways 
to expand and accelerate research in this area and report back 
to the Committee prior to next year's hearing.
    Sepsis.--The Committee is aware that sepsis kills more than 
215,000 Americans each year. To improve health care provider 
education in correctly diagnosing sepsis, the Committee urges 
the Director to work with outside organizations to create and 
implement a program to train infectious disease physicians, 
emergency room doctors, critical care nurses, and oncologists, 
especially those serving in rural and underserved areas, in the 
use of new guidelines to identify sepsis to improve patient 
outcomes. The Committee further encourages the Director to work 
with the NIAID, NHLBI and NCI in these provider education 
efforts.
    Spina Bifida.--The Committee recognizes that Spina Bifida 
is the leading permanently disabling birth defect in the United 
States and has concerns that the NIH has not prioritized 
research into primary and secondary prevention of this 
condition. While Spina Bifida is highly preventable through 
proper nutrition, including appropriate folic acid consumption, 
too many pregnancies are still affected each year by this 
devastating birth defect. The Committee also acknowledges that 
prevention does not assist the more than 70,000 individuals 
living with Spina Bifida and therefore urges the NIH/NINDS/
NICHD to allocate adequate and additional resources to 
prioritize research into primary and secondary prevention for 
Spina Bifida.
    Spinal Muscular Atrophy.--The Committee strongly urges the 
OD to ensure the success of the SMA Project by providing active 
and ongoing support from the OD as well as from other related 
Institute Directors, most notably NICHD. The OD is urged to 
take all necessary steps to ensure that the NICHD is fully 
engaged by expanding their scope and level of resources 
dedicated to SMA.
    Stroke in Women.--As the second leading cause of death 
among women worldwide, stroke in women is a major health 
problem. Stroke kills more than twice as many women as do 
breast cancer and AIDS combined. Acute care of women stroke 
victims is often delayed, and 62 percent of all stroke-related 
deaths occur in women. Recognizing that women are the single 
largest group at risk for death from stroke, the Committee 
believes that special attention should be focused on better 
understanding the gender-related differences in stroke. Some 
aspects of the disease unique to women include strokes related 
to pregnancy and the use of oral contraceptives. Stroke is 
additionally a leading cause of serious disability among women 
and may contribute to late-life cognitive decline. The 
Committee supports the funding of new and continuing NIH 
studies that investigate the impact of postmenopausal hormone 
replacement therapy on stroke risk. Continued support of 
clinical and basic research on hormone physiology in women is 
necessary to understanding the impact of hormones on women's 
vascular systems. The Committee urges NIH to increase research 
in stroke among women of all ages, with specific attention to 
gender-related differences in stroke risk, and to stroke 
prevention interventions, acute stroke management, post-stroke 
recovery, long-term outcomes, and quality of care. The 
Committee further urges NIH to increase research into new 
therapies for stroke in women as well as into ways of enhancing 
the vascular health of all Americans.
    The Committee also encourages and supports NIH's 
initiatives toward advancing the organization of stroke care, 
including post-stroke rehabilitation, and the identification of 
stroke treatment and research centers that would provide rapid, 
early, continuous 24-hour treatment to stroke victims, 
including the use of the clot-buster t-PA, when appropriate. 
Designated areas in medical facilities equipped with the 
resources and personnel for treating stroke would also promote 
the early evaluation of innovative stroke treatments.
    Temporomandibular Joint [TMJ] Disorders.--The Committee 
commends the NIH for holding a scientific meeting in May 2004 
on the co-morbidities of TMJ. This meeting highlighted the 
complexity of TMJ diseases and disorders, the research 
opportunities available and the importance of inter-institute 
collaborations to further the understanding, treatment, and 
prevention of this condition. The Committee is disappointed, 
however, that the NIH Temporomandibular Disorders Interagency 
Working Group [TMJDIWG] has not yet developed a trans-NIH 
research agenda on TMJ disorders, as discussed in the fiscal 
year 2005 congressional budget justification. The Committee 
strongly urges the Director to ensure that this plan is 
completed as soon as possible. The plan should incorporate 
input from patients and should include listings of the specific 
research opportunities that have been identified by the 
TMJDIWG. It should also include summaries from each Institute 
in the working group regarding which research opportunities it 
plans to pursue, with approximate timeframes. The Committee 
requests a report on this plan by April 1, 2005. Finally, the 
Committee urges the NIH to develop informational materials on 
TMJ disorders for distribution to patients, the media, health 
care organizations, and the public.
    Tuberous Sclerosis Complex.--In its report accompanying the 
fiscal year 2004 appropriations, the Committee called upon the 
Office of the Director to formulate an NIH-wide research agenda 
on tuberous sclerosis complex, and to report back to the 
Committee on this effort. While a research agenda was 
developed, the Committee is disappointed by the failure to act 
upon it. The report to the Committee cited research studies 
were carried out several years ago or which only generally 
relate to TSC, and failed to establish a mechanism to 
coordinate research activities across several Institutes. The 
Committee strongly urges the OD to establish such coordinating 
mechanism as soon as possible, and to undertake TSC-specific 
research.
    Vascular Biology.--The Committee recognizes the importance 
of advancing research in the field of vascular biology, the 
study of blood and blood vessels and their interactions. Not 
only is the maintenance of the blood supply critical to the 
functioning of all organs of the body, understanding the 
mechanisms and treatment of diseases that interrupt the blood 
supply is relevant to all organ systems and their disorders. 
Research into vascular biology can provide the scientific basis 
for new therapies to prevent thrombosis; therapies that are 
important to the prevention and control of heart disease, 
stroke, recurrent fetal loss, and complications associated with 
sickle cell anemia and diabetes; and therapies related to the 
interruption of the blood supply to tumors and cancers. Because 
of the cross-cutting aspects of this research, the Committee 
urges the NIH Director to develop a comprehensive NIH-wide 
approach to identify and pursue research opportunities in this 
field.

                        OFFICE OF AIDS RESEARCH

    The Committee recommendation does not include a direct 
appropriation for the Office of AIDS Research [OAR]. 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 among Institutes and Centers throughout 
the year if needs change or unanticipated opportunities arise. 
The Committee requests that the Director 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.

                        BUILDINGS AND FACILITIES

Appropriations, 2004....................................     $88,972,000
Budget estimate, 2005...................................      99,500,000
Committee recommendation................................     114,500,000

    The Committee recommends an appropriation of $114,500,000 
for buildings and facilities [B&F;]. The budget requested 
$99,500,000 and the fiscal year 2004 appropriation was 
$88,972,000.
    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.
    The Committee has included full-scope bill language within 
this appropriation to give flexibility to the NIH to continue 
work on the John E. Porter Neuroscience Research Center for 
which $15,000,000 has been included. Funds have also been 
included for the Animal Research Center, the Rocky Mountain 
Laboratories Buffer Replacement Facility, asbestos abatement, 
fire protection and health and safety compliance, air quality 
improvement programs and to eliminate barriers to persons with 
disabilities.

       Substance Abuse and Mental Health Services Administration

Appropriations, 2004....................................  $3,350,958,000
Budget estimate, 2005...................................   3,550,242,000
Committee recommendation................................   3,484,729,000

    The Committee recommends $3,484,729,000 for the Substance 
Abuse and Mental Health Services Administration [SAMHSA] for 
fiscal year 2005. This amount is $133,771,000 above the 
comparable fiscal year 2004 level and $65,513,000 below the 
administration request. The recommendation includes 
$123,303,000 in transfers available under section 241 of the 
Public Health Service Act. SAMHSA is responsible for supporting 
mental health programs and 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 programs of regional 
and national significance under each of the three SAMHSA 
centers: mental health services, substance abuse treatment and 
substance abuse prevention. Separate funding is available for 
the children's mental health services program, projects for 
assistance in transition from homelessness, the protection and 
advocacy program, data collection activities undertaken by the 
Office of Applied Studies and the two block grant programs: the 
community mental health services block grant and the substance 
abuse prevention and treatment block grant.
    The Committee strongly supports SAMHSA's Federal leadership 
role to improve the quality and availability of empirically-
based prevention and treatment services in the areas of mental 
health and substance abuse. The Committee commends SAMHSA for 
its ongoing collaboration with the National Institutes of 
Health, specifically with the National Institute of Mental 
Health [NIMH], the National Institute on Drug Abuse [NIDA], and 
the National Institute on Alcohol Abuse and Alcoholism [NIAAA]. 
As one example of this partnership, the Committee notes that 
SAMHSA collaborated with NIDA on the recent NIH Request for 
Applications [RFA] designed to strengthen the capacity of State 
Alcohol and Drug Abuse Agencies to support and engage in 
research that will foster adoption of science-based policies 
and practices. The Committee urges that SAMHSA and NIH continue 
its collaboration to reduce the current 15 to 20-year lag 
between the discovery of an effective treatment or intervention 
and its availability at the community level. The Committee is 
particularly interested in recent brain imaging research being 
conducted and supported by NIH. The Committee believes this 
research will have a significant impact on the development of 
new science-based treatment and prevention strategies for those 
suffering from mental illness and substance abuse.
    The Committee requests that SAMHSA work with the Centers 
for Medicare and Medicaid Services to maximize reimbursement of 
a more complete continuum of treatment and prevention services, 
including recovery support services, through the Medicaid 
program. Medicaid is an important but under-utilized funding 
stream for drug and alcohol treatment and prevention services 
that complements the funding provided through SAMHSA programs, 
especially when evidence shows that when treatment is provided 
other health care costs can be reduced by as much as 50 
percent.
    The Committee remains concerned by the disproportionate 
presence of substance abuse in rural and native communities, 
particularly for American Indian, Alaska Native and Native 
Hawaiian 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.

                   CENTER FOR MENTAL HEALTH SERVICES

Appropriations, 2004....................................    $862,220,000
Budget estimate, 2005...................................     912,502,000
Committee recommendation................................     935,082,000

    The Committee recommends $935,082,000 for mental health 
services. This amount is $72,862,000 above the comparable level 
for fiscal year 2004 and $22,580,000 above the administration 
request. The recommendation includes $21,803,000 in transfers 
available under section 241 of the Public Health Service Act. 
Included in the recommendation is funding for programs of 
regional and national significance, the mental health 
performance partnership block grant to the States, children's 
mental health services, projects for assistance in transition 
from homelessness, and protection and advocacy services for 
individuals with mental illnesses.
    The Committee notes that that SAMHSA's 2002 ``Report to 
Congress on the Prevention and Treatment of Co-occurring 
Substance Abuse Disorders and Mental Health Disorders'' found 
that a ``significant lack of prevalence data on co-occurring 
disorders exist.'' The Committee encourages SAMHSA to work with 
NIMH, NIAAA, and NIDA to collaborate with States to develop 
more recent and accurate data on persons with co-occurring 
mental health and substance use disorders, with an emphasis on 
individuals with mild to moderate mental health disorders.

Programs of Regional and National Significance

    The Committee recommends $303,128,000 for programs of 
regional and national significance. This amount is $62,332,000 
above the comparable level for fiscal year 2004 and $32,580,000 
above the administration request. Programs of regional and 
national significance address priority mental health needs 
through developing and applying best practices, offering 
training and technical assistance, providing targeted capacity 
expansion grants, and changing the delivery system through 
family, client-oriented and consumer-run activities.
    The Committee is deeply concerned that between 5 percent to 
9 percent of all children suffer from a mental, behavioral or 
emotional disorder which, if undiagnosed and untreated, can 
substantially interfere with academic achievement, or lead to 
student drop-out, substance abuse, violent behavior, or 
suicide. Because most youth aged 15 to 19 are in school, the 
educational system is the best environment to identify those 
youth at risk for suicide and to facilitate the services that 
the individual needs. The Committee is aware that SAMHSA is 
overseeing a pilot study in one school system, utilizing 
evidence-based screening techniques and tools to screen and 
identify teenagers who are at risk. Several promising screening 
techniques to identify youth at risk exist but they need 
further testing. There also is a need to develop evidence-based 
interventions to work with students found to be at risk and 
their families so as to facilitate treatment. The Committee has 
included $4,500,000 for SAMHSA to make grants to local 
educational systems or non-profit entities in conjunction with 
local educational systems both to further test the use of the 
screening mechanisms and to identify evidence-based practices 
for facilitating treatment for youth at risk.
    The Committee has included $3,000,000 to continue 
supporting the National Suicide Prevention Resource Center. 
This important initiative supports technical assistance in 
developing, implementing and evaluating effective suicide 
prevention programs. The Resource Center serves as a training 
and field support and acts as a clearinghouse for all pertinent 
best practices information regarding suicide prevention, and it 
promotes evaluation of suicide prevention programs to ensure 
that effective techniques, strategies, and recommended best 
practices are made available to users. The Committee also 
continues funding at last year's level for the Suicide 
Prevention Hotline program.
    The Committee continues to support funding for mental 
health counselors for school-age children, as part of an effort 
to reduce the incidence of youth violence. The Committee 
intends that $95,000,000 be used for counseling services for 
school-age youth. Among other things, the Committee believes 
that mental health counseling for troubled youth can help 
prevent violent acts, and therefore is providing continued 
funding to help schools in that effort. It is again expected 
that SAMHSA will collaborate with the Departments of Education 
and Justice to continue a coordinated approach.
    The Committee appreciates CMHS's commitment to improving 
the quality, effectiveness and availability of therapeutic 
services delivered to traumatized children and adolescents; 
furthering the understanding of the individual, familial, and 
community impact of child and adolescent traumatic stress and 
the methods used to prevent its consequences; and reducing the 
frequency and consequences of traumatic events on children and 
adolescents. The Committee recommendation includes $30,000,000 
to continue and build on the National Child Traumatic Stress 
Initiative.
    The Committee provides $2,000,000 to continue the current 
level of funding for the consumer and consumer-supporter 
national technical assistance centers. The Committee directs 
CMHS to support multi-year grants to five such national 
technical assistance centers.
    The Committee recommendation includes $5,000,000 to 
continue the elderly treatment and outreach program. The 
administration did not request funding for this program. The 
Committee notes that this is the only federally funded services 
program dedicated specifically to the mental health care of 
older adults. From 15 to 25 percent of elderly people in the 
United States suffer from significant symptoms of mental 
illness. In addition, the highest suicide rate in America is 
among those aged 65 and older. This grant program will help 
local communities establish the infrastructure necessary to 
better serve the mental health needs of older adults.
    The Committee supports $7,000,000 for the jail diversion 
grant program. The Department of Justice estimates that 16 
percent of all inmates in local and state jails suffer from a 
mental illness. The Committee recognizes that as many as 
700,000 persons suffering from a mental illness are jailed each 
year. Recognizing these troubling statistics, the President's 
New Freedom Commission on Mental Health called for the adoption 
of diversion strategies to avoid unnecessary criminalization 
and incarceration of non-violent offenders with mental illness. 
The Committee urges SAMHSA to work with the Department of 
Justice, the law enforcement community, the court system and 
other appropriate agencies and associations to ensure that 
funding is utilized to divert inappropriate incarcerations and 
link individuals with mental illnesses with the support they 
need to avoid future contact with the criminal justice system.
    The Committee recommendation fully funds the administration 
request for the new State Incentive Grants for Transformation 
program. The Committee directs SAMHSA to ensure that State 
mental health planning and advisory councils play a significant 
role in the development of comprehensive State plans under this 
new program. The Committee believes that the councils must play 
a key role in the development of these new plans because the 
councils represent the consumer and family voice in States 
across the country.
    The Committee recognizes the urgent need to train 
increasing numbers of minority mental health professionals, 
including Native Hawaiians, to provide competent, accessible 
mental health and substance abuse services for diverse 
populations. It encourages SAMHSA to provide additional 
resources for the Minority Fellowship program.
    The Committee recognizes the need to support grants to 
community-based providers operating in traditional and non-
traditional settings who provide direct mental health services 
to racial and ethnic minorities suffering from HIV/AIDS and 
associated mental health problems. Individuals suffering from 
HIV/AIDS and co-occurring disorders present unique and unmet 
treatment needs necessitating specialized training for 
providers. The Committee encourages SAMHSA to provide 
additional funding for training mental health professionals to 
provide integrated mental health and substance abuse services 
for persons suffering from HIV/AIDS and co-occurring disorders.
    Due to lack of authorizing legislation for the Samaritan 
Initiative, the Committee has included $10,000,000 in this 
account for grants to fund services in permanent supportive 
housing to help end chronic homelessness. The Committee 
encourages CMHS to award these grants to applicants that 
operate permanent supportive housing funded by HUD's Homeless 
Assistance Programs, section 8, or comparable programs 
administered by States or local governments.

Mental Health Performance Partnership Block Grant

    The Committee recommends $436,070,000 for the mental health 
performance partnership block grant, which is $1,380,000 above 
the comparable fiscal year 2004 amount and the same as the 
administration's request. The recommendation includes 
$21,803,000 in transfers available under section 241 of the 
Public Health Service Act. 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 and territories by formula.

Children's Mental Health Services

    The Committee recommends $106,013,000 for the children's 
mental health services program. This amount is $3,659,000 above 
the comparable fiscal year 2004 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. Grantees must provide matching funds, and 
services must involve the educational, juvenile justice, and 
health systems.
    The Committee encourages SAMHSA to expand this program into 
new States and localities. Such a financial investment is vital 
given the increased number of young children diagnosed with 
mental disorders, the rising teen suicide rate, incidents of 
school violence, and the psychological consequences of 
terrorism and war. These factors all indicate that our Nation's 
children and youth need appropriate, quality mental health 
services.

Projects for Assistance in Transition From Homelessness [PATH]

    The Committee recommends $55,251,000 for the PATH Program. 
This amount is $5,491,000 above the comparable fiscal year 2004 
level and is the same as the administration's request.
    PATH is a critical program which provides outreach, mental 
health, and case management services and other community 
support services to individuals with serious mental illness who 
are homeless or at risk of becoming homeless. 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 $34,620,000 for the protection and 
advocacy program, which is the same as the comparable fiscal 
year 2004 level and the administration request. This program 
helps ensure that the rights of mentally ill individuals are 
protected while they are patients in treatment facilities, or 
while they are living in the community, including their own 
homes. Funds are allocated to States according to a formula 
based on population and relative per capita income.

Samaritan Initiative

    The Committee has not included funding for the Samaritan 
Initiative due to lack of authorizing legislation. The 
administration requested $10,000,000 for this new program, 
which would provide the full range of services needed by 
chronically homeless people, such as housing, health care, 
mental health and substance abuse treatment, supportive and 
other services. The Committee has included $10,000,000 in 
funding for homeless programs within the Programs of Regional 
and National Significance account. The Committee will 
reconsider the administration's request for the Samaritan 
Initiative once authorizing legislation is enacted.

                  CENTER FOR SUBSTANCE ABUSE TREATMENT

Appropriations, 2004....................................  $2,198,365,000
Budget estimate, 2005...................................   2,349,267,000
Committee recommendation................................   2,256,252,000

    The Committee recommends $2,256,252,000 for substance abuse 
treatment programs. This amount is $57,887,000 above the 
comparable fiscal year 2004 funding level and $93,015,000 below 
the administration's request. The recommendation includes 
$83,500,000 in transfers available under section 241 of the 
Public Health Service Act. This amount funds substance abuse 
treatment programs of regional and national significance and 
the substance abuse prevention and treatment block grant to the 
States.
    The Committee remains concerned with the negative impact 
substance abuse has on our country. The National Survey on Drug 
Use and Health [NSDUH] estimated that 22 million Americans 
suffered from substance dependence or abuse due to drugs, 
alcohol or both in 2002. In contrast, studies conclude that 
approximately 3 million receive care in any given year. As a 
result, our Nation continues to face a severe ``treatment 
gap''--those who need treatment but do not receive the services 
necessary to address their problems. The Committee is concerned 
that, according to SAMHSA, approximately 40 percent of those 
not receiving treatment reported cost as the reason why they 
did not receive appropriate services.
    The Committee recognizes that the effectiveness of alcohol 
and drug treatment programs and the sustained recovery of 
individuals require an appropriately trained workforce. The 
Committee encourages SAMHSA to prioritize the development and 
implementation of a workforce action plan. This plan could 
include recommendations, survey instruments, studies, training, 
and technical assistance, and incentive programs that would 
improve the recruitment, training and retention of the alcohol 
and drug treatment workforce. The Committee requests that 
SAMSHA consult closely with drug and alcohol programs, States, 
drug and alcohol recovery organizations, other experts and 
stakeholders in the development of its recommendations.
    The Committee commends SAMHSA's recent efforts to develop 
performance measures and further demonstrate the efficacy of 
prevention and treatment programs in order to manage for 
results and further improve the effectiveness of these critical 
programs. The Committee requests that SAMHSA continue to 
consult with States, drug and alcohol programs, drug and 
alcohol recovery organizations, other stakeholders and experts 
to develop and implement reasonable and meaningful performance 
measures that can be applied by SAMHSA and State governments 
consistently across programs. The Committee also requests that 
States receiving SAMHSA funds consult with local alcohol and 
drug programs, recovery organizations, stakeholders and experts 
in order to improve the implementation of these performance 
measures at the local level.

Programs of Regional and National Significance

    The Committee recommends $424,017,000 for programs of 
regional and national significance [PRNS]. The comparable 
fiscal year 2004 level was $419,219,000 and the 
administration's request was $517,032,000. The recommendation 
includes $4,300,000 in transfers available under section 241 of 
the Public Health Service Act.
    Programs of regional and national significance include 
three primary activities: best practice programs are used to 
develop more information on how best to serve those most in 
need; training and technical assistance supports dissemination 
of information through knowledge development; and targeted 
capacity expansion programs enable the agency to respond to 
service needs in local communities.
    The Committee recommendation includes $100,000,000 for the 
Access to Recovery program.
    The Committee commends SAMHSA for including States as 
eligible applicants for all new Targeted Capacity Expansion 
[TCE] grants. The Committee believes States must be eligible to 
apply for all appropriate grants in order to assist States in 
planning, coordinating, and implementing a comprehensive 
Statewide service delivery system.
    The Committee continues to be concerned about the incidence 
of drug addiction among pregnant and parenting women. The 
Committee believes that increased capacity is necessary for 
treatment programs designed for pregnant and parenting women 
and their families. Within the funds appropriated for CSAT, the 
Committee recommends $10,000,000 for treatment programs for 
pregnant, postpartum, and residential women and their children. 
No less than last year's funding shall be used for the 
Residential Treatment Program for Pregnant and Postpartum Women 
[PPW], authorized under section 508 of the Public Health 
Service Act.

Substance Abuse Prevention and Treatment Block Grant

    The Committee recommends $1,832,235,000 for the substance 
abuse prevention and treatment block grant. The recommendation 
includes $79,200,000 in transfers available under section 241 
of the Public Health Service Act. The recommendation is 
$53,089,000 more than the comparable level for fiscal year 2004 
and is the same as the administration request. The 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.
    The Children's Health Act of 2000 made several changes in 
SAMHSA, including transforming the current Block Grant to a 
Performance Partnership Grant [PPG], in which States are 
granted program flexibility and reduced reporting burden in 
exchange for implementing a set of common performance measures. 
The Committee is concerned that SAMHSA failed to issue a report 
to Congress by the October 2002 deadline set in the Children's 
Health Act outlining a suggested roadmap for the PPG 
transition. The Committee once again strongly urges SAMHSA to 
make the PPG implementation its number one priority for 
substance abuse programming and to allocate commensurate 
resources to support the transition to reflect this priority 
status.
    The Committee's recommendation reflects its continued 
belief that the most effective and efficient way to support 
substance abuse programs in every State and territory is to 
direct the bulk of available new resources into the Block Grant 
and the PPG. The Committee also continues to express its strong 
support for preserving the current Block Grant and PPG as the 
foundation of our publicly funded substance abuse system in 
every State and territory in the United States. The Committee 
remains very concerned with any effort that could erode the 
strength of this vital funding stream.

                 CENTER FOR SUBSTANCE ABUSE PREVENTION

Appropriations, 2004....................................    $198,458,000
Budget estimate, 2005...................................     196,018,000
Committee recommendation................................     198,940,000

    The Committee recommends $198,940,000 for programs to 
prevent substance abuse. The comparable fiscal year 2004 level 
was $198,458,000 and the administration request was 
$196,018,000. This amount funds substance abuse prevention 
programs of regional and national significance.
    The Committee notes that effective substance abuse 
prevention efforts pay economic dividends--every dollar spent 
on drug use prevention will save communities $4 to $5 in costs 
for drug abuse treatment and counseling. Findings from the 
Monitoring the Future study showed an 11 percent decrease in 
illicit teen drug use between 2001 and 2003. Ecstasy use, which 
soared between 1998 and 2001, fell by more than half among high 
school students. These findings show that drug prevention 
efforts are working. With drug use finally dropping among 
school-aged youth after almost a decade of dramatic increases, 
the Committee reiterates its support for prevention programs 
and is pleased that the administration has requested a funding 
level sufficient to continue CSAP's existing programs. The 
Committee expects CSAP to focus its efforts on identifying and 
diffusing comprehensive community-wide strategies to reduce 
youth drug use, with an emphasis on increasing the age of first 
use of alcohol and illicit drugs.

Programs of Regional and National Significance

    The Committee has provided $198,940,000 for programs of 
regional and national significance [PRNS]. The comparable 
fiscal year 2004 level was $198,458,000 and the administration 
request was $196,018,000. The Center for Substance Abuse 
Prevention is the sole Federal organization with responsibility 
for improving accessibility and quality of substance abuse 
prevention services. Through the programs of regional and 
national significance activity, CSAP supports: development of 
new practice knowledge on substance abuse prevention; 
identification of proven effective models; dissemination of 
science-based intervention information; State and community 
capacity-building for implementation of proven effective 
substance abuse prevention programs; and programs addressing 
new needs in the prevention system.
    In implementing the Strategic Prevention Framework State 
Incentive Grant program [SPFSIG], CSAP and the States should 
give priority in the use of funds to support drug and alcohol 
prevention community coalition efforts to plan and implement 
comprehensive local strategies to address specific local needs. 
The Committee expects States receiving funding under the SPFSIG 
to give priority in the use of the 20 percent prevention set-
aside in the Substance Abuse Prevention and Treatment Block 
Grant to funding the specific priorities identified in the 
comprehensive community strategies developed by the communities 
in their States.
    The Committee notes that prenatal alcohol exposure is the 
leading known cause of mental retardation and birth defects in 
the United States. It is associated with lifelong difficulties 
with learning, memory, attention, and problem solving as well 
as problems with mental health and social interactions. A 
recent study showed that 15 percent of pregnant women surveyed 
as they waited in clinics for prenatal care indicated they had 
drunk alcohol during pregnancy. At least 5,000 infants are born 
each year with Fetal Alcohol Syndrome [FAS] and another 50,000 
children show symptoms of Fetal Alcohol Effect [FAE]. The 
Committee has provided $11,000,000 to strengthen system-wide 
approaches to identify and serve women at risk of delivering 
FAS/FAE children, with an emphasis on teen mothers.

                           PROGRAM MANAGEMENT

    The Committee recommends $94,455,000 for program management 
activities of the agency. The recommendation includes 
$18,000,000 in transfers available under section 241 of the 
Public Health Service Act. The recommendation is $2,540,000 
above the comparable level for fiscal year 2004 and $2,000,000 
above the budget request.
    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 SAMHSA's programs.
    The Committee has included $2,000,000 to establish 
surveillance measures to address the mental and behavioral 
health needs of the population of the United States. Despite 
the significant levels of Federal, State, and local funding for 
mental health services, and a growing consensus that the 
Nation's mental health care system must be reformed, there are 
currently no population-based sources of data on the mental and 
behavioral health needs in this country. The Committee believes 
that such data would help policymakers implement the 
recommendations in the President's New Freedom Commission on 
Mental Health report ``Achieving the Promise: Transforming 
Mental Health Care in America.'' Therefore, the Committee urges 
SAMHSA, in consultation with the Centers for Disease Control 
and Prevention, to develop ways of monitoring the mental health 
status of the population, the mental and behavioral health 
risks facing the Nation, and the immediate and long-term impact 
of emergencies on population mental health and behavior. Such 
measures could include new survey instruments or enhancements 
to existing public health surveillance systems that do not 
currently address mental and behavioral health. The Committee 
envisions that when these measures are implemented in future 
years, they will allow SAMHSA and CDC to document the health 
status of the population and of important subgroups; identify 
disparities in health status and use of health care by race/
ethnicity, socio-economic status, region, and other population 
characteristics; and monitor trends in health status, access, 
and health care delivery.
    The Committee remains concerned that SAMHSA has not yet 
provided to Congress information detailing the resources each 
State will need for data infrastructure and other needs 
relating to the transition from the current Block Grant to the 
emerging PPG. The Committee directs SAMHSA to work with the 
States to assess the costs regarding data infrastructure needs 
and report its findings to the Committee.

               Agency for Healthcare Research and Quality

Appropriations, 2004....................................    $303,695,000
Budget estimate, 2005...................................     303,695,000
Committee recommendation................................     318,695,000

    The Committee recommends $318,695,000 for the Agency for 
Healthcare Research and Quality [AHRQ]. This amount is 
$15,000,000 above the administration request and the comparable 
funding level for fiscal year 2004. The Committee has funded 
AHRQ through transfers available under section 241 of the 
Public Health Service Act.
    The Agency for Healthcare Research and Quality 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. AHRQ 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. AHRQ 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.

                  HEALTH COSTS, QUALITY, AND OUTCOMES

    The Committee provides $260,695,000 for research on health 
costs, quality and outcomes [HCQO]. The comparable amount for 
fiscal year 2004 was $245,695,000. 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.
    For fiscal year 2005, the Committee directs AHRQ to devote 
$84,000,000 of the total amount provided for HCQO to 
determining ways to reduce medical errors. This represents an 
increase of $4,500,000 over the comparable fiscal year 2004 
level.
    The Committee also directs AHRQ to devote $15,000,000 of 
the total amount provided for HCQO to research on outcomes, 
comparative clinical effectiveness and appropriateness of 
prescription drugs and other health care items as authorized in 
Section 1013 of the Medicare Prescription Drug, Improvement and 
Modernization Act of 2003.
    Autoimmune Disease.--In support of continued HHS-wide 
implementation of the HHS Autoimmune Diseases Research Plan, 
the Committee encourages AHRQ to estimate the annual treatment 
and societal costs of autoimmune diseases in the United States, 
in order to project their future impact and burden on the 
healthcare system.
    Duchenne Muscular Dystrophy.--The Committee urges AHRQ to 
study and develop recommendations on the need for standards of 
care for individuals with Duchenne muscular dystrophy, allowing 
for input from external entities including parent advocacy 
programs. In addition, the Committee encourages AHRQ to conduct 
a workshop on standards of care for the muscular dystrophies 
and coordinate this activity with national advocacy 
organizations dedicated to this condition.
    Elderly Mental Health.--The Committee is seriously 
concerned about the prevalence of undiagnosed and untreated 
mental illness among older Americans. Affective disorders, 
including depression, anxiety, dementia, and substance abuse 
and dependence, are often misdiagnosed or not recognized at all 
by primary and specialty care physicians in their elderly 
patients. While effective treatments for these conditions are 
available, there is an urgent need to translate advancements 
from biomedical and behavioral research to clinical practice. 
The Committee urges AHRQ to support evidence-based research 
projects focused on the diagnosis and treatment of mental 
illnesses in the geriatric population, and to disseminate 
evidence-based reports to physicians and other health care 
professionals.
    Hospital-Based Patient Initiative.--The Committee 
encourages AHRQ to work with multi-site academic medical 
centers to identify and implement programs to improve patient 
safety in a hospital setting. The Committee is interested in 
patient safety improvements that are designed for rapid 
turnaround and for developing practical and replicable projects 
in the future.
    Multiple Sclerosis.--The Committee is aware of an 
increasing number of non-chemotherapy infused biologicals that 
are under FDA review or are currently available for the 
treatment of diseases such as multiple sclerosis. The Committee 
urges AHRQ to conduct a study examining changes in the market 
involving infused biologicals. The report should examine 
changes in market demand for non-chemotherapy infused 
therapies, whether health care providers have adequate capacity 
to meet increased demand, the cost to providers for meeting 
increased demand, as well as geographical and subspecialty 
variations in access and demand.
    Nurse-Managed Health Centers.--The Committee encourages 
AHRQ to include nurse-managed health centers and advanced 
practice nurses in research and demonstration projects 
conducted by the agency.
    Organ Donation.--The Committee recognizes that there is 
presently no formal mechanism to scientifically evaluate the 
efficacy of many new medications, devices, surgical techniques, 
and technical innovations that are being developed to improve 
organ preservation and maximize organ usage. The Committee 
encourages AHRQ to study and develop scientific evidence in 
support of efforts to increase organ donation and improve the 
recovery, preservation, and transportation of organs.
    Provider Level Data.--The Committee understands that 
policies on databases and data elements are being developed in 
many State and local jurisdictions. The Committee urges AHRQ to 
conduct a study on the role and importance of provider level 
data for patient safety, quality of care, electronic health 
data interchange, and development of evidence-based practice 
standards. The Committee believes that such a report could 
serve as an important benchmark for jurisdictions developing 
database policies both in the United States and abroad.
    Unequal Treatment.--The Committee encourages the Agency to 
carefully evaluate the analysis, findings, and recommendations 
of the March 2002 Institute of Medicine report regarding the 
disparities of medical care delivery to minorities. In 
particular, the Agency should pursue creative ways to address 
this serious finding and improve health care delivery for 
African-Americans, those of Hispanic and Asian origin, Native-
Americans, Alaskans and Native Hawaiians.

                   MEDICAL EXPENDITURES PANEL SURVEYS

    The Committee provides $55,300,000 for health insurance and 
medical expenditures panel surveys [MEPS], which is the same as 
the administration request and the comparable fiscal year 2004 
level. 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 $2,700,000 for program support. 
This amount is the same as the administration request and the 
comparable fiscal year 2004 level. This activity supports the 
overall management of the Agency.

               Centers for Medicare and Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

Appropriations, 2004....................................$130,892,197,000
Budget estimate, 2005................................... 119,124,488,000
Committee recommendation................................ 119,124,488,000

    The Committee recommends $119,124,488,000 for Grants to 
States for Medicaid. This amount is $11,767,709,000 less than 
the fiscal year 2004 appropriation and the same as the 
administration's request. This amount excludes $58,416,275,000 
in fiscal year 2004 advance appropriations for fiscal year 
2005. In addition, $58,517,290,000 is provided for the first 
quarter of fiscal year 2006, 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 is based upon the State's 
average per capita income relative to the national average, and 
shall be no less than 50 percent and no more than 83 percent.

                  PAYMENTS TO HEALTH CARE TRUST FUNDS

Appropriations, 2004.................................... $95,084,100,000
Budget estimate, 2005................................... 114,608,900,000
Committee recommendation................................ 114,608,900,000

    The Committee recommends $114,608,900,000 for Federal 
payments to health care trust funds. This amount is the same as 
the administration's request and is an increase of 
$19,524,800,000 from the fiscal year 2004 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 that have not been financed by payroll 
taxes or premium contributions.
    The Committee has provided $114,002,000,000 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's request and is $19,484,000,000 more than the 
fiscal year 2004 amount. The increase includes $5,742,000,000 
to cover an anticipated shortfall in the amount appropriated in 
fiscal year 2004.
    The recommendation also includes $87,000,000 for hospital 
insurance for the uninsured. This amount is the same as the 
administration's request and is $110,000,000 less than the 2004 
amount.
    The Committee also recommends $199,000,000 for 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 an increase of 
$31,000,000 over the fiscal year 2004 level, reflecting an 
increase on the number of covered individuals who are currently 
enrolled. The recommendation also includes the budget estimate 
of $105,900,000 for General Revenue for the Medicare 
Prescription Drug account, a new funding requirement. This 
account was established by Public Law 108-173; the Medicare 
Prescription Drug, Improvement and Modernization Act of 2003. 
The general fund will finance $105,900,000 in State low-income 
determination activities through the Prescription Drug Account. 
Requested bill language is also included to ensure prompt 
payments of Medicare prescription drug benefits as provided 
under section 1860 D-16 of the Social Security Act, of 
$5,216,900,000 for fiscal year 2006.
    The Committee recommendation includes $215,000,000 to be 
transferred to the Hospital Insurance Trust Fund as the general 
fund share of CMS's program management administrative expenses. 
This amount is the same as the administration's request and is 
$13,900,000 more than the fiscal year 2004 level.

                           PROGRAM MANAGEMENT

Appropriations, 2004....................................  $2,636,846,000
Budget estimate, 2005...................................   2,746,127,000
Committee recommendation................................   2,756,644,000

    The Committee recommends $2,756,644,000 for CMS program 
management, which is $10,517,000 more than the amount requested 
by the administration and $119,798,000 more than the fiscal 
year 2004 enacted level.

Research, Demonstrations, and Evaluations

    The Committee recommends $77,791,000 for research, 
demonstrations, and evaluation activities. This amount is 
$9,517,000 more than the budget request.
    CMS research and demonstration activities facilitate 
informed, rational Medicare and Medicaid policy choices and 
decision making. These studies and evaluations include projects 
to measure the impact of Medicare and Medicaid policy analysis 
and decision making, 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 Committee has included $40,000,000 for Real Choice 
Systems Change Grants to States to fund initiatives that 
establish specific action steps and timetables to achieve 
enduring system improvements and to provide long-term services 
and supports, including community-based attendant care, to 
eligible individuals in the most integrated setting 
appropriate.
    The Secretary shall report to Congress on measurable 
outcomes for these grants and shall work in collaboration with 
the technical assistance provider to do so. The Committee 
further recommends that the technical assistance funding shall 
be used solely to fund technical assistance for the systems 
change grants, including ongoing technical assistance to ensure 
continuous quality improvement and progress on measurable 
outcomes. The Committee acknowledges the work of the consumer-
controlled consortium and recommends continued funding for 
technical assistance for the State system change consumer task 
forces.
    The Committee recognizes the critical role of direct 
service workers in the Nation's community-based long-term care 
system and supports the administration's efforts to improve 
recruitment, training and retention of direct service workers. 
The Committee has included $3,000,000 more than the 
administration requested for the national demonstration 
designed to address workforce shortages of community service 
direct care workers. The Committee is doing so in recognition 
of the current shortage of direct service workers and the 
predicted increase in the need for additional direct service 
workers over the next 10 years. The Bureau of Labor Statistics 
predicts a 39 percent growth in the need for direct service 
workers in the next 10 years.
    The funds should be used to improve recruitment, training, 
supervision by managers and people with disabilities, 
retention, health insurance and other benefits, career 
development, education, working environments, and managers' 
cultural competence. To the extent that funds are used for 
direct service costs, those funds must be phased out by the end 
of the grant period and the State must have a plan for 
maintaining these supports that the grant made possible. CMS 
should require States to involve people with disabilities and 
direct service workers in the planning and implementation of 
the projects funded under this initiative.

Medicare Operations

    The Committee recommends $1,796,879,000 for Medicare 
operations, which is the amount requested by the 
administration, adjusted to reflect the $3,000,000 transfer of 
BIPA section 522 funding to the Medicare Operations line from 
the Federal Administration line. Based on current operations, 
the Committee believes that both national and local coverage 
determinations are more appropriately funded from the Medicare 
Operations line. In addition, $720,000,000 is available for the 
Medicare Integrity Program within the mandatory budget as part 
of the health insurance reform legislation.
    The Medicare operations line item covers a broad range of 
activities including claims processing and program safeguard 
activities performed by Medicare contractors. These contractors 
also provide information, guidance, and technical support to 
both providers and beneficiaries. In addition, this line item 
includes a variety of projects that extend beyond the 
traditional fee-for-service arena.
    The Committee recommends that not less than $31,700,000 be 
made available for the State Health Insurance Counseling 
Program, which has expanded responsibilities related to 
providing assistance to services concerning prescription drug 
benefits. Of this amount, at least $14,100,000 would come from 
this Program Management account, with additional amounts from 
Medicare Modernization Act funding.

State Survey and Certification

    The Committee recommends $270,392,000 for Medicare State 
survey and certification activities, which is $19,140,000 more 
than the fiscal year 2004 level.
    Survey and certification activities ensure that 
institutions and agencies providing care to Medicare and 
Medicaid beneficiaries meet Federal health, safety, and program 
standards. On-site surveys are conducted by State survey 
agencies, with a pool of Federal surveyors performing random 
monitoring surveys.

Federal Administration

    The Committee recommends $587,182,000 for Federal 
administration costs, which is an increase of $10,036,000, over 
the fiscal year 2004 level and reflects the shift of $3,000,000 
requested for BIPA section 522 funding to the Medicare 
Operations activity. This funding level allows for fixed cost 
increases associated with the current staffing level of 4,398 
full-time equivalent positions. An additional $1,000,000 over 
the request is included for the cost of an Institute of 
Medicine study and report described under general provision 
language in section 221, pertaining to the Medicare 75 percent 
rule.
    The Committee recommends continuing the current level of 
$13,000,000 for the Healthy Start, Grow Smart program. The 
Healthy Start, Grow Smart program develops, prints, and 
disseminates a series of 13 informational brochures in English 
and Spanish to new Medicaid-eligible mothers. These brochures 
are distributed at the time of birth, an then monthly over the 
first year of each child's life. Each publication focuses on 
activities that stimulate infant brain development and build 
the skills these children need to be successful in school. In 
addition to these educational suggestions, each Healthy Start 
pamphlet includes vital health and safety information for new 
parents. Content for each brochure is tied to the developmental 
stage of the child at the time it is sent.
    The Committee is pleased with the demonstration project at 
participating sites licensed by the Program for Reversing Heart 
Disease and encourages its continuation. The Committee further 
urges CMS to continue with the demonstration project being 
conducted at the Mind Body Institute of Boston, Massachusetts.
    The Committee is aware of the importance of providing 
vision rehabilitation services and is interested in ensuring 
that vision rehabilitation services are available on a 
nationwide basis, and that they may be provided by vision 
rehabilitation professionals acting under a physician's general 
supervision. The Secretary of the Department of Health and 
Human Services, with funding included in this bill, is urged to 
continue the nationwide 5-year outpatient vision rehabilitation 
services demonstration project authorized in the fiscal year 
2004 omnibus report, under which vision rehabilitation 
professionals may deliver services in the home under the 
general supervision of a qualified physician.
    The Committee first addressed the issue of proper coding 
within the Medicare outpatient Ambulatory Procedure 
Classification system for cobalt\60\ stereotactic neurosurgery 
in its fiscal year 2000 report. The Committee is pleased that 
CMS subsequently separated stereotactic radiosurgery by 
industry segment. However, in doing so CMS has changed the 
clinical definition of one segment--cobalt\60\ stereotactic 
neurosurgery--and its acceptable coding has been divided and 
positioned with radiation therapy and not neurosurgery. This 
has resulted in significant reimbursement issues between 
insurers and the hospitals providing the surgery since early 
2002, including development of secondary ``in-house'' coding 
systems, and the delay and/or denials of patient treatments. 
The Committee strongly urges CMS to reinstate one neurosurgical 
billing code for cobalt\60\ outpatient stereotactic 
neurosurgery, beginning as soon as possible, to alleviate the 
hospital burden in this area and to represent the way hospitals 
are set up and staffed to provide this neurosurgical procedure. 
The Committee again encourages CMS to work with the 
International Radiosurgery Association which represents 
hospitals, professionals and patients, and the neurosurgical 
community before designating, defining or changing coding for 
cobalt\60\ stereotactic neurosurgery. CMS is also urged to 
consult these groups when making changes or additions to 
radiosurgery coding in the future.
    The Committee understands the CMS Ambulatory Procedure 
Classification [APC] system is a method to provide proper 
coding and reimbursement to hospitals for outpatient Medicare 
treatments. The Committee also understands that at this time, 
the APC panel is primarily composed of physicians and 
representatives of physician associations who are not subject 
to hospital coding. These members may have self interests in 
coding that is in conflict with and not in the best interests 
of hospitals. The Committee urges CMS to add hospital and 
hospital trade association representatives to the APC panel as 
vacancies arise. The Committee is concerned that CMS work with 
hospitals and their representatives and that the APC panel be 
responsive to hospital issues when a hospital industry segment 
is bringing issues before the panel.
    The Committee notes that when hospitals are routinely 
performing procedures in the outpatient setting, CMS may 
restrict reimbursement to the inpatient setting. This penalizes 
hospitals for reducing costs and avoiding overnight hospital 
stays. The Committee encourages CMS through its APC panel to 
allow coding in the setting that hospitals are providing the 
treatment procedures and to use established clinical 
definitions for the coding.
    The Committee recommendation includes funding to study the 
cost-effectiveness of innovative State dental Medicaid programs 
for children. The study should focus on those programs that 
reported improvements in access to care through innovative 
designs that have attracted adequate numbers of dentists and 
assured improved access for patients.
    The Committee is very pleased with the efforts of CMS to 
address the extraordinary adverse health status of Native 
Hawaiians in Waimanalo, Hawaii. The Committee continues to urge 
additional focus upon American Samoan residents in that 
geographical area utilizing the expertise of the Waimanalo 
Health Center.
    The Committee urges the Centers for Medicare and Medicaid 
Services to consider waivers for rural or isolated area 
demonstration projects when calculating such requirements as 
population density in the State of Hawaii.
    The Committee has been informed about recent CMS data which 
shows that less than one-third of Medicare beneficiaries 
eligible for diabetes self-managed training are receiving the 
care they need. To identify the primary barriers to access in 
urban and rural settings, the Committee recommends that CMS 
conduct demonstrations in partnership with an association that 
has expertise in providing diabetes self-management training to 
determine the effectiveness of diabetes self-management 
training and the various obstacles to access.
    The Committee is aware of changes being developed by CMS to 
alter the Medicare coverage policy for power mobility devices 
including power wheelchairs. The Committee strongly encourages 
CMS to use its resources toward development of a coverage 
policy firmly based on a functional standard of nonambulatory. 
The Committee believes beneficiaries who cannot perform their 
basic acts of daily living, toileting, food preparation and 
emergency egress, are nonambulatory and must have access to 
this mobility benefit to function independently. The committee 
supports controlling fraud and abuse through requirements that 
ensure proper substantiation of medical need for this equipment 
but does not support narrowing the definition of nonambulatory 
to exclude the elderly and disabled dependent on these devices 
to function in the home. The Committee believes that the 
medically necessary application of this mobility benefit can 
save Medicare money through cost-avoidance associated with 
expensive institutional care or hospitalization resulting from 
falls by the growing elderly population.
    The Committee encourages CMS to examine the unintended 
consequences current reimbursement policies have on restricting 
access and utilization of oral anticancer therapies through the 
Part B drug payment policies. CMS is encouraged to evaluate 
reimbursement policies for such oral therapies.
    The Committee is concerned that the current Medicare 
payment cap for federally-qualified health centers [FQHC] has 
had a detrimental impact on the financial stability of these 
safety net providers that jeopardizes access to care in 
underserved areas. The Committee understands that the payment 
cap has not been adjusted in more than 10 years, the data used 
to initially create the cap was not based on FQHC data, 
increases in health centers costs have not been accounted for, 
and more than one half of all health centers are now negatively 
impacted. The Committee urges the Secretary to recalculate the 
payment cap for FQHCs to take into account these issues.
    The Committee urges CMS to provide for reimbursement for 
services rendered to Native Hawaiians in federally qualified 
health centers in the same manner that it currently does for 
American Indians and Alaskan Natives. Further, the Committee 
requests a report on this matter by next year's budget 
hearings.
    The Committee remains extremely concerned over CMS' 
continuing failure to articulate clear guidelines and to set 
expeditious timetables for consideration of new technologies, 
procedures and products for Medicare coverage. However, the 
Committee applauds CMS' decision to expand Medicare coverage of 
Positron Emission Tomography [PET] in cases of suspected 
Alzheimer's disease, when a specific diagnosis remains 
uncertain despite a thorough clinical evaluation, and in cases 
where patients with early dementia or unexpected memory loss 
are enrolled in clinical trials containing certain patient 
safeguards. The Committee is also pleased to note that CMS will 
collaborate with the National Institutes of Health and the Food 
and Drug Administration to develop needed evidence on the role 
of PET scans in guiding the diagnosis and treatment of, and 
predicting the course of, Alzheimer's disease. In choosing 
panels to develop criteria and evaluate use of PET scans for 
Alzheimer's disease, the Committee expects the agencies 
involved to name members familiar with PET technology and its 
uses. The Committee does not expect that the Agency for 
Healthcare Research and Quality will direct or be involved in 
this effort. The Committee firmly believes that these steps 
will increase Medicare beneficiaries' access to innovative 
technologies and will ultimately lead to improved health 
outcomes.
    The Committee expects CMS to continue to gather pertinent 
information relative to model practices of quality chronic care 
management by implementing Section 721 of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003. 
The Committee recommends that CMS support independently 
financed demonstration projects for serious illnesses and 
coordinated care.
    The Committee is aware of innovative information technology 
that promises substantial advances such as more fully informing 
and educating patients and numerous potential applications. The 
Committee encourages a demonstration of the ways in which this 
technology may improve the health care system.
    The Committee is aware that a recent study by the General 
Accountability Office has revealed that Medicare Call Centers 
need to improve responses to policy-oriented questions from 
providers. According to the study, only 4 percent of the 
responses received from GAO test calls were correct and 
complete. The Committee understands that CMS generally agrees 
with the GAO's findings, and urges that it expedite efforts to 
implement the recommendations, including: a process to route 
policy inquiries to staff with appropriate expertise; clear and 
easily accessible policy-oriented material to assist customer 
service representatives; and an effective monitoring program 
for call centers. The Committee expects CMS to provide a report 
on its actions to improve responses to policy-oriented 
inquiries from providers as part of its fiscal year 2006 
congressional budget justification material.
    The Committee believes that in the Medicare continuum of 
care there is a vital role for long-term acute care hospitals 
[LTACHs], including hospitals set up in other hospitals to 
provide that care. On August 2, 2004 CMS promulgated a rule 
which, over 4 years, establishes a patient quota rule setting 
limits on the percentage of patients which can go into an LTACH 
from the host facility. The Committee believes that the 
decision as to which patients should go into a LTACH should be 
made by physicians based on well-defined patient and hospital 
admissions criteria--not on an arbitrary quota and therefore, 
that this rule should be replaced with a rule developed on 
clinically-based criteria. The Committee recommends that CMS 
commission a comprehensive study on what patient and hospital 
admissibility criteria should be put in place to assure the 
responsible growth and development of this important part of 
medical services for the elderly.
    The Committee commends CMS for removing barriers to 
reimbursement for treatment of obesity. CMS is encouraged to 
work with the Centers for Disease Control and Prevention in 
reviewing scientific evidence in order to determine coverage of 
obesity treatment and prevention, and also in establishing a 
national public health action plan on obesity. The Committee 
also recommends that CMS work with State health educators and 
health promotion directors to assure that people receive 
relevant information to their life-stage on how obesity should 
be treated and prevented.
    Reducing Medicare Mispayments.--The Committee is pleased 
with recent improvements in the rate of mispayments by the 
Medicare program. Additional resources and efforts have begun 
to make a difference. However, the Committee remains very 
concerned with the amount of money that continues to be lost to 
fraud, waste, and abuse in the Medicare program. The Committee 
has held many hearings and taken other corrective actions over 
a 15 year period to expose and reduce these losses. The 
Committee held a hearing on overpayments for certain medical 
supplies in June of last year. At that time the Administrator 
of CMS promised to move forward with implementation of enhanced 
inherent reasonableness authority. Yet, to date no action has 
been taken. The Committee calls upon the Administrator to 
promptly utilize the IR authority granted to the Secretary and 
request a briefing as to his timeline for action by December 1, 
2004. By March 1, 2005, the Committee would like to receive a 
progress report and future work plan for all Departmental 
efforts to reduce fraud, waste and abuse in Medicare.

Revitalization Plan

    The Committee recommends the budget request of $24,400,000, 
as the second-year investment in CMS's efforts to make 
significant improvements to key aspects of managing the agency 
and the Medicare program. First-year funding is fiscal year 
2004 was $29,619,000. Funding in fiscal year 2005 will target 
system-related improvements.

HMO Loan and Loan Guarantee Fund

    The Committee concurs with requested bill language making 
receipts of this fund available for payment of obligations, but 
prohibiting the issuance of additional direct loans or loan 
guarantees to health maintenance organizations from this fund.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

Appropriations, 2004....................................  $3,312,970,000
Budget estimate, 2005...................................   2,825,802,000
Committee recommendation................................   2,873,802,000

    The Committee recommends $2,873,802,000 be made available 
in fiscal year 2005 for payments to States for child support 
enforcement and family support programs. The comparable funding 
level for fiscal year 2004 is $2,825,802,000 and the budget 
request includes $2,873,802,000 for this program. The Committee 
recommendation provides the full amount requested under current 
law. The budget request includes net savings of $48,000,000 
based on proposed legislation.
    These payments support the States' efforts to promote the 
self-sufficiency and economic security of low-income families. 
These funds also support efforts to locate non-custodial 
parents, determine paternity when necessary, and establish and 
enforce orders of support. The appropriation, when combined 
with the $1,200,000,000 in advance funding provided in last 
year's bill and an estimated $194,800,000 from offsetting 
collections, supports a program level of $4,268,602,000.
    The Committee also has provided $1,200,000,000 in advance 
funding for the first quarter of fiscal year 2006 for the child 
support enforcement program, the same as the budget request.

               LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2004....................................  $1,888,790,000
Budget estimate, 2005...................................   2,000,500,000
Committee recommendation................................   2,000,500,000

    The Committee recommends $2,000,500,000 for fiscal year 
2005 for LIHEAP. The comparable funding level for fiscal year 
2004 is $1,888,790,000 and the budget request includes 
$2,000,500,000 for this program. LIHEAP is made up of two 
components: the State grant program and the contingency fund.
    The Committee recommendation includes $1,901,090,000 for 
fiscal year 2005 for the State grant program. The comparable 
funding level for fiscal year 2004 is $1,789,380,000 and the 
budget request includes $1,800,500,000 for this program. Within 
the funds provided, the Committee recommends $500,000 for 
evaluation purposes, as requested by the administration. LIHEAP 
grants are awarded to States, territories, Indian tribes, and 
tribal organizations 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. These 
resources are distributed by formula to these entities as 
defined by statute, based in part on each State's share of home 
energy expenditures by low-income households.
    The Committee recommends $99,410,000 for fiscal year 2005 
for the contingency fund. The comparable funding level for 
fiscal year 2004 is $99,410,000 and the budget request includes 
$200,000,000 designated as non-emergency funding for this 
program. The contingency fund may be used to provide assistance 
to one or more States adversely affected by extreme heat or 
cold, significant price increases, or other causes of energy-
related emergencies. The Committee is committed to ensuring 
that sufficient resources are available in the fund, to provide 
additional assistance to households with energy burdens not met 
by the regular program, and to meet the objectives of the 
authorizing statute. The Committee intends to monitor household 
energy burdens that might require action in future 
appropriations bills.
    The Committee intends that up to $27,500,000 of the amount 
recommended for LIHEAP for fiscal year 2005 be used for the 
leveraging incentive fund. The fund will provide a percentage 
match to States for private or non-Federal public resources 
allocated to low-income home energy benefits.

                     REFUGEE AND ENTRANT ASSISTANCE

Appropriations, 2004....................................    $447,598,000
Budget estimate, 2005...................................     473,239,000
Committee recommendation................................     477,239,000

    The Committee recommends $477,239,000 for fiscal year 2005 
for refugee and entrant assistance. The comparable funding 
level for fiscal year 2004 is $447,598,000 and the budget 
request includes $473,239,000 for this program.
    The Refugee and Entrant Assistance Program is designed to 
assist States in their efforts to assimilate refugees, asylees, 
Cuban and Haitian entrants, and adults and minors who are 
trafficking victims, into American society as quickly and 
effectively as possible. The program funds State-administered 
transitional and medical assistance, the voluntary agency 
matching grant program, programs for victims of trafficking and 
torture, employment and social services, targeted assistance, 
and preventive health.
    Based on an estimated refugee admission ceiling of 70,000, 
this appropriation, together with prior-year funds available 
for fiscal year 2005 expenses, will enable States to continue 
to provide at least 8 months of cash and medical assistance to 
eligible refugees and entrants, a variety of social and 
educational services, as well as foster care for refugee and 
entrant unaccompanied minors.
    In order to carry out the refugee and entrant assistance 
program, the Committee recommends $193,577,000 for transitional 
and medical assistance, including State administration and the 
voluntary agency program; $10,000,000 for victims of 
trafficking; $155,121,000 for social services; $4,835,000 for 
preventive health; and $49,477,000 for targeted assistance.
    The Committee has included $19,000,000 within the funds 
provided for social services for increased support to 
communities with large concentrations of refugees whose 
cultural differences make assimilation especially difficult 
justifying a more intense level and longer duration of Federal 
assistance.
    The Committee is aware that the State Department has made 
arrangements for 15,000 Hmong refugees to enter the United 
States starting in 2004 and carrying over into 2005. The 
Committee is concerned that unlike prior groups of Hmong 
refugees, which were made up of military and political leaders 
with the means and education to succeed in America, these 
immigrants have spent their lives in a refugee camp. Few, if 
any, speak English. Most are under 18 and have little 
schooling. Even with the greater level of education and skills 
possessed by prior refugees, current statistics indicate that 
about 38 percent of current Hmong-Americans live in poverty. In 
addition, the Committee has become aware of efforts by the 
State Department to admit a significant number of Bantu 
refugees from camps along the Somali-Kenya border. A persecuted 
minority in Somalia, the Bantus were barred from school and so 
are largely illiterate. The Committee is concerned that the 
Bantus only recently began arriving in the United States, thus 
there is no currently existing Bantu population in the United 
States to welcome the newcomers. In addition, the Bantus 
represent the largest cohesive refugee group presented for 
resettlement screening since the mid-1990s. For these reasons, 
the Committee has set aside $8,000,000 within the ORR 
appropriation for the resettlement of unanticipated arrivals.
    The Committee recommends $54,229,000 for unaccompanied 
children pursuant to section 462 of the Homeland Security Act 
of 2002. Funds are provided for the care and placement of 
unaccompanied alien minors in the Office of Refugee 
Resettlement. Approximately 5,000 unaccompanied alien children 
are apprehended each year in the United States by INS/Homeland 
Security agents, Border Patrol officers, or other law 
enforcement agencies and taken into care pending resolution of 
their claims for relief under U.S. immigration law, released to 
an adult family member, or released to a responsible adult 
guardian.
    The Committee is encouraged by steps taken by the Office of 
Refugee Resettlement to improve access to legal representation 
for children served through this program, as called for by 
Congress in the statement of the managers accompanying the 
Department of Health and Human Services Appropriations Act, 
2004. The Committee encourages the Office to continue efforts 
in this area, in particular focusing on developing an 
infrastructure for identifying, assigning, coordinating and 
tracking competent pro bono counsel in addition to independent 
guardians ad litem for all such children. Furthermore, the 
Committee strongly encourages the Office of Refugee 
Resettlement to give high priority to the location of 
immigration courts and services when electing ORR contracted 
facilities. The Committee requests a full discussion of efforts 
taken in this area to be included in the 2006 congressional 
justification.
    The Committee also recommends $10,000,000 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 acknowledges that well-established treatment centers, 
such as the Center for Victims of Torture, have developed the 
knowledge base that has fostered growth of treatment facilities 
around the country and strengthened treatment services 
generally. This positive trend may continue if leading centers 
are able to expand their staffs to create more trainers and 
improve evaluation and research needed to guide and develop new 
programs. The Committee urges the Office of Refugee 
Resettlement to place a priority on continued and sufficient 
grant support for services provided by existing centers before 
using funds to expand communities served through this 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.

                 CHILD CARE AND DEVELOPMENT BLOCK GRANT

Appropriations, 2004....................................  $2,087,310,000
Budget estimate, 2005...................................   2,099,729,000
Committee recommendation................................   2,099,729,000

    The Committee recommends $2,099,729,000 for fiscal year 
2005 for child care and development block grant. The comparable 
funding level for fiscal year 2004 is $2,087,310,000 and the 
budget request includes $2,099,729,000 for this program.
    The child care and development block grant supports 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 to 
allow States to continue funding the activities previously 
provided under the consolidated programs.
    The Committee recommendation continues specific earmarks in 
appropriations language, also included in the budget request, 
that provide targeted resources to specific policy priorities 
including $19,120,000 for the purposes of supporting before and 
afterschool services, as well as resource and referral 
programs. This represents the Federal commitment to the 
activities previously funded under the dependent care block 
grant. The Committee 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 continue 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 an additional 
$272,672,000 for child care quality activities, and sets aside 
$100,000,000 specifically for an infant care quality 
initiative. These funds are recommended in addition to the 4 
percent quality earmark established in the authorizing 
legislation. The Committee has provided these additional 
quality funds because of the considerable research that 
demonstrates the importance of serving children in high quality 
child care settings which include nurturing providers who are 
educated in child development and adequately compensated. While 
considerable progress has been made, the Committee believes 
States should continue to invest in education and training 
linked to compensation of the child care workforce in order to 
improve the overall quality of child care.
    The Committee recommendation also provides $10,000,000 for 
child care research, demonstration and evaluation activities.
    The Committee recommendation for resource and referral 
activities also includes $1,000,000 to continue support for the 
National Association of Child Care Resource and Referral 
Agencies' information service, Child Care Aware, and the 
national toll-free information hotline which links families to 
local child care services and programs.

                      SOCIAL SERVICES BLOCK GRANT

Appropriations, 2004....................................  $1,700,000,000
Budget estimate, 2005...................................   1,700,000,000
Committee recommendation................................   1,700,000,000

    The Committee recommends $1,700,000,000 for fiscal year 
2005 for the social services block grant. The comparable 
funding level for fiscal year 2004 is $1,700,000,000 and the 
budget request includes $1,700,000,000 for this program. The 
Committee has included bill language that allows States to 
transfer up to 10 percent of their TANF allotment to the social 
services block grant.

                CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2004....................................  $8,833,371,000
Budget estimate, 2005...................................   9,097,897,000
Committee recommendation................................   9,094,146,000

    The Committee recommends $9,094,146,000 for fiscal year 
2005 for children and families services programs. The 
comparable funding level for fiscal year 2004 is $8,833,371,000 
and the budget request includes $9,097,897,000 for this 
program. In addition, $10,500,000 in transfers are available 
under section 241 of the Public Health Service Act.
    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

    The Committee recommends $6,935,452,000 for fiscal year 
2005 for Head Start. The comparable funding level for fiscal 
year 2004 is $6,774,980,000 and the budget request includes 
$6,935,452,000 for this program. The Committee recommendation 
includes $1,400,000,000 in advance funding that will become 
available on October 1, 2005. The Committee recommendation does 
not include the $45,000,000 requested in the budget for the 
grant program for those States that directly administer the 
Head Start program.
    The Committee is aware that studies on early childhood that 
provide clear evidence that the brain undergoes its most 
dramatic development during the first 3 years of life, when 
children acquire the ability to think, speak, learn, and 
reason. Disparities in children's cognitive and social 
abilities become evident well before they enter Head Start or 
pre-kindergarten programs at age 4. Early Head Start minimizes 
these disparities so that children are ready to enter school 
and learn. The National Evaluation of Early Head Start 
concluded that Early Head Start is making a positive difference 
in areas associated with children's success in school, family 
self-sufficiency, and parental support of child development. 
Currently only 3 percent of estimated eligible infants and 
toddlers are enrolled in Early Head Start. Over the past 5 
years, the Committee has significantly increased funding for 
Early Head Start, to provide more low-income infants and 
toddlers with the positive experiences they need for later 
school and life successes. The Committee intends to continue 
this important investment.
    Given the recent changes in the overall Head Start training 
and technical assistance system and the special training and 
technical assistance needs of programs working with infants, 
toddlers, and their families, the Committee is concerned about 
the maintenance of the Early Head Start Training and Technical 
Assistance System. In particular, the Committee is concerned 
that long distance, technology-based technical assistance is 
taking the place of providing programs with support from 
qualified on-site people. The Committee believes that in order 
to sustain the positive outcomes generated by the program, 
Early Head Start programs and staff need to continue to receive 
ongoing training opportunities and technical assistance from 
organizations with specialized expertise relating to infants, 
toddlers and families and the demonstrated capacity needed to 
provide direction and support to the Head Start national 
training and technical assistance system.
    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 understands the serious need for additional 
and expanded Head Start facilities among Native American 
populations and in rural areas. The Committee believes that the 
Department could help serve these needy communities by 
providing minor construction funding, as authorized, in remote 
Native American communities.
    Tribal colleges and universities [TCUs) play a central role 
in strengthening education, economic development, and self-
sufficiency to American Indian communities. The Committee 
recognizes the success of the Head Start-TCU partnership formed 
in 1999 to foster educational, health, nutritional, and social 
services for Indian children, and recommends that this program 
be continued and expanded. The Committee supports the 
Department's commitment to continue to award 5-year grants to 
tribal colleges and universities.
    While current law requires that 50 percent of Head Start 
teachers in center-based Head Start programs have not less than 
an associate degree in early childhood education or a related 
field, American Indian Head Start programs are generally 
located in areas that are isolated from mainstream colleges 
where such degrees can be earned. This program provides 
accessible, high-quality, and accredited education 
opportunities to American Indian Head Start agency staff, 
enabling them to better deliver services that enhances the 
social and cognitive development of low income American Indian 
children.
    The Committee strongly supports the effort to strengthen 
the qualifications of Head Start teachers. The Committee 
encourages Head Start to continue to work toward the goal of 
having all of their teachers in center-based Head Start 
programs have an associate, baccalaureate, or advanced degree 
in early childhood education, or a degree in a related field 
with experience in teaching preschool children. The Committee 
expects the Department to focus staff development efforts on 
increasing the educational level of Head Start teachers in 
order to meet this goal.
    The Committee is aware that the Department's ``Descriptive 
Study of Seasonal Farmworker Families'' published in September 
2001 revealed that just 19 percent of eligible children of 
migrant and seasonal farmworkers are served by Migrant Head 
Start programs. The study also concluded ``that Migrant Head 
Start agencies greatly improve the lives of migrant and 
seasonal farmworker families, and in doing so, help to 
strengthen local agricultural economies.'' The Committee urges 
the Head Start Bureau to examine this issue and develop a plan 
to ensure that sufficient funds are provided for Migrant Head 
Start programs.
    The Head Start Bureau shall provide the Committee with the 
number and cost of buses purchased, by region, in fiscal years 
2002, 2003, and the first half of 2004 with Head Start funds no 
later than March 31, 2005.
    The Committee is conscious of efforts currently being 
undertaken to improve pre-literacy skills in Head Start 
children and lauds the administration for its commitment to 
this effort. However, the Committee continues to caution 
against anything that would detract from the comprehensive 
nature of the program in delivering early childhood development 
and family services. While school readiness is front and center 
in the goals of Head Start, the elements necessary to achieve 
that readiness range from adequate nutrition and health 
screening, to social and emotional development and family 
building, as well as the cognitive growth of young children.
    The Committee encourages ACF's Head Start Bureau and HRSA's 
Maternal and Child Health Bureau to continue and expand their 
successful interagency agreement to jointly address dental 
disease, a significant unmet health need of Head Start 
children. This partnership has brought together Head Start and 
the dental community at the national, State and local levels to 
seek solutions to improve access to oral health care for these 
children through the public and private sectors.
    The Committee recognizes that assessing the effectiveness 
of Head Start nationwide is an important goal and that by 
sponsoring the development of the National Reporting System 
[NRS] the U.S. Department of Health and Human Services hopes to 
aggregate and report data nationally. The Committee commends 
the efforts of the Administration for Children and Families 
[ACF] to measure the effectiveness of Head Start and to assess 
progress among Head Start children. In order to ensure that the 
National Reporting System is effectively meeting its objective, 
the Committee urges ACF to utilize an independent organization 
to review the test's validity and its impact on instruction.
    The Committee acknowledges Head Start's effort to test both 
English and Spanish language speakers. Currently, the 
determining factor for which language version will be 
administered is the child's repeated failure to comprehend 
questions posed in English. The Committee urges ACF to review 
this policy in order to minimize any potential unintended 
consequences for children and the teacher-child relationship.
    The Committee intends that no Head Start agency, Head Start 
center, or Early Head Start center receiving financial 
assistance available through this Act shall provide 
compensation for any of its employees (including program 
directors) in excess of the salary of the Secretary of the 
Department of Health and Human Services and that each Head 
Start agency, Head Start center, or Early Head Start center 
receiving financial assistance available through this Act shall 
maintain and annually submit to the Secretary, a complete 
accounting of its administrative expenses, including expenses 
for salaries and compensation funded under this subchapter 
disaggregated by employee.
    It has come to the Committee's attention that one Head 
Start grantee did not adequately obtain parental consent before 
performing a health screening on Head Start students which 
included intrusive physical examinations. The Committee 
believes that Head Start agencies receiving financial 
assistance available through this Act should obtain written 
parental consent before administration of, or referral for, any 
health care service provided or arranged to be provided, 
including any non-emergency intrusive physical examination of a 
child in connection with participation in a Head Start program. 
This should not in any way be interpreted to prohibit agencies 
from using established methods for handing cases of suspected 
or known child abuse and neglect that are in compliance with 
applicable Federal, State, or tribal law.
    The Committee is interested meeting the goal of this 
important program through the efficient and effective 
expenditure of Head Start program funds. With respect to 
training activities of Head Start agencies and providers, the 
Committee is concerned that funds provided under this section 
shall not be used for long-distance travel expenses for 
training activities that are substantially similar to training 
activities that are locally or regionally available. The 
Committee would like to note that this is not intended to 
automatically prevent attendance in National Conferences within 
the 50 United States.

Consolidated Runaway and Homeless Youth Program

    The Committee recommends $95,000,000 for fiscal year 2005 
for the consolidated runaway and homeless youth program. The 
comparable funding level for fiscal year 2004 is $89,431,000 
and the budget request includes $89,447,000 for this program. 
The Committee recommends $49,181,000 for basic centers and 
$46,819,000 for transitional living programs.
    This program addresses the crisis needs of runaway and 
homeless youth and their families through support to local and 
State governments and private agencies. Basic centers and 
transitional living programs help address the needs of some of 
the estimated 500,000 to 1.5 million and homeless youth, many 
of whom are running away from unsafe or unhealthy living 
environments. These programs have been proven effective at 
supporting positive youth development, securing stable and safe 
living arrangements and providing the skills required to engage 
in positive relationships with caring adults and contribute to 
society.
    Under current law the Runaway and Homeless Youth Act 
requires that not less than 90 percent of the funds be 
allocated to States for the purpose of establishing and 
operating community-based runaway and homeless youth centers, 
as authorized under Parts A and B of the Act. Funds are 
distributed 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.
    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 basic centers program, authorized under Part A of the 
Act, supports grants to community-based public and private 
agencies for the provision of outreach, crisis intervention, 
temporary shelter, counseling, family unification and aftercare 
services to runaway and homeless youth and their families.
    The transitional living program [TLP] 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.
    Under the new authorization, the maximum age limit for 
youth seeking shelter is reduced from 21 to 18, however there 
is an exception that allows youth in the program who have not 
reached age 18 to remain in the program after 540 days. Centers 
are now able to exceed the 20 youth capacity limit if the State 
requires a higher limit in order to be licensed under the Basic 
Center program. Finally, the allotment for Transitional Living 
Programs is increased to 45 percent and, under warranted 
conditions, to 55 percent.
    The Committee recommendation does not include the 
$10,000,000 requested in the budget for a separate maternity 
group homes program. The Committee is aware of the need for and 
shares the administration's interest in funding residential 
services for young mothers and their children who are unable to 
live with their own families because of abuse, neglect, or 
other circumstances. The Committee notes that pregnant and 
parenting youth are currently eligible for and served through 
the TLP.
    The Committee also recognizes the need for and value of 
expanding transitional living opportunities for all homeless 
youth. Therefore, the Committee seeks to preserve the 
flexibility afforded in current law to respond to the needs of 
the young people who are most at-risk and in greatest need of 
transitional living opportunities in their communities by 
providing additional resources to the existing portfolio of 
consolidated Runaway and Homeless Youth Act programs.
    It is the Committee's expectation that current and future 
TLP grantees will continue to provide transitional living 
opportunities and support to pregnant and parenting homeless 
youth, as is their current practice. To further ensure that 
pregnant and parenting homeless youth are able to access 
transitional living opportunities and support in their 
communities, the Committee encourages the Secretary, acting 
through the network of federally-funded runaway and homeless 
youth training and technical assistance providers, to offer 
guidance to grantees and others on the programmatic 
modifications required to address the unique needs of pregnant 
and parenting youth and on the various sources of funding 
available for residential services to this population.

Maternity Group Homes

    The Committee recommendation does not include the 
$10,000,000 requested in the budget for the maternity group 
homes program. Under this proposed program, the ACF would 
provide targeted funding for community-based, adult-supervised 
group homes for young mothers and their children. These homes 
would provide safe, stable, nurturing environments for mothers 
who cannot live safely with their own families and assist them 
in moving forward with their lives by providing support so they 
can finish school, acquire job skills, and learn to be good 
parents.
    The Committee expects the Family and Youth Services Bureau 
to continue to provide the technical assistance needed to 
enable TLP grantees and their community partners to address the 
unique needs of young mothers and their children, as well as 
helping interested entities in identifying sources of funding 
currently available to provide residential services to this 
population.

Runaway Youth Prevention Program

    The Committee recommends $15,802,000 for fiscal year 2005 
for the runaway youth prevention program. The comparable 
funding level for fiscal year 2004 is $15,302,000 and the 
budget request includes $15,302,000 for this program. 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. The goal of this program is to help young people leave 
the streets.

Child Abuse Prevention Programs

    The Committee recommends $61,886,000 for fiscal year 2005 
for child abuse prevention programs. The comparable funding 
level for fiscal year 2004 is $56,269,000 and the budget 
request includes $68,279,000 for this program. The 
recommendation includes $27,500,000 for State grants and 
$34,386,000 for discretionary activities.
    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.

Abandoned Infants Assistance

    The Committee recommends $12,052,000 for fiscal year 2005 
for abandoned infants assistance. The comparable funding level 
for fiscal year 2004 is $12,052,000 and the budget request 
includes $12,086,000 for this program.
    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 Services

    The Committee recommends $291,986,000 for fiscal year 2005 
for child welfare services. The comparable funding level for 
fiscal year 2004 is $289,320,000 and the budget request 
includes $291,986,000 for this program.
    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. These services are 
provided without regard to income.

Child Welfare Training

    The Committee recommends $7,470,000 for fiscal year 2005 
for child welfare training. The comparable funding level for 
fiscal year 2004 is $7,411,000 and the budget request includes 
$7,470,000 for this program.
    Under section 426, title IV-B of the Social Security Act, 
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.

Adoption Opportunities

    The Committee recommends $27,343,000 for fiscal year 2005 
for adoption opportunities. The comparable funding level for 
fiscal year 2004 is $27,103,000 and the budget request includes 
$27,343,000 for this program.
    This program eliminates barriers to adoption and helps find 
permanent homes for children who would benefit by adoption, 
particularly children with special needs.

Adoption Incentives

    The Committee recommends $32,103,000 for fiscal year 2005 
for adoption incentives. The comparable funding level for 
fiscal year 2004 is $7,456,000 and the budget request includes 
$32,103,000 for this program.
    The purpose of this program is to provide incentive funds 
to States to encourage an increase in the number of adoptions 
of children from the public foster care system. These funds are 
used to pay States bonuses for increasing their number of 
adoptions. The appropriation allows incentive payments to be 
made for adoptions completed prior to September 30, 2005.

Adoption Awareness

    The Committee recommends $12,906,000 for fiscal year 2005 
for adoption awareness. The comparable funding level for fiscal 
year 2004 is $12,785,000 and the budget request includes 
$12,906,000 for this program.
    This program was authorized in the Children's Health Act of 
2000. The program consists of two activities: the Infant 
Adoption Awareness Training Program and the Special Needs 
Awareness Campaign. The Infant Adoption Awareness Training 
Program provides grants to support adoption organizations in 
the training of designated health staff, in eligible health 
centers that provide health services to pregnant women, to 
inform them about adoption and make referrals on request on an 
equal basis with all other courses of action. Within the 
Committee recommendation, $9,906,000 is available for this 
purpose.
    The Special Needs Adoption Campaign supports grants to 
carry out a national campaign to inform the public about the 
adoption of children with special needs. The Committee 
recommendation includes $3,000,000 to continue this important 
activity.

Compassion Capital Fund

    The Committee recommends $47,702,000 for fiscal year 2005 
for the compassion capital fund. The comparable funding level 
for fiscal year 2004 is $47,702,000 and the budget request 
includes $100,000,000 for this program.
    The Committee expects funds made available through this 
program to supplement and not supplant private resources and 
encourages the Secretary to require private resources to match 
grant funding provided to public/private partnerships.
    Funds available will support grants to charitable 
organizations to emulate model social service programs and to 
encourage research on the best practices of social service 
organizations.

Social Services Research

    The Committee recommends $19,168,000 for fiscal year 2005 
for the social services research. The comparable funding level 
for fiscal year 2004 is $19,168,000 and the budget request 
includes $5,982,000 for this program.
    The Committee has funded $6,000,000 of this program through 
transfers available under section 241 of the Public Health 
Service Act. 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.
    The Committee notes ACF's efforts to assist States with 
meeting the extensive record-keeping, reporting, and tracking 
requirements of the TANF program. Working through the state 
information technology consortium, ACF is providing States with 
the tools necessary to strengthen and improve the complex IT 
systems required to support TANF. Similarly, on behalf of Child 
Support Enforcement, the consortium is helping to expand data 
exchange capabilities between the courts and State child 
support enforcement agencies as well as increase collection 
efficiency in States and tribal organizations. The Committee 
recommends that both collaborative efforts with the state 
information technology consortium be continued at their current 
levels.

Community-Based Resource Centers

    The Committee recommends $43,205,000 for fiscal year 2005 
for community-based resource centers. The comparable funding 
level for fiscal year 2004 is $33,205,000 and the budget 
request includes $65,002,000 for this program.
    These resources support two purposes: assisting each State 
in developing, operating, expanding, and enhancing a network of 
community-based, prevention-focused, family resource and 
support programs and supporting activities that foster an 
understanding, appreciation, and knowledge of diverse 
populations in order to be effective in preventing and treating 
child abuse and neglect.

Abstinence Education

    The Committee recommends $154,500,000 for fiscal year 2005 
for community based abstinence education. The comparable 
funding level for fiscal year 2004 is $124,549,000 and the 
budget request includes $236,426,000 for this program. Within 
the funds provided, $100,000,000 is provided for community-
based abstinence education, $4,500,000 is provided through an 
evaluation set-aside as requested by the administration, and 
$50,000,000 is provided as pre-appropriated mandatory funds.
    This program provides support for the development and 
implementation of abstinence education programs for 
adolescents, ages 12 through 18. These programs are unique in 
that their entire focus is to educate young people and create 
an environment within communities that supports teen decisions 
to postpone sexual activity until marriage.

Developmental Disabilities

    The Committee recommends $171,438,000 for fiscal year 2005 
for programs administered by the Administration on 
Developmental Disabilities. The comparable funding level for 
fiscal year 2004 is $164,772,000 and the budget request 
includes $164,854,000 for these programs. Within the funds 
provided, $156,526,000 is for carrying out the Developmental 
Disability Act, and $14,912,000 is for carrying out the Help 
America Vote Act of 2002.
    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 ADD also administers monies for 
election assistance for individuals with disabilities. This 
program is for individuals with any type of disability.
    Of the funds provided, the Committee recommends $73,081,000 
for State councils. These councils assist each State in 
promoting the development of a comprehensive, statewide, 
consumer and family-centered system which provides a 
coordinated array of culturally-competent services, and other 
assistance for individuals with development disabilities. State 
councils undertake a range of activities including 
demonstration of new approaches, program and policy analysis, 
interagency collaboration and coordination, outreach and 
training.
    The Committee recommends $40,000,000 for protection and 
advocacy grants. 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.
    The Committee recommends $11,642,000 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 potential benefits that assistive technology can 
have for individuals with developmental disabilities. Of these 
funds, $4,000,000 is available to expand activities of the 
Family Support Program. The Committee's placement of funds for 
family support within the Projects of National Significance 
account does not provide ACF with discretion on this definition 
of family support as defined in Title II of the Developmental 
Disability Act. The Committee makes a crucial distinction 
between support services designed for families of children with 
disabilities and support services designed for an individual 
with a disability. The Committee intends that these funds be 
used for the support and assistance of families of children 
with disabilities, in accordance with the statute.
    The Committee recommends $31,803,000 for university-
affiliated programs. This program consists of a network of 
centers that are interdisciplinary education, research and 
public service units of a university system, or are public or 
non-profit entities associated with universities. These centers 
conduct research, develop evidence based practices and teach 
thousands of parents, professionals, students, and people with 
disabilities about critical disability areas such as early 
intervention, health care, community-based services, inclusive 
and meaningful education, transition from school to work, 
employment, housing, assistive technology, aging with a 
disability and transportation. The centers serve as the major 
vehicle to translate disability related research into community 
practice and service systems and to train the next cohort of 
future professionals who will provide services and supports to 
an increasingly diverse population of people with disabilities. 
The increase provided in the bill will allow funding for 
existing centers to reach the authorized level, support new 
center grants in five States that currently have unserved or 
underserved populations, and establish four new centers that 
specialize in minority health disparities and education issues.
    The Committee recommends $14,912,000 for disabled voter 
services. Of these funds, $10,000,000 is to promote disabled 
voter access, and the remaining $4,912,000 is for disabled 
voters protection and advocacy systems. The election assistance 
for individuals with disabilities program was authorized in the 
Help America Vote Act of 2002. The program enables an applicant 
to establish, expand, and improve access to, and participation 
by, any individual with a disability in the election process.

Native American Programs

    The Committee recommends $45,157,000 for fiscal year 2005 
for Native American programs. The comparable funding level for 
fiscal year 2004 is $45,157,000 and the budget request includes 
$45,155,000 for this program.
    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 continues its significant interest in the 
revitalization of native languages through education. The 
Committee encourages ANA to allocate additional resources to 
support the Native American Languages program and urges the ANA 
to make schools a part of this effort, consistent with the 
policy expressed in the Native American Languages Act.

Community Services

    The Committee recommends $727,650,000 for fiscal year 2005 
for the community services programs. The comparable funding 
level for fiscal year 2004 is $731,284,000 and the budget 
request includes $552,350,000 for this program.
    Within the funds provided, the Committee recommends 
$650,000,000 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 rejects the administration's recommendation 
to cut the community services block grant funding. Although a 
restrictive Committee allocation prevented CSBG funding from 
being substantially increased this year, the Committee 
continues to recognize the importance of CSBG and the Community 
Action Agencies it funds in helping meet the extraordinary 
challenges facing low-income communities.
    The Nation's Community Action Agency network relies on CSBG 
funding to help initiate and administer programs designed to 
alleviate poverty. The universal characteristic of these CSBG-
funded programs is that they provide people with the resources 
and the tools to become self-sufficient. The Committee 
understands that the Department of Health and Human Services, 
and its Office of Community Services in particular, could 
better use this network in developing future policy 
initiatives. The Committee notes that in a number of States, 
including Iowa and Pennsylvania, CAA-initiated family 
development and self-sufficiency programs are a integral 
component of welfare reform efforts. The administration is 
encouraged to look for further nationwide linkages between 
those individuals seeking to leave the welfare system and 
become self-sufficient and the many family development and 
self-sufficiency strategies operated by Community Action 
Agencies.
    The Committee expects the Office of Community Services to 
release funding to States in the most timely manner. The 
Committee also expects States to make funds available promptly. 
The Committee is aware that the Office of Community Services 
and some States have been extraordinarily delinquent in 
providing funds to local eligible entities.
    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 2005: community economic 
development, $38,000,000, of which $2,000,000 is for 
neighborhood innovation projects; individual development 
accounts, $24,912,000; rural community facilities, $7,500,000; 
and community food and nutrition, $7,238,000. The Committee did 
not provide funds for the national youth sports program.
    The Committee continues to support strongly the Community 
Economic Development program because of the substantial record 
of achievement that Community Development Corporations have 
complied in working in distressed urban and rural communities. 
The Committee, in particular, notes that Federal funds leverage 
substantial non-Federal resources in meeting the objectives of 
this program. Therefore, it is the Committee's intent that 
appropriated funds should be allocated to the maximum extent 
possible in the form of grants to qualified Community 
Development Corporations in order to maximize the leveraging 
power of the Federal investment and the number and amount of 
set-asides should be reduced to the most minimal levels.
    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. The Committee has 
included bill language clarifying that Federal funds made 
available through this program may be used for financing for 
construction and rehabilitation and loans or investments in 
private business enterprises owned by Community Development 
Corporations.
    The Committee recognizes that manufacturing is an important 
part of the economic base in urban communities and rural areas. 
The Committee notes that recent research indicates that very 
little venture or equity capital makes it into this sector and 
this is particularly the case for manufacturing businesses 
located in economically distressed communities. The Committee 
is aware that a number of community development corporations 
[CDCs] have provided financing to manufacturing businesses in 
low income areas.
    A principal source of capital for CDCs is Community 
Economic Development Grants. The Committee recommendation 
includes an additional $3,500,000 above the budget request for 
the purpose of providing technical and financial assistance to 
manufacturing enterprises. The Committee intends that these 
funds be made available to experienced CDCs with a record of 
lending or investing in manufacturing. Further, the Committee 
intends these funds to be used for providing technical 
assistance and financial assistance--including loans and 
investments for plants, equipment and working capital--to 
manufacturing businesses. Of the total provided, the Committee 
has included $5,481,000 for the Job Creation Demonstration 
authorized under the Family Support Act to target community 
development activities to create jobs for people on public 
assistance. This demonstration program provides grants on a 
competitive basis to non-profit organizations to create new 
employment and business opportunities for TANF recipients and 
other low-income individuals. Funding also supports technical 
and financial assistance for private employers that will result 
in the creation of full-time permanent jobs for eligible 
individuals. The Committee recognizes that continued funding of 
the Job Creation Demonstration program would provide 
opportunities for more low-income individuals. As in the past, 
the Committee expects that a priority for grants under this 
program go to experienced community development corporations.
    Within the funds provided, the Committee has also included 
$2,000,000 for neighborhood innovation projects (42 USC 
9921(a)(4)) to enable the Office of Community Services to 
participate with the Department of Housing and Urban 
Development, foundations, and financial institutions.
    Most of the drinking water and wastewater 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 funds available from the Rural Community 
Facilities Program to assist a number of communities in gaining 
access to adequate community facilities, gaining financing for 
new or improved water and wastewater systems and in complying 
with Federal standards.
    The Committee has included bill language allocating funding 
to the Office of Community Services for Rural Community 
Facilities Technical Assistance as authorized under section 
680(3)(B) of the Community Services Block Grant Act. In 
providing this funding, the Committee expects that it be used 
solely for the purpose of improving water and wastewater 
facilities in poor, rural communities. As in the past, these 
funds should be allocated to regional, rural community 
assistance programs.
    The Committee is concerned that many small and very small 
community water and wastewater treatment systems might be most 
vulnerable to terrorist attack, and yet least prepared to deal 
with the issue. The Committee urges OCS to continue to support 
RCAP Small Community Infrastructure Safety and Security 
Training and Technical Assistance project, which provides 
State, regional and national infrastructure safety and security 
training workshops and on-site technical assistance targeted to 
small and very small community water and wastewater treatment 
systems. The goal of the project is to improve the capacity of 
small systems to better prepare for emergencies, develop 
emergency preparedness training manuals for small water 
systems, identify appropriate technologies to secure such 
systems, and provide technical assistance to small communities 
struggling to deal with these issues.

Domestic Violence Hotline

    The Committee recommends $3,500,000 for fiscal year 2005 
for the national domestic violence hotline. The comparable 
funding level for fiscal year 2004 is $2,982,000 and the budget 
request includes $3,000,000 for this program.
    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.

Battered Women's Shelters

    The Committee recommends $128,000,000 for fiscal year 2005 
for battered women's shelters program. The comparable funding 
level for fiscal year 2004 is $125,648,000 and the budget 
request includes $125,648,000 for this program.
    This is a formula grant program to support community-based 
projects which operate shelters and provide related assistance 
for victims of domestic violence and their dependents. Emphasis 
is given to projects which provide counseling, advocacy, and 
self-help services to victims and their children.

Early Learning Opportunities Program

    The Committee recommends $36,000,000 for fiscal year 2005 
for early learning opportunities program. The comparable 
funding level for fiscal year 2004 is $33,580,000 and the 
budget request did not include funds for this program.
    This program supports grants to local community councils 
comprised of representatives from agencies involved in early 
learning programs, parent organizations and key community 
leaders. Funds are used to increase the capacity of local 
organizations to facilitate development of cognitive skills, 
language comprehension and learning readiness; enhance 
childhood literacy; improve the quality of early learning 
programs through professional development and training; and 
remove barriers to early learning programs.

Faith-Based Center

    The Committee recommends $1,386,000 for fiscal year 2005 
for the operation of the Department's Center for Faith-Based 
and Community Initiatives. The comparable funding level for 
fiscal year 2004 is $1,386,000 and the budget request includes 
$1,400,000 for this program.

Mentoring Children of Prisoners

    The Committee recommends $50,000,000 for fiscal year 2005 
for mentoring children of prisoners. The comparable funding 
level for fiscal year 2004 is $49,701,000 and the budget 
request includes $50,000,000 for this program.
    The mentoring children of prisoners program was authorized 
in 2001 under section 439 of the Social Security Act. The 
purpose of this program is to help children while their parents 
are imprisoned and includes activities that keep children 
connected to a parent in prison in order to increase the 
chances that the family will come together successfully when 
the parent is released. As a group, children of prisoners are 
less likely than their peers to succeed in school and more 
likely to become engaged in delinquent behavior.

Independent Living Training Vouchers

    The Committee recommends $44,734,000 for fiscal year 2005 
for independent living training vouchers. The comparable 
funding level for fiscal year 2004 is $44,734,000 and the 
budget request includes $60,000,000 for this program.
    These funds will support vouchers of up to $5,000 for 
college tuition, or vocational training for individuals who age 
out of the foster care system so they can be better prepared to 
live independently and contribute productively to society. 
Studies have shown that 25,000 youth leave foster care each 
year at age 18 and just 50 percent will have graduated high 
school, 52 percent will be unemployed and 25 percent will be 
homeless for one or more nights.

Promotion of Responsible Fatherhood and Healthy Marriage

    The Committee does not provide funds for fiscal year 2005 
for promotion of responsible fatherhood and healthy marriage. 
The budget request includes $50,000,000 for this new program 
designed to promote responsible fatherhood and responsible 
marriage. The purpose of this proposed program, for which 
authorizing legislation is pending, is to spur approaches at 
State and community levels to assist fathers to be more 
actively and productively involved in the lives of their 
children.

Program Administration

    The Committee recommends $190,206,000 for fiscal year 2005 
for program administration. The comparable funding level for 
fiscal year 2004 is $177,894,000 and the budget request 
includes $190,206,000 for this program.
    The Committee urges ACF to continue to make progress in 
improving its Annual Performance Plan and Annual Performance 
Report. The Committee notes that many programs proposed for 
funding do not have solid data for baselines or performance 
outcome measures. This lack of objective data makes more 
difficult the Committee's decisions regarding the allocation of 
limited resources. The Committee believes that the Agency 
should work with program grantees and relevant associations to 
identify the most objective ways in which to evaluate the 
effectiveness of ACF programs and establish a timeline for 
producing meaningful data by which programs can be assessed. 
The Committee urges that steps be taken to improve this 
situation and expects information regarding such actions to be 
included in the fiscal year 2006 congressional justification.
    The Committee continues its interest in the Department's 
Child and Family Services reviews. These reviews are an 
effective method for monitoring the progress States are making 
in assuring the safety, health, and permanency for children in 
child welfare and foster care as required in the Adoption and 
Safe Families Act. The Committee encourages the Department to 
make available sufficient resources to ensure full 
implementation of the new collaborative monitoring system.

                   PROMOTING SAFE AND STABLE FAMILIES

Appropriations, 2004....................................    $404,383,000
Budget estimate, 2005...................................     505,000,000
Committee recommendation................................     404,383,000

    The Committee recommends $404,383,000 for fiscal year 2005 
for promoting safe and stable families. The comparable funding 
level for fiscal year 2004 is $404,383,000 and the budget 
request includes $505,000,000 for this program.
    Funding available provides grants to States in support of: 
(1) family preservation services; (2) time-limited family 
reunification services; (3) community-based family support 
services; and, (4) adoption promotion and support services. The 
Committee notes that most of the Federal funding related to 
child welfare is provided for the removal and placement of 
children outside of their own homes. Funds available through 
the Promoting Safe and Stable Families program are focused on 
supporting those activities that can prevent family crises from 
emerging which might require the temporary or permanent removal 
of a child from his or her own home.
    The Promoting Safe and Stable Families program is comprised 
of $305,000,000 in capped entitlement funds authorized by the 
Social Security Act and $99,383,000 in discretionary 
appropriations.

       PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE

Appropriations, 2004....................................  $5,068,300,000
Budget estimate, 2005...................................   5,037,900,000
Committee recommendation................................   5,037,900,000

    The Committee recommends $5,037,900,000 for fiscal year 
2005 for payments to States for foster care and adoption 
assistance. The comparable funding level for fiscal year 2004 
is $5,068,300,000 and the budget request includes 
$5,037,900,000 for this program. In addition, the Committee 
recommendation concurs with the administration's request of 
$1,767,200,000 for an advance appropriation for the first 
quarter of fiscal year 2006.
    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.
    The Independent Living Program provides services to foster 
children under 18 and foster youth ages 18-21 to help them make 
the transition to independent living by engaging in a variety 
of services including educational assistance, life skills 
training, health services and room and board. States are 
awarded grants from the annual appropriation proportionate to 
their share of the number of children in foster care, subject 
to a matching requirement.

                        Administration on Aging

Appropriations, 2004....................................  $1,373,917,000
Budget estimate, 2005...................................   1,376,527,000
Committee recommendation................................   1,395,117,000

    The Committee recommends an appropriation of $1,395,117,000 
for aging programs. This amount is $21,200,000 above the 
comparable fiscal year 2004 level and $18,590,000 above the 
administration request.

Supportive Services and Senior Centers

    The Committee recommends an appropriation of $357,000,000 
for supportive services and senior centers, which is $3,111,000 
above the comparable fiscal year 2004 level and the same as the 
administration request. This State formula grant program funds 
a wide range of social services for the elderly, including 
multipurpose senior centers, adult day care 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 and those residing in rural areas. Under the basic 
law, States have the option to transfer up to 30 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.

Preventive Health Services

    The Committee recommends $21,919,000 for preventive health 
services, which is the same as the administration request. The 
comparable fiscal year 2004 level was $21,790,000. 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.
    The Committee is pleased that the budget request includes 
$5,500,000 to expand medication management, screening and 
education activities, including the use of new medication 
management devices, to prevent incorrect medication and adverse 
drug reactions among the elderly.

Protection of Vulnerable Older Americans

    The Committee recommends $20,474,000 for grants to States 
for protection of vulnerable older Americans. This is 
$1,030,000 above the comparable fiscal year 2004 level and 
$1,915,000 above the administration request. Within the 
Committee recommendation, $15,276,000, an increase of 
$1,000,000 over the fiscal year 2004 level, is for the 
ombudsman services program and $5,198,000 is for the prevention 
of elder abuse program. 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 encourages the Administration on Aging to 
fund a demonstration grant program in support of the activities 
authorized under Title VII, Subtitle B of the Older Americans 
Act for programs directed to preventing abuse, neglect, and 
exploitation of older individuals in Indian Country. Funds 
should be used for education programs directed toward 
increasing awareness of elder abuse in Indian Country and on 
developing enforceable codes at the tribal level.

National Family Caregiver Support Program

    The Committee recommends $157,000,000 for the national 
family caregiver support program, which is $4,262,000 above the 
comparable fiscal year 2004 level and $1,488,000 above the 
administration request. Funds appropriated for this activity 
established a multifaceted support system in each State for 
family caregivers. All States are expected to implement the 
following five components into their program: individualized 
referral information services; assistance to caregivers in 
locating services from a variety of private and voluntary 
agencies; caregiver counseling, training and peer support; 
respite care provided in the home, an adult day care center or 
other residential setting located in an assisted living 
facility; and limited supplemental services that fill remaining 
service gaps.

Native American Caregiver Support Program

    The Committee recommendation includes $6,355,000 to carry 
out the Native American Caregiver Support Program, which is the 
same as the administration request. The comparable fiscal year 
2004 level was $6,318,000. The program will assist tribes in 
providing multifaceted systems of support services for family 
caregivers and for grandparents or older individuals who are 
relative caregivers. In fiscal year 2004, funds were used to 
provide both discretionary and formula grants to support the 
goals of this program.

Congregate and Home-delivered Nutrition Services

    For congregate nutrition services, the Committee recommends 
an appropriation of $388,646,000, which is $2,293,000 above the 
comparable fiscal year 2004 level and the same as the 
administration request. For home-delivered meals, the Committee 
recommends $180,985,000, which is $1,068,000 above the 
comparable fiscal year 2004 level and the same as the 
administration request. 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 40 percent of funds between these programs.

Nutrition Services Incentives Program

    The Committee recommendation includes $149,183,000 for the 
nutrition services incentives program, the same as the 
administration request. The comparable fiscal year 2004 funding 
level was $148,191,000. This program, which was transferred 
from the Department of Agriculture in fiscal year 2003, 
augments funding for congregate and home-delivered meals 
provided to older adults. Funds provided under this program are 
dedicated exclusively to the provision of meals. NSIP rewards 
effective performance by States and Tribal organizations in the 
efficient delivery of nutritious meals to older individuals 
through the use of cash or commodities.

Aging Grants to Indian Tribes and Native Hawaiian Organizations

    The Committee recommends $26,612,000 for grants to native 
Americans, which is $159,000 above the fiscal year 2004 
comparable level and the same as the administration request. 
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 supportive services and assure that nutrition 
services and information and assistance are available.
    The Committee recognizes that this program is the primary 
vehicle for providing nutrition and other supportive services 
to Indian, Alaska Native, and Native Hawaiian elders. The 
Committee urges the Administration on Aging to devote its 
attention toward this purpose.

Training, Research and Discretionary Projects

    The Committee recommends $37,647,000 for training, 
research, and discretionary projects. The comparable fiscal 
year 2004 level was $33,509,000. These funds support activities 
designed to expand public understanding of aging and the aging 
process, apply social research and analysis to improve access 
to and delivery of services for older individuals, test 
innovative ideas and programs to serve older individuals, and 
provide technical assistance to agencies that administer the 
Older Americans Act. Given the enormous demands on Alzheimer's 
family caregivers, the Committee has included $1,000,000 to 
support an Alzheimer's family contact center for round-the-
clock help to Alzheimer's families in crisis.
    The Committee continues to support funding at no less than 
last year's level for national programs scheduled to be 
refunded in fiscal year 2005 that address a variety of issues, 
including elder abuse, native American issues and legal 
services.
    The Committee is aware of the high incidence of chronic 
diseases among elders in Indian Country. The Committee 
encourages the agency to carry out a demonstration program 
directed at decreasing health disparities through prevention 
and wellness outreach. The Committee also recommends that the 
agency continue and expand programs that focus on improving 
access to social services by elders in Indian Country.
    The Committee encourages the Administration on Aging to 
facilitate the expansion of demonstration projects gauging the 
efficiency of nurse-managed Geriatric Wellness Centers.
    The Committee is concerned about the prevalence of 
undiagnosed and untreated mental illness among older Americans. 
Disorders such as anxiety, depression, and dementia are common 
in older patients, but often go undetected. The Committee urges 
the Administration on Aging to study the benefits of 
integrating mental health treatment for older adults with 
primary medical treatment, commonly referred to as 
collaborative care.
    The Committee expects the Administration on Aging to 
continue to fund the national program of statewide senior legal 
services hotlines (also called legal helplines) at their 
current levels and ideally to provide an increase in the number 
of States served by these legal hotlines.

Aging Network Support Activities

    The Committee recommends $13,373,000 for aging network 
support activities, the same as the administration request. The 
comparable amount for fiscal year 2004 was $13,294,000. The 
Committee recommendation includes $1,199,000 for the Eldercare 
Locator and $1,180,000 for the pension information and 
counseling projects.
    The Eldercare Locator, a toll-free, nationwide directory 
assistance service for older Americans and their caregivers, is 
operated by the National Association of Area Agencies on Aging. 
Since 1991, the service has linked more than 700,000 callers to 
an extensive network of resources for aging Americans and their 
caregivers.
    Pension counseling projects provide information, advice, 
and assistance to workers and retirees about pension plans, 
benefits, and how to pursue claims when pension problems arise. 
The information dissemination and outreach activities of the 
pension counseling projects have served over 25,000 people and 
has helped obtain more than $50,000,000 in retirement benefits 
for older individuals.
    The Committee has provided funding at the administration 
request level for the National Long Term Care Ombudsman 
Resource Center, the National Center on Elder Abuse and the 
Health Care Anti-Fraud, Waste and Abuse Program.

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 20 years. The Committee recommends a funding 
level of $12,883,000 for Alzheimer's disease demonstration 
grants to States. This is $1,000,000 above the comparable 
fiscal year 2004 level and $1,383,000 above the administration 
request.
    Currently, an estimated 70 percent of individuals with 
Alzheimer's disease live at home, where families provide the 
preponderance of care. For these families, caregiving comes at 
enormous physical, emotional and financial sacrifice. The 
Alzheimer's disease demonstration grant program currently 
provides matching grants to 37 States to stimulate and better 
coordinate services for families coping with Alzheimer's. With 
a relatively small amount of Federal support to provide the 
stimulus, States have found innovative ways to adapt existing 
health, long-term care, and community services to reach 
previously underserved populations, particularly minorities and 
those living in rural communities.

White House Conference on Aging

    The Committee recommends $4,558,000 for the White House 
Conference on Aging, which is the same level as the 
administration request. These funds are available until 
September 30, 2007. Funds will be used for start up costs for 
the Conference, which will be held prior to December 31, 2005 
and is required by the Older Americans Act Amendments of 2000.

Program Administration

    The Committee recommends $18,482,000 to support Federal 
staff that administer the programs in the Administration on 
Aging, which is the same as the administration request. These 
funds provide administrative and management support for 
programs administered by the agency.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2004....................................    $360,069,000
Budget estimate, 2005...................................     437,822,000
Committee recommendation................................     382,555,000

    The Committee recommends $382,555,000 for general 
departmental management [GDM]. The comparable level for fiscal 
year 2004 was $360,069,000 and the administration request was 
$437,822,000. The Committee recommendation includes the 
transfer of $5,851,000 from Medicare trust funds, which is the 
same as the administration request.
    The Committee directs that specific information requests 
from the chairman and ranking member of the Subcommittee on 
Labor, Health and Human Services, and Education, and Related 
Agencies, on scientific research or any other matter, shall be 
transmitted to the Committee on Appropriations in a prompt 
professional manner and within the time frame specified in the 
request. The Committee further directs that scientific 
information requested by the Committees on Appropriations and 
prepared by Government researchers and scientists be 
transmitted to the Committee on Appropriations, uncensored and 
without delay.
    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 has provided $3,634,000 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 understands that there are nearly 400,000 
frozen embryos in fertility clinics in the United States and 
only approximately 2 percent of these are donated to other 
couples in order to bear children. The Committee continues to 
believe that increasing public awareness of embryo donation and 
adoption remains an important goal and therefore directs the 
Department to continue its embryo adoption awareness campaign. 
The Committee has provided $1,000,000 for this purpose.
    The Committee recommendation includes $3,000,000 for the 
Secretary to establish a Citizens' Health Care Working Group as 
authorized in Section 1014 of the Medicare Prescription Drug, 
Improvement and Modernization Act of 2003.
    Childhood Drinking.--The Committee understands that new 
research from the National Institute on Alcohol Abuse and 
Alcoholism shows that serious drinking problems previously 
associated with adulthood actually begin to emerge during 
childhood and adolescence. In this context, alcohol abuse and 
dependence are best characterized as developmental disorders 
that begin during ages that are a critical time for cognitive 
and physiological growth. These findings underscore the public 
health challenge of preventing childhood drinking, as well as 
raising the age of first use of alcohol.
    The Committee commends the Secretary for establishing the 
Interagency Coordinating Committee on the Prevention of 
Underage Drinking [ICCPUD] and applauds the SAMHSA 
Administrator for taking a strong leadership role. The ICCPUD's 
interim report describes the steps involved in developing a 
coordinated plan for combating underage drinking and lists the 
related current and planned activities by the numerous Federal 
agencies involved in this effort. The Committee was 
disappointed to see that the Surgeon General is not engaged in 
any activities specifically intended to reduce underage 
drinking, nor does he plan any such activities in the near 
future. The Committee notes that the Surgeon General has a 
unique role that involves advocating for effective disease 
prevention and health promotion programs, as well as providing 
a highly recognized symbol of national commitment to combating 
public health threats. The Surgeon General, as the Nation's top 
doctor, has issued Reports and Calls to Action in the past to 
focus National attention on important public health issues such 
as suicide prevention, youth violence and obesity. The 
Committee believes that the Surgeon General must be fully 
engaged in the effort to combat childhood drinking. Therefore, 
the Committee strongly urges the Surgeon General, in 
coordination with SAMHSA, to issue a Call to Action on the 
health crisis of underage drinking.
    Diabetes.--The Committee is aware and very supportive of 
the Secretary's recently announced Diabetes Detection 
Initiative, but is concerned about meeting the treatment needs 
of all the newly diagnosed patients with diabetes. The 
Committee is aware of the valuable services that certified 
diabetes educators provide to newly diagnosed patients--
teaching them the necessary skills they need to self-manage the 
disease throughout their life including nutrition, exercise, 
blood sugar monitoring and medication management. The Committee 
urges the Secretary to dedicate appropriate resources to 
conduct demonstrations to measure the effectiveness of diabetes 
self-management training in preventing diabetes and the 
complications it causes.
    HIV1-2 Rapid Testing.--The Committee is aware that wide-
scale deployment of new oral fluid testing for AIDS is a 
significant step towards helping citizens, throughout the 
United States and around the world, to know their HIV status. 
The Committee urges the Secretary to significantly increase the 
use of bulk purchasing and wide-scale deployment of FDA-
approved oral fluid HIV1-2 rapid tests for domestic and 
international programs.
    National Children's Study.--The Committee strongly supports 
full and timely implementation of the National Children's 
Study, which aims to quantify the impacts of a broad range of 
environmental influences on child health and development. The 
Committee urges the Department to coordinate the involvement of 
the CDC and the NICHD, and to work closely with the EPA and 
other interested institutes, agencies and non-Federal partners 
conducting research on children's environmental health and 
development so that this study is ready for the field by no 
later than 2006.
    Pharmacy Services.--The Committee encourages the Department 
to begin a study on comprehensive pharmacy services in light of 
changes in technology, distance and distributive learning 
models, the aging of the population and the Department's study 
on the severe pharmacist shortage in order to analyze how they 
may influence the nature of pharmaceutical education and 
interventions in healthcare.
    Public Health Training.--The Committee is aware that public 
health physicians play an important role in the Federal, State 
and local public health infrastructure and are critical for 
public health preparedness. However, currently there is not a 
generally agreed upon model for training physicians for public 
health careers. Therefore, the Committee has included $500,000 
for a study by the Institute of Medicine to determine what 
knowledge and skills are needed by public health physicians; 
what type of training program would prepare physicians for 
public health careers; how many training programs are needed to 
maintain an adequate public health physician workforce; and how 
these training programs should be funded.
    Transportation Coordination.--The Committee notes with 
approval the increased attention being paid to the coordination 
of human services with transportation. The Committee notes the 
recent executive order issued by the President calling for a 
report on transportation coordination within 1 year. The 
Committee expects the Department, as a lead agency mentioned in 
the executive order, to report its finding to the Committee as 
soon as the study is finished.
    Vision Screening.--The Committee is concerned that many 
children in the United States have uncorrected vision problems, 
such as amblyopia, that can lead to difficulty in school and 
permanent vision loss. Amblyopia, also known as ``lazy eye,'' 
is the leading cause of vision loss in young Americans, yet 
many children do not receive timely diagnosis or treatment for 
the condition. The Committee encourages the Secretary to 
examine ways to increase the number of children that receive an 
eye exam from an eye doctor in order to reduce vision loss in 
children.

Adolescent Family Life

    The Committee has provided $37,500,000 for the Adolescent 
Family Life Program [AFL], which is $6,554,000 above the 
comparable fiscal year 2004 level. The administration request 
was $54,349,000.
    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 has included 
$2,500,000 for the development of a National Abstinence 
Education Campaign. This campaign will help parents communicate 
with their children about the health risks associated with 
premarital activity.

Minority Health

    The Committee recommends $53,351,000 for the Office of 
Minority Health. The comparable level for fiscal year 2004 was 
$55,190,000 and the administration request was $47,236,000.
    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 continues to support the National Minority 
Male Health Project and urges the Office of Minority Health to 
fund a consortium of historically black colleges and 
universities [HBCUs] to plan for the implementation of this 
project. The Committee understands that Bowie State University, 
Lincoln University, Morehouse College, Morgan State University 
and Wilberforce University will be part of the initial group of 
demonstration institutions. The Committee urges OMH to dedicate 
adequate funds to expand support to the existing HBCUs and to 
add other minority-serving institutions.
    The Committee commends the OMH for establishing in 2003 a 
public and private partnership to address the protective and 
risk factors identified in the Aberdeen Area Infant Mortality 
Study. In 2004 the Committee included $1,000,000 to reduce SIDS 
disparity rates and provide risk reduction education to African 
American and American Indian populations in the United States. 
The Committee was pleased that the Deputy Secretary chose to 
supplement the Committee's effort, resulting in an $8,650,000 
infant mortality reduction initiative. However the Committee is 
disappointed to note the lack of any notification about the 
change in scope and direction of the $1,000,000 provided by the 
Committee, nor of the diversion of funds from other maternal 
and child health programs. In addition, the Committee is 
concerned that the fiscal year 2005 budget justifications 
include no information about the future of this initiative. The 
Committee directs the Secretary to report on the progress of 
the Deputy Secretary's infant mortality initiative and 
specifically on the SIDS portion of that initiative no later 
than July 1, 2005, and to include adequate information 
pertaining to the initiative in the Department's fiscal year 
2006 budget request.

Office on Women's Health

    The Committee recommends $29,103,000 for the Office on 
Women's Health, the same as the administration request. The 
comparable level for fiscal year 2004 was $28,915,000.
    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.
    The Committee remains strongly supportive of the work done 
by the Office on Women's Health in the Office of the Secretary. 
In addition to its own work advancing women's health, it 
provides critical coordinating services with offices located in 
NIH, CDC, HRSA, FDA, SAMHSA, AHRQ, and CMS. In totality, these 
offices assure that issues related to research, treatment, 
services, training, and education efforts by HHS reflect the 
distinct needs of women. The Secretary should notify the 
Committee in advance of any changes planned for the status, 
location, or reporting structure of this office or any of the 
offices enumerated above.

HIV/AIDS in Minority Communities

    To address high-priority HIV prevention and treatment needs 
of minority communities heavily impacted by HIV/AIDS, the 
Committee recommends $52,838,000. This amount is $3,294,000 
above the comparable fiscal year 2004 level and the same as the 
administration request. 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.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2004....................................     $39,094,000
Budget estimate, 2005...................................      40,323,000
Committee recommendation................................      40,323,000

    The Committee recommends an appropriation of $40,323,000 
for the Office of Inspector General, which is the same as the 
administration request. The fiscal year 2004 comparable level 
was $39,094,000. In addition to discretionary funds, the Health 
Insurance Portability and Accountability Act of 1996 provides 
$160,000,000 in mandatory funds for the Office of Inspector 
General in fiscal year 2005; the total funds provided to the 
Office by this bill and the authorizing bill would be 
$200,323,000 in fiscal year 2005.
    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.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 2004....................................     $33,901,000
Budget estimate, 2005...................................      35,357,000
Committee recommendation................................      35,357,000

    The Committee recommends $35,357,000 for the Office for 
Civil Rights. This is the same as the administration request. 
The comparable fiscal year 2004 level was $33,901,000. The 
recommendation includes the transfer of $3,314,000 from the 
Medicare trust funds.
    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, 2004....................................     $20,750,000
Budget estimate, 2005...................................      28,750,000
Committee recommendation................................      28,750,000

    The Committee recommends $28,750,000 for policy research 
funded through transfers available under section 241 of the 
Public Health Service Act. The comparable program level for 
fiscal year 2004 was $20,750,000. The increase in funding in 
fiscal year 2005 will provide support for the National 
Electronic Health Information Initiative and the Current 
Population Survey.
    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.

     RETIREMENT PAY AND MEDICAL BENEFITS FOR COMMISSIONED OFFICERS

Appropriations, 2004....................................    $321,763,000
Budget estimate, 2005...................................     330,636,000
Committee recommendation................................     330,636,000

    The Committee provides an estimated $330,636,000 for 
retirement pay and medical benefits for commissioned officers 
of the U.S. Public Health Service, the same as the 
administration request. The comparable level for fiscal year 
2004 was $321,763,000.
    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.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2004....................................  $2,164,003,000
Budget estimate, 2005...................................   2,225,058,000
Committee recommendation................................   2,330,058,000

    The Committee recommends $2,330,058,000 for the Public 
Health and Social Services Emergency Fund, which is 
$105,000,000 above the administration request and $166,055,000 
above the comparable level for fiscal year 2004.
    The Committee provides $934,454,000 to CDC for upgrading 
State and local capacity. This amount is $105,106,000 above the 
administration request and the same as the comparable level for 
fiscal year 2004. The Committee continues to recognize that 
bioterrorism events will occur at the local level and will 
require local capacity, preparedness and initial response. It 
is the Committee's intent that significant funding for State 
and local public health infrastructure be used to improve local 
public health capacity and meet the needs determined by local 
public health agencies. The Committee's intent remains firm. 
Because it is essential to the Nation's public health readiness 
that bioterrorism funding be made available at the local level, 
the Committee urges the CDC and the Department to ensure that 
monies appropriated for State and local capacity building be 
spent to improve local public health readiness in a manner with 
which local public health officials concur. It is expected that 
local public health agencies are and will continue to be full 
partners in developing State plans.
    Within the total for State and local capacity, the 
Committee has included at least the same amount as last year 
for the Health Alert Network [HAN]. To ensure that these funds 
continue to be used to improve local capacity for electronic 
communications and data exchange, the Committee encourages CDC 
to provide adequate funding to improve public health capacity 
for electronic communication and data exchange at the local 
level in a manner consistent with the Public Health Information 
Network and with which local public health officials concur. 
This will enable enhanced local capacity that has resulted from 
HAN funding to continue.
    The Committee intended that one function of HAN was to 
assure that essential, time-sensitive public health information 
become available to both State and local public health agencies 
in a timely manner. The Committee is concerned about reports 
from localities, including large cities, participating in HAN 
that they are not receiving all CDC-generated messages promptly 
because such messages are going only to their State agencies. 
Recognizing that both timeliness and redundancy in 
communications are important in addressing urgent public health 
concerns, the Committee strongly urges CDC to ensure that all 
local public health agencies receive CDC information on the 
same timely basis as do States.
    Of the total amount provided, the Committee recommends 
$400,000,000 for the Strategic National Stockpile, $157,183,000 
for upgrading CDC capacity, $17,934,000 for anthrax vaccine 
research, and $130,000,000 for biosurveillance activities.
    The Committee remains concerned about the emergence of new 
infectious diseases and the increasing zoonotic disease 
transmission between animals and humans. As noted in last 
year's report, some thirty previously unheard of infectious 
diseases have been discovered in the last 30 years. Increases 
in human and animal air travel and global commerce provide more 
opportunities for infectious diseases like SARS, monkey pox and 
avian flu to spread. The Committee notes that wild animal 
veterinarians, often located at zoos in populated urban areas, 
are sometimes the first to see these diseases and can 
contribute significantly to the detection and understanding of 
these diseases. The Committee commends the CDC's efforts to 
merge surveillance systems of State diagnostic labs, veterinary 
labs, wildlife health agencies and zoos, and urge the CDC to 
consider the usefulness of including institutions with live 
animal collections in the new biosurveillance initiative.
    The Committee has again included bill language to exempt 
employees of the CDC or the Public Health Service, detailed as 
field assignees for purposes related to homeland security, from 
full-time equivalent [FTE] employment limitations, 
administrative ceilings, or targets. The effect of the bill 
language is to furnish States, municipalities, and other 
organizations with a sufficient number of field assignees to 
implement important public health programs related to homeland 
security.
    The Committee's recommendation includes $64,438,000 for the 
Office of the Secretary and $75,000,000 for activities to 
ensure an adequate supply of vaccine in the event of an 
influenza pandemic.
    The Committee provides $503,649,000 to HRSA for 
bioterrorism activities. Of this amount, $27,705,000 is for 
curriculum development and training, and $475,944,000 is for 
hospital preparedness and infrastructure improvements related 
to bioterrorism. The Committee intends that States use these 
funds to develop hospital preparedness in a manner that is 
consistent with State and local bioterrorism preparedness 
plans. The Committee expects the Department will ensure that 
hospitals receiving funds have consulted with the local public 
health agency (or State agency where no local agency exists) 
and that the hospitals' uses of these funds are fully 
coordinated with local, regional and State bioterrorism 
preparedness plans.
    The Committee recognizes the role community health centers 
play in bioterrorism preparedness and response for millions of 
underserved individuals, and therefore continues to support the 
inclusion of both health centers and State and regional primary 
care associations in bioterrorism preparedness and response 
funding at the Federal, State and local levels.
    The Committee's recommendation includes $47,400,000 for the 
National Institutes of Health. These funds will be used for 
research into the development of nuclear and radiological 
countermeasures.

      General Provisions, Department of Health and Human Services

    The Committee recommendation includes language placing a 
$50,000 ceiling on official representation expenses (sec. 201).
    The Committee recommendation includes language carried in 
fiscal year 2003 which limits the assignment of certain public 
health personnel (sec. 202).
    The Committee recommendation retains language 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 2003 and 2004 to limit the use of grant funds to 
pay individuals no more than an annual rate of Executive Level 
I (sec. 204).
    The Committee recommendation retains language carried in 
fiscal year 2003 restricting the Secretary's use of taps for 
program evaluation activities unless he submits a report to the 
Appropriations Committees on the proposed use of funds (sec. 
205).
    The Committee recommendation includes language authorizing 
the transfer of up to 2.5 percent of Public Health Service 
funds for evaluation activities (sec. 206).
    The Committee recommendation contains language restricting 
transfers or reprogramming of appropriated funds between 
programs, projects, and activities, and requires 15 day 
notification to both the House and Senate Appropriations 
Committees (sec. 207).
    The Committee recommendation retains language carried in 
fiscal year 2003 permitting the transfer of up to 3 percent of 
AIDS funds among Institutes and Centers by the Director of NIH 
and the Director of the Office of AIDS Research at NIH (sec. 
208).
    The Committee recommendation retains language which 
requires that the use of AIDS research funds be determined 
jointly by the Director of the National Institutes of Health 
and the Director of the Office of AIDS Research and that those 
funds be allocated directly to the Office of AIDS Research for 
distribution to the Institutes and Centers consistent with the 
AIDS research plan (sec. 209).
    The Committee recommendation retains language carried in 
fiscal year 2003 regarding requirements for family planning 
applicants (sec. 210).
    The Committee recommendation retains language which 
restricts the use of funds to carry out the MedicareChoice 
Program if the Secretary denies participation to an otherwise 
eligible entity (sec. 211).
    The Committee recommendation retains language which States 
that no provider services under Title X of the PHS Act may be 
exempt from State laws regarding child abuse (sec. 212).
    The Committee recommendation retains language carried in 
fiscal year 2004 extending the refugee status of persecuted 
religious groups (sec. 213).
    The Committee recommendation retains language which 
prohibits the Secretary from withholding substance abuse 
treatment funds (sec. 214).
    The Committee recommendation includes language carried in 
fiscal year 2003 which facilitates the expenditure of funds for 
international AIDS activities (sec. 215).
    The Committee recommendation includes a provision allowing 
the Division of Federal Occupational Health to use personal 
services contracting to employ professional, administrative, 
and occupational health professionals (sec. 216).
    The Committee recommendation includes bill language 
allowing use of funds to continue operating the Council on 
Graduate Medical Education (sec. 217).
    The Committee recommendation retains a provision carried in 
fiscal year 2004 authorizing the Director of the National 
Institutes of Health to enter into certain transactions to 
carry out research in support of the NIH Roadmap Initiative of 
the Director (sec. 218).
    The Committee recommendation includes a provision that 
$10,000 of the amount provided under the Public Health Services 
but may be used for official representation expenses under 
sections 399 and 499 of that Act (sec. 219).
    The Committee recommendation rescinds $199,900,000 of the 
unobligated balance of funds appropriated by section 1016 of 
the Medicare Modernization Act for a facilities loan fund. The 
Committee recommendation includes funding for such activities 
directly in appropriations accounts, rather than through 
authorizing Committee action (sec. 220).
    The Committee recommendations includes a requirement that 
none of the funds provided in this Act may be expended to apply 
the criteria, commonly known as the Medicare ``75 percent 
rule'', that are used to determine whether a hospital or unit 
of a hospital is an inpatient rehabilitation facility. The 
Committee is concerned that this new rule has severe 
consequences for access to inpatient services. The Committee 
directs the Secretary of Health and Human Services to contract 
with the Institute of Medicine of the National Academy of 
Sciences to study and make recommendations on a clinical 
consensus on how to modernize the Medicare criteria used to 
distinguish an inpatient rehabilitation facility from an acute 
care hospital and other providers of intensive medical 
rehabilitation, and the appropriate medical necessity criteria 
for determining clinical appropriateness of inpatient 
rehabilitation facility admissions. Under the contract, the 
Institute is expected to use a panel that includes a multi-
disciplinary group of expert researchers and clinicians in the 
field of medical rehabilitation, and report its recommendations 
to the Secretary and Congress not later than October 1, 2005 
(sec. 221).
    The Committee recommendation includes language authorizing 
the Secretary of Health and Human Services to make 
demonstration grants to accredited universities and/or 
community colleges to establish summer health career 
introductory programs for middle school and high school 
students (sec. 222).
    The Committee recommendation includes a provision 
transferring $35,000,000 from the $1,000,000,000 appropriated 
to HHS under the Medicare Modernization Act to the Office of 
the Inspector General for work related to the oversight of that 
Act (sec. 223).

                   TITLE III--DEPARTMENT OF EDUCATION

                    Education for the Disadvantaged

Appropriations, 2004.................................... $14,443,641,000
Budget estimate, 2005...................................  15,202,466,000
Committee recommendation................................  15,500,684,000

    The Committee recommends an appropriation of 
$15,500,684,000 for education for the disadvantaged. The 
comparable funding level for fiscal year 2004 is 
$14,443,641,000 and the budget request includes $15,202,466,000 
for this account.
    The programs in the education for the disadvantaged account 
help ensure that poor and low-achieving children are not left 
behind in the Nation's effort to raise the academic performance 
of all children and youth. That goal is more pressing than ever 
since the passage of the No Child Left Behind Act, which 
incorporates numerous accountability measures into Title I 
programs, especially part A grants to local educational 
agencies--the largest Federal elementary and secondary 
education program.
    In particular, the new law strengthens Title I 
accountability by requiring States to implement statewide 
accountability systems covering all public schools and 
students. These systems must be based on challenging State 
standards in reading and mathematics, annual statewide progress 
objectives ensuring that all groups of students reach 
proficiency in reading and math by the end of the 2013-14 
school year, and annual testing for all students in grades 3-8. 
State progress objectives and assessment results must be broken 
out by poverty, race and ethnicity, disability, and limited 
English proficiency. States, school districts, and schools must 
report annually on their progress toward statewide proficiency 
goals. Districts and schools that fail to make adequate yearly 
progress [AYP] toward these goals will, over time, be subject 
to increasingly rigorous improvement, corrective action, and 
restructuring measures aimed at getting them back on course to 
meet State standards. Students attending schools that fail to 
meet annual State AYP objectives for 2 consecutive years will 
be permitted to transfer to a better public school or, if the 
school continues to fail to meet AYP for 3 years or more, to 
use Title I funds to obtain educational services from a public-
or private-sector provider selected by their parents.
    Funds appropriated in this account primarily support 
activities in the 2005-2006 school year.

Grants to Local Educational Agencies

    Title I Grants to Local Educational Agencies [LEAs] provide 
supplemental education funding, especially in high-poverty 
areas, for local programs that provide extra academic support 
to help raise the achievement of eligible students or, in the 
case of schoolwide programs, help all students in high-poverty 
schools to meet challenging State academic standards. The 
program serves more than 15 million students in nearly all 
school districts and more than half of all public schools--
including two-thirds of the Nation's elementary schools.
    Title I schools help students reach challenging State 
standards through one of two models: ``targeted assistance'' 
that supplements the regular education program of individual 
children deemed most in need of special assistance, or a 
``schoolwide'' approach that allows schools to use Title I 
funds--in combination with other Federal, State, and local 
funds--to improve the overall instructional program for all 
children in a school.
    Starting with the fiscal year 2004 appropriation, States 
are required to reserve 4 percent of their allocation under 
this program for school improvement activities, double the 
requirement in fiscal year 2003. States must distribute 95 
percent of these reserved funds to local educational agencies 
for schools identified for improvement, corrective action, or 
restructuring. At the level of the Committee recommendation, 
this set-aside will generate more than $520,000,000 for school 
improvement activities.
    More than any other Federal program, Title I grants to LEAs 
are critical to the success of the No Child Left Behind Act. 
The Committee recommends $13,457,607,000 for this program. The 
comparable funding level for fiscal year 2004 is 
$12,339,607,000 and the budget request includes $13,339,607,000 
for Title I grants to LEAs. The Committee recommendation 
proposes an increase of 54 percent over the amount provided 
prior to passage of the No Child Left Behind Act. These Federal 
resources represent the significant commitment this Committee 
has made to provide the resources necessary to help all 
children succeed in school.
    The budget request includes bill language that authorizes 
the use of $10,000,000 of Title I grants to LEAs by the 
Secretary to support National Leadership activities, including 
identifying and disseminating best practices undertaken by 
school districts for closing the achievement gap and for 
ensuring and supporting compliance with the No Child Left 
Behind Act. The Committee bill does not include the requested 
language.
    Title I grants are distributed through four formulas: 
basic, concentration, targeted, and education finance incentive 
grant [EFIG].
    For Title I basic grants, including the amount transferred 
to the Census Bureau for poverty updates, the Committee 
recommends an appropriation of $7,104,447,000. The comparable 
funding level for fiscal year 2004 and the budget request are 
both $7,034,890,000 for the basic grants funding stream. Basic 
grants are awarded to school districts with at least 10 poor 
children who make up more than 2 percent of enrollment.
    The Committee bill includes language which provides 
$71,557,000 from the amount made available under basic grants 
to those States scheduled to receive, in aggregate, less funds 
under the title I grants program for the 2004-2005 school year 
than they received for the 2003-2004 school year. These funds 
supplement funds previously appropriated for the 2004-2005 
school year. The Committee has taken this action because of the 
statutorily required change from bi-annual to annual updates 
for poverty estimates that occurred this year and the 
significant shifts that resulted from that statuary change. 
These additional funds will allow affected States to allocate 
funds for the 2004-2005 school year to offset partially reduced 
allocations to many LEAs under Title I formulas.
    For concentration grants, the Committee recommends an 
appropriation of $1,365,031,000. The comparable funding level 
for fiscal year 2004 and the budget request are both 
$1,365,031,000. Funds under this program are distributed 
according to the basic grants formula, except that they go only 
to LEAs where the number of poor children exceeds 6,500 or 15 
percent of the total school-aged population.
    Last year, Congress provided all of the additional funding 
for Title I grants to LEAs above the fiscal year 2003 level 
through the EFIG and targeted formulas. The Committee 
recommends allocating all of the increase proposed this year in 
a similar manner. The Committee notes that analysis conducted 
by the Congressional Research Service has demonstrated that 
these formulas deliver a larger share of Title I funds to high-
poverty school districts than any other Title I formula. In 
addition, the EFIG formula uses State-level ``equity'' and 
``effort'' factors to make allocations to States that are 
intended to encourage States to spend more on education and to 
improve the equity of State funding systems. Once State 
allocations are determined, suballocations to the LEA level are 
based on a modified version of the targeted grants formula, 
described below.
    The targeted grants formula weights child counts to make 
higher payments to school districts with high numbers or 
percentages of poor students. For these grants, the Committee 
recommends an appropriation of $2,231,954,000. The comparable 
funding level for fiscal year 2004 is $1,969,843,000 and the 
budget request includes $4,146,187,000 for this funding stream.
    The Committee recommends an appropriation of $2,756,175,000 
for education finance incentive grants. The comparable funding 
level for fiscal year 2004 is $1,969,843,000 and the budget 
request includes $793,499,000 for the EFIG funding stream.

William F. Goodling Even Start Family Literacy Program

    The Committee does not recommend any funding in fiscal year 
2005 for the Even Start program. The comparable funding level 
for fiscal year 2004 is $246,910,000 and the budget request 
does not include any funds for this program.
    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.

Reading First State Grants

    The Committee recommends $1,062,000,000 for the Reading 
First State Grants program. The comparable funding level for 
fiscal year 2004 is $1,023,923,000 and the budget request 
includes $1,125,000,000 for the Reading First State Grants 
program. The Committee remains very supportive of the 
President's goal of providing $5,000,000,000 over a 5-year 
period for the Reading First program. The Committee 
recommendation, in addition to amounts previously appropriated 
for this program, brings the 4-year total up to $3,979,423,000. 
Since President Bush took office, Federal funding for reading 
programs has grown by more than 290 percent.
    Reading First is a comprehensive effort to provide States 
and LEAs with funds to implement comprehensive reading 
instruction for children in grades K-3. The purpose of the 
program is to help ensure that every child can read by the end 
of third grade. LEAs and schools that receive funds under this 
program should use the money to provide professional 
development in reading instruction for teachers and 
administrators, adopt and use reading diagnostics for students 
in grades K-3 to determine where they need help, implement 
reading curricula that are based on scientific research, and 
provide reading interventions for children who are not reading 
at grade level.

Early Reading First

    The Committee recommends $110,000,000 for the Early Reading 
First program. The comparable funding level for fiscal year 
2004 is $94,439,000 and the budget request includes 
$132,000,000 for Early Reading First.
    Early Reading First complements Reading First State Grants 
by providing competitive grants to school districts and 
nonprofit groups to support activities in existing preschool 
programs that are designed to enhance the verbal skills, 
phonological awareness, letter knowledge, pre-reading skills, 
and early language development of children ages 3 through 5. 
Funds are targeted to communities with high numbers of low-
income families.

Striving Readers

    The Committee recommends $25,000,000 for the Striving 
Readers initiative. The budget request includes $100,000,000 
for a new program intended to improve the reading skills of 
secondary school students. This new initiative would help 
develop, implement, and evaluate reading interventions for 
middle- or high-school students reading significantly below 
grade level. To carry out this proposed initiative, awards will 
be made to partnership including institutions of higher 
education, eligible nonprofit or for-profit organization and 
school districts with one or more high or middle schools that 
include a significant number or students reading below grade 
level.

Improving Literacy Through School Libraries

    The Committee recommends $22,842,000 for the Improving 
Literacy Through School Libraries program. The comparable 
funding level for fiscal year 2004 and the budget request both 
are $19,842,000 for the Improving Literacy Through School 
Libraries program.
    This program provides funds for urgently needed, up-to-date 
school library books and training for school library media 
specialists in order to support the scientifically based 
reading programs authorized by the Reading First initiative. 
LEAs with a child-poverty rate of at least 20 percent are 
eligible for the competitive awards. Funds may be used to 
acquire school library media resources, including books and 
advanced technology; facilitate resource-sharing networks among 
schools and school libraries; provide professional development 
for school library media specialists; and provide students with 
access to school libraries during non-school hours.

Migrant Education Program

    The Committee recommends $393,577,000 for the Migrant 
Education program. The comparable fiscal year 2004 funding 
level and the budget request are both $393,577,000 for the 
Migrant Education program.
    The Title I Migrant Education 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 actual counts of migratory 
children ages 3 through 21 residing within the States in the 
previous year. Only migratory children who have moved within 
the last 3 years are generally eligible to be counted and 
served by the program.
    This appropriation also supports activities to improve 
interstate and intrastate coordination of migrant education 
programs, as well as identifying and improving services to the 
migrant student population.

Neglected and Delinquent

    The Committee recommends $52,000,000 for the Title I 
neglected and delinquent program. The comparable funding level 
for fiscal year 2004 and the budget request both are 
$48,395,000 for the neglected and delinquent program.
    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 at least 15 percent, but 
not more than 30 percent, of their neglected and delinquent 
funds to help students in State-operated institutions make the 
transition into locally operated programs and to support the 
successful reentry of youth offenders, who are age 20 or 
younger and have received a secondary school diploma or its 
recognized equivalent. Reentry activities may include 
strategies designed to expose the youth to, and prepare the 
youth for, postsecondary education, or vocational and technical 
training programs. The Committee urges the Secretary to provide 
appropriate technical assistance to States in identifying and 
implementing best practices for effectively utilizing funds 
available for transition services and other activities.
    Under the No Child Left Behind Act, the Congress provided 
the Secretary with the authority to reserve up to 2.5 percent 
of the appropriation for national activities. The Committee 
urges the Secretary to fully utilize this authority to support 
capacity building in and dissemination of best practices to 
State agency programs and to develop a uniform model for 
evaluating State performance under this program.

Evaluation

    The Committee recommends $9,500,000 for evaluation of Title 
I programs. The comparable funding level for fiscal year 2004 
is $8,790,000 and the budget request includes $9,500,000 for 
such activities.
    Evaluation funds are used to support large-scale national 
surveys that examine how the Title I programs are contributing 
to student academic achievement. Funds also are used to 
evaluate State assessment and accountability systems and 
analyze the effectiveness of educational programs supported 
with Title I funds.
    The Committee bill includes language that provides the 
Secretary with authority to use funds for technical assistance 
to State and local educational agencies. The Committee 
encourages the Secretary to focus these funds on disseminating 
best practices through school leadership, supporting 
professional development, and identifying and disseminating 
exceptional methods used to communicate with parents.

Assistance for Local School Improvement

    The Committee recommendation includes $100,000,000 for the 
Assistance for Local School Improvement program. This program 
has not been funded previously and the budget request did not 
include any funds for this purpose.
    The Assistance for Local School Improvement program was 
authorized by the No Child Left Behind Act. This program 
authorizes the Secretary to make grants to States for 
additional assistance to school districts identified for 
improvement. Funds may be used to support the implementation of 
school improvement plans, public school choice, supplemental 
services or other activities related to schools identified for 
improvement.
    Together with more than $520,000,000 available through the 
school improvement set aside required from State Title I 
allocations, these funds will provide a record level of Federal 
support for assisting schools identified for improvement and 
supporting public school choice and supplemental services for 
students in low performing schools.

Comprehensive School Reform Demonstration

    The Committee recommends $233,613,000 for the comprehensive 
school reform demonstration program. The comparable funding 
level for fiscal year 2004 is $233,613,000 and the budget 
request did not include any funds for the comprehensive school 
reform program.
    This program provides schools with funding to develop or 
adopt, and implement, comprehensive school reforms that will 
enable children in participating schools to meet State 
standards. The Department allocates funds to States based on 
their relative shares of the previous year's Title I basic 
grants funds.

High School Equivalency Program

    The Committee recommends $18,888,000 for the high school 
equivalency program [HEP]. The comparable funding level for 
fiscal year 2004 and the budget request both are $18,888,000 
for the HEP.
    This program provides 5-year grants to institutions of 
higher education and other nonprofit organizations to recruit 
migrant students ages 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. At the 
budget request, HEP will serve roughly 5,500 migrants.

College Assistance Migrant Program

    For the College Assistance Migrant Program [CAMP], the 
Committee recommends $15,657,000. The comparable funding level 
for fiscal year 2004 and the budget request both are 
$15,657,000 for the CAMP.
    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 
follow-up services after students have completed their first 
year of college, including assistance in obtaining student 
financial aid.

                               Impact Aid

Appropriations, 2004....................................  $1,229,527,000
Budget estimate, 2005...................................   1,229,527,000
Committee recommendation................................   1,229,527,000

    The Committee recommends an appropriation of $1,229,527,000 
for impact aid for the Department of Education. The comparable 
funding level for fiscal year 2004 and the budget request both 
are $1,229,527,000 for the impact aid account.
    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.
    The Committee notes that the administration is working to 
develop an ``analysis plan'' to measure the performance of the 
Impact Aid program. The Committee is committed to utilizing 
performance outcome information to assess the effectiveness of 
Federal programs and to determine their appropriate funding 
levels. Therefore, the Committee requests a copy of the 
``analysis plan'' as soon as it is available, and also expects 
appropriate discussion of activities related to the plan to be 
included in the fiscal year 2006 Justifications of 
Appropriation Estimates to the Congress.
    Basic Support Payments.--The Committee recommends 
$1,063,687,000 for basic support payments. The comparable 
funding level for fiscal year 2004 and the budget request both 
are $1,063,687,000. Under this statutory formula, payments are 
made on behalf of all categories of federally connected 
children, with a priority placed on making payments first to 
heavily impacted school districts and providing any remaining 
funds for regular Basic Support Payments.
    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 
$50,369,000 for this purpose. The comparable funding level and 
the budget request both are $50,369,000.
    Facilities Maintenance.--This activity provides funding for 
emergency repairs and comprehensive capital improvements to 
certain school facilities owned by the Department of Education 
and used by local educational agencies to serve federally 
connected military dependent students. The Committee recommends 
$7,901,000. The comparable funding level for fiscal year 2004 
and the budget request both are $7,901,000 for this purpose. 
Funds appropriated for this purpose are available until 
expended.
    Construction.--Formula and competitive grants are awarded 
to eligible LEAs for emergency repairs and modernization of 
school facilities. The Committee recommends $45,936,000 for 
this program. Funds appropriated for the construction activity 
are available for obligation for a period of 2 years. The 
comparable fiscal year 2004 funding level and the budget 
request both are $45,936,000 for construction activities.
    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 LEAs 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 
$61,634,000 for this activity. The comparable funding level for 
fiscal year 2004 and the budget request both are $61,634,000 
for this program.

                      School Improvement Programs

Appropriations, 2004....................................  $5,872,847,000
Budget estimate, 2005...................................   5,955,561,000
Committee recommendation................................   5,770,632,000

    The Committee recommends an appropriation of $5,770,632,000 
for school improvement programs. The comparable funding level 
in fiscal year 2004 for this account is $5,872,846,000 and the 
budget request includes $5,955,561,000.

State Grants for Improving Teacher Quality

    The No Child Left Behind Act requires States to ensure that 
all teachers teaching in core academic subjects are ``highly 
qualified'' by the end of the 2005-2006 school year. The 
Committee recommends $2,975,126,000 for State grants for 
improving teacher quality. The comparable funding level for 
fiscal year 2004 and the budget request both are 
$2,930,126,000.
    Under the Committee recommendation, funding for programs 
that specifically support high-quality professional development 
for teachers and school leadership will have increased by 43 
percent since passage of the No Child Left Behind Act. The 
Committee recommendation for fiscal year 2005 includes 
$3,640,034,000 for such activities in recognition of the 
critical role that these individuals occupy in educating the 
Nation's children and the significant academic benefit that 
students may derive from the presence of a highly qualified 
teacher in their classroom. In addition, State and local 
educational agencies have considerable flexibility to use funds 
from their Title I grants to LEAs allocations, as well as other 
State grant program dollars in support of high-quality 
professional development opportunities.
    States and LEAs may use the funds for a range of activities 
related to the certification, recruitment, professional 
development, and support of teachers and administrators. 
Activities may include reforming teacher certification and 
licensure requirements, addressing alternative routes to State 
certification of teachers, recruiting teachers and principals, 
and implementing teacher mentoring systems, teacher testing, 
merit pay, and merit-based performance systems.
    These funds may also be used by districts to hire teachers 
to reduce class sizes. The Committee recognizes that smaller 
classes, particularly in the early grades, can have a positive 
impact on students by improving classroom discipline, providing 
students with more individualized attention, and allowing 
parents and teachers to work more closely together. Funds 
within the teacher quality State grants program may be used to 
continue this commitment to our Nation's students, parents, and 
teachers, without taking away from other efforts to invest in 
professional development.

Early Childhood Educator Professional Development

    The Committee recommends $14,814,000 to support 
professional development activities for early childhood 
educators and caregivers in high-poverty communities. The 
comparable funding level for fiscal year 2004 and the budget 
request are both $14,814,000 for this program. From this 
appropriation, the Secretary makes competitive grants to 
partnerships of early childhood and family literacy caregivers 
and educators in order to provide high quality, sustained and 
intensive professional development for early childhood 
educators to help them provide developmentally appropriate 
school-readiness services for preschool-age children.

Mathematics and Science Partnerships

    The Committee recommends $200,000,000 for the mathematics 
and science partnerships program. The comparable funding level 
for fiscal year 2004 is $149,115,000 and the budget request 
includes $269,115,000 for this purpose. These funds will be 
used to improve the performance of students in the areas of 
math and science by bringing math and science teachers in 
elementary and secondary schools together with scientists, 
mathematicians, and engineers to increase the teachers' 
subject-matter knowledge and improve their teaching skills. 
When the appropriation for this program is $100,000,000 or 
greater, the Secretary is authorized to award grants to States 
by a formula which includes consideration of the number of 
children aged 5 to 17 below the poverty line. States then are 
required to make grants competitively to eligible partnerships 
to enable the entities to pay the Federal share of the costs of 
developing or redesigning more rigorous mathematics and science 
curricula that are aligned with State and local standards; 
creating opportunities for enhanced professional development 
that improves the subject-matter knowledge of math and science 
teachers; recruiting math and science majors; and improving and 
expanding training of math and science teachers, including the 
effective integration of technology into curricula and 
instruction.
    The budget request includes a legislative proposal to allow 
the Secretary to use $120,000,000 in appropriated funds to make 
competitive awards to projects designed to improve the 
mathematics learning of secondary students. The Committee has 
not provided this requested authority.

Innovative Education Program Strategies State Grants

    The Committee does not recommend any funding for innovative 
education program strategies State grants. The comparable 
funding level for fiscal year 2004 and the budget request both 
are $296,549,000 for this purpose. The Committee recommendation 
does not provide an appropriation for this source of funding 
due to the significantly enhanced flexibility authorized under 
No Child Left Behind, the lack of evidence of effectiveness in 
contributing to improved student learning and the importance of 
investments in other areas where a system for measuring program 
performance is in place.
    The innovative education program is a flexible source of 
Federal funds that provides support to States and LEAs in 
developing education reform initiatives that will improve the 
performance of students, schools, and teachers.
    The Committee notes that States and LEAs may transfer funds 
into this State grant program for authorized activities 
described in Part A of Title V of the Elementary and Secondary 
Education Act, even though no funding is provided in this 
fiscal year 2005 appropriations bill. The Committee encourages 
States and LEAs to transfer funds from one of the eligible 
State grant programs if they believe Federal funds can be 
better utilized under this authority to improve the academic 
achievement of all students.

Educational Technology State Grants

    The Committee recommends $691,841,000 for educational 
technology State grants. The comparable funding level for 
fiscal year 2004 and the budget request both are $691,841,000 
for this program.
    The educational technology State grants program supports 
efforts to integrate technology into curricula to improve 
student learning. Funds flow by formula to States and may be 
used for the purchase of hardware and software, teacher 
training on integrating technology into the curriculum, and 
efforts to use technology to improve communication with 
parents, among other related purposes. An LEA must use at least 
25 percent of its formula allocation for professional 
development in the integration of technology into the curricula 
unless it can demonstrate that it already provides such high-
quality professional development.

21st Century Community Learning Centers

    The Committee recommends an appropriation of $1,007,000,000 
for the 21st Century Community Learning Centers program. The 
comparable funding level for fiscal year 2004 and the budget 
request both are $999,070,000 for this program.
    Funds are allocated to States by formula, which in turn, 
award at least 95 percent of their allocations to local 
educational agencies, community-based organizations and other 
public and private entities. Grantees use these resources to 
establish or expand community learning centers that provide 
activities offering significant extended learning 
opportunities, such as before- and after-school programs, 
recreational activities, drug and violence prevention and 
family literacy programs for students and related services to 
their families. Centers must target their services on students 
who attend schools that are eligible to operate a schoolwide 
program under Title I of the Elementary and Secondary Education 
Act or serve high percentages of students from low-income 
families.

State Assessments and Enhanced Assessment Instruments

    The Committee recommends $420,000,000 for State 
assessments. The comparable funding level for fiscal year 2004 
is $390,000,000 and the budget request includes $410,000,000 
for such activities.
    A key accountability measure in the No Child Left Behind 
Act requires annual State assessments in reading and 
mathematics for all students in grades 3-8 beginning in the 
2005-2006 school year. The new assessments will be used to 
determine whether States, LEAs, and schools are making adequate 
yearly progress toward the goal of helping all students attain 
proficiency within 12 years of the 2001-2002 school year.
    This program has two components. The first provides formula 
grants to States to pay the cost of developing standards and 
assessments required by the new law. The statute includes 
funding ``trigger amounts'' for fiscal years 2002-2007; States 
may defer the new assessments if the appropriation falls below 
the trigger level. The trigger for fiscal year 2004 is 
$390,000,000 and it rises to $400,000,000 in fiscal year 2005. 
The Committee recommendation includes $400,000,000 for this 
purpose.
    Under the second component of State assessments--Grants for 
Enhanced Assessment Instruments--appropriations in excess of 
the trigger level are used for a competitive grant program 
designed to support efforts by States to improve the quality 
and fairness of their assessment systems. The Committee 
recommendation for the second component is $20,000,000. The 
budget request included $10,000,000 for enhanced assessment 
instruments. No funds were appropriated for this purpose in 
fiscal year 2004.
    The Committee is concerned that many schools are unable to 
properly assess the performance of students with disabilities 
and students with limited English proficiency. Therefore, the 
Committee urges the Department to place a high priority on 
grant applications that aim to improve the quality of State 
assessments for these two groups of students and to ensure the 
most accurate means of measuring their performance on these 
assessments.
    The Committee recommends that grants should be used for 
such activities as developing alternate assessments for 
students with disabilities and for students with limited 
English proficiency; developing appropriate accommodations to 
ensure the full participation of these two groups of students 
in State assessments; and developing universally designed 
assessments that are accessible and valid for the widest 
possible range of students, including students with 
disabilities and students with limited English proficiency.
    The Committee also recommends that States that receive 
grants should submit a report to the Secretary regarding the 
participation of students with disabilities and/or students 
with limited English proficiency in State assessment programs 
and changes, if any, in these students' achievement levels as a 
result of more accurate assessments.

Statewide Data Systems

    The Committee recommendation includes $40,000,000 for 
Statewide Data Systems. This program was not funded previously 
and the budget request did not include any funds for this 
purpose.
    The Educational Technical Assistance Act authorized a 
competitive grant program to State Educational Agencies to 
enable such agencies to design, develop, and implement 
statewide, longitudinal data systems to manage, analyze, 
disaggregate, and use individual student data. The Committee 
believes these funds are necessary to help States measure 
individual student performance, particularly as it relates to 
adequate yearly progress goals, more efficiently and 
accurately. The Committee urges the Department to establish a 
priority for those States that currently have the most limited 
ability to collect, analyze and report student achievement data 
when considering applications for funds available through this 
program.

Javits Gifted and Talented Education

    The Committee recommends $12,111,000 for the Javits Gifted 
and Talented Students Education Program. The comparable fiscal 
year 2004 funding level is $11,111,000 and the President's 
budget proposes to eliminate funding for this program. Funds 
are used for awards to State and local education agencies, 
institutions of higher education, and other 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.

Foreign Language Assistance

    The Committee recommends $19,000,000 for the Foreign 
Language Assistance program. The comparable funding level for 
fiscal year 2004 is $16,546,000 and the budget request proposes 
eliminating funds for foreign language assistance activities.
    Funds from this program support competitive grants to 
increase the quality and quantity of foreign language 
instruction. At least 75 percent of the appropriation must be 
used to expand foreign language education in the elementary 
grades. The Committee intends that none of the Foreign Language 
Assistance program funds shall be used for the Foreign Language 
Incentive program. The Committee is concerned that this 
program, which is the only Federal program designed to help 
schools meet the need for foreign language instruction, is 
unavailable to the poorest schools because grant recipients 
must provide a 50 percent match from non-Federal sources. The 
Committee, therefore, encourages the Secretary to use his 
ability to waive the matching requirement for qualifying 
schools and to increase awareness of this accommodation among 
the affected school population.

Education for Homeless Children and Youth

    For carrying out education activities authorized by Title 
VII, subtitle B of the Stewart B. McKinney Homeless Assistance 
Act, the Committee recommends $62,000,000. The comparable 
fiscal year 2004 funding level and the budget request both are 
$59,646,000.
    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 make subgrants to LEAs to support the 
education of those children. Grants are made to States based on 
the total that each State receives in Title I grants to LEAs.
    Under the McKinney-Vento Homeless Children and Youths 
Program, State educational agencies [SEAs] must ensure that 
homeless children and youth have equal access to the same free 
public education, including a public preschool education, as is 
provided to other children and youth. States must review and 
undertake steps to revise any laws, regulations, practices, or 
policies that may act as barriers to the enrollment, 
attendance, or success in school of homeless children and 
youth.

Training and Advisory Services

    For training and advisory services authorized by Title IV 
of the Civil Rights Act, the Committee recommends $7,243,000. 
The comparable fiscal year 2004 funding level and the budget 
request both are $7,243,000 for these services.
    The funds provided will support a new competition for 
awards to operate the 10 regional equity assistance centers 
[EACs]. Each EAC 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.

Education for Native Hawaiians

    For programs for the education of Native Hawaiians, the 
Committee bill includes $36,000,000. The comparable fiscal year 
2004 funding level and the budget request are both $33,302,000 
for these programs.
    The Committee bill includes language allowing funds to be 
used for construction and renovation of Native Hawaiian 
educational facilities.
    The Committee recognizes the important role that the Native 
Hawaiian Education Council plays in coordinating services, 
conducting needs assessments, and providing direction and 
guidance on educational and related services available to 
Native Hawaiians, including the activities assisted under this 
program. The Committee urges the Secretary to continue working 
with the Council to help it meet its congressionally-mandated 
mission, and, in particular, focus on helping create an 
appropriate mechanism for prioritizing activities within the 
Council's jurisdiction.
    The Committee encourages opportunities and educational 
programs be provided to restore cultural pride and stimulate 
the development of leadership skills by celebrating the Native 
Hawaiian heritage and seafaring traditions as long distance 
voyagers and ocean navigators.
    Of all the indigenous languages of the United States, the 
Hawaiian language has the most extensive written resources 
preserved. It has come to the attention of the Committee that a 
number of Hawaiian academic, cultural, and educational 
organizations have joined together to preserve and develop 
these written resources for contemporary use. Many of these 
traditional perspectives and practices could have practical 
application in resolving environmental management, medical and 
natural resource challenges. The Committee urges attention in 
this area.
    The Committee is interested in the preservation and 
recording of Hawaiian history through storytelling and 
encourages support for efforts underway in Hawaii to perpetuate 
these collections. The Committee also encourages efforts toward 
the preservation and documentation of Native Hawaiian 
traditional cultural healing practices.
    Fathering Programs.--In 1997, a Department of Education 
study found that children realize greater educational success 
when fathers are involved in their child's education. The 
Committee urges the Secretary devote special attention to this 
subject through this grant program, as there are no competitive 
grants for fathering programs. The Committee realizes great 
value in fathering programs as they seek to improve the lives 
of children by inspiring and equipping men to be more 
effectively engaged in the lives of children.
    Native Hawaiian Law Center of Excellence.--The Committee is 
very pleased with the efforts underway to establish a Center of 
Excellence in Native Hawaiian Law.
    Prisoner Education.--Native Hawaiians continue to represent 
a major, if not the largest, ethnic group in the 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. Significant progress has resulted over the past 
several years. Efforts should target Native Hawaiian youth in 
districts with high percentages of school dropouts and youth 
offenders.
    The numbers of Hawaiian language immersion schools and 
Hawaiian charter schools continue to increase as more families 
are opting to more closely integrate culture, language and 
education. The Committee is interested in greater development 
of curriculum especially at the early education and secondary 
levels, increasing the number of teachers certified in Hawaiian 
language, and disseminating best practices to this growing 
community of schools from pre-K through 12th grade.

Alaska Native Educational Equity

    The Committee recommends $36,000,000 for the Alaska Native 
educational equity assistance program. The comparable fiscal 
year 2004 funding level and the budget request both are 
$33,302,000 for this purpose.
    These funds address the severe educational handicaps of 
Alaska Native schoolchildren. Funds are used for the 
development of supplemental educational programs to benefit 
Alaska Natives. The Committee bill includes language which 
allows funding provided by this program to be used for 
construction. The Committee expects the Department to use some 
of these funds to address the construction needs of rural 
schools.

Rural Education

    The Committee recommends $175,000,000 for rural education 
programs. The comparable fiscal year 2004 funding level and 
budget request both are $167,831,000 for these programs.
    The Committee strongly supports the continued use of 
Federal funding specifically for rural education. Rural schools 
face difficult challenges in meeting the mandates in the No 
Child Left Behind Act, particularly in the areas of attracting 
highly qualified teachers and adapting to new assessment 
requirements and reporting expectations. The rural education 
programs are intended to help level the playing field for small 
and high-poverty rural school systems that typically receive 
less Federal formula funding than their urban and suburban 
counterparts, and are frequently unable to compete for 
competitive grants. In addition to providing more total funding 
for such districts, the program also allows these districts to 
combine funds from four categorical programs and use the money 
to address their highest priorities, such as recruiting 
teachers, purchasing technology, or upgrading curricula.
    The Committee expects that rural education funding will be 
equally divided between the Small, Rural Schools Achievement 
Program, which provides funds to LEAs that serve a small number 
of students, and the Low-Income and Rural Schools Program, 
which provides funds to LEAs that serve concentrations of poor 
students, regardless of the number of students served.

Comprehensive Centers

    The Committee recommends $57,283,000 for the comprehensive 
centers program. The comparable fiscal year 2004 funding level 
and budget request are both $27,654,000 for such activities.
    The budget request would support a new comprehensive 
centers program, which would be comprised of not less than 20 
centers with at least one in each of the 10 regions of the 
United States. The centers, which would be operated by research 
organizations, agencies, institutions of higher education or 
partnerships thereof, would provide training and technical 
assistance to States, LEAs, and schools as identified through 
needs assessments undertaken in each region.
    The new comprehensive centers program, as authorized by the 
Educational Technical Assistance Act of 2002, would replace the 
comprehensive regional assistance centers, the Eisenhower 
regional mathematics and science consortia, the Eisenhower 
National Clearinghouse for Mathematics and Science Education, 
and the regional technology in education consortia which are no 
longer authorized activities. The comprehensive regional 
assistance centers provide technical assistance and training 
through a network of 15 university-based or non-profit centers. 
The Eisenhower regional mathematics and science consortia 
program supports 10 regional centers that disseminate 
information about exemplary mathematics and science 
instructional materials, provide technical assistance on 
teaching methods and assessment tools and build networks of 
mathematics and science resources. The Mathematics and Science 
Clearinghouse is a resource for mathematics and science 
educators. The regional technology in education consortia 
program supports 10 regional centers that disseminate 
information and resources and provide training to States, 
school districts, and schools with a large number of 
disadvantaged students with limited access to technology.
    Fiscal year 2005 funds will be used to continue funding for 
existing grantees and support grants to carry out the new 
comprehensive centers program. The Committee believes it is 
important that training and technical assistance continue to be 
of high-quality and accessible to school districts during this 
transition year.

Supplemental Education Grants

    The Committee recommendation includes $17,214,000 for the 
supplemental education grants program. The comparable funding 
level for fiscal year 2004 and the budget request both are 
$15,068,000. This grant program was authorized by the Compact 
of Free Association Amendments Act of 2003. The Act 
discontinued the eligibility of Republic of Marshall Islands 
and the Federated States of Micronesia for funding available 
from Adult, Dislocated Worker and Youth Workforce Investment 
Act programs, Head Start, Title I Grants to LEAs, Adult and 
Vocational Education State Grants, Federal Work-Study and 
Federal Supplemental Educational Opportunities Grants. In place 
of funding from these sources, the Act provided a separate 
supplemental education grant program that provides these 
entities with a more flexible source of funds that can be 
tailored to local needs. These funds will be transferred from 
the Department of Education to the Secretary of Interior for 
grants to these entities, and up to 10 percent may be used for 
oversight and technical assistance, which may include 
reimbursement of the Departments of Labor, Health and Human 
Services and Education for such services. Of the funds 
appropriated, $11,717,000 is for the Federated States of 
Micronesia and $5,497,000 is for the Republic of the Marshall 
Islands.
    The Committee also has included bill language to clarify 
the intent of section 105(f)(1)(B)(ix) of the Compact of Free 
Association Amendments Act that the government, institutions, 
and people of Palau shall continue to be eligible, and to 
receive assistance in fiscal year 2005, as they have up to and 
including fiscal year 2004.

                            Indian Education

Appropriations, 2004....................................    $120,856,000
Budget estimate, 2005...................................     120,856,000
Committee recommendation................................     120,856,000

    The Committee recommends $120,856,000 for Indian Education 
programs. The comparable fiscal year 2004 funding level and the 
budget request both are $120,856,000 for such activities.

Grants to Local Education Agencies

    For grants to local education agencies, the Committee 
recommends $95,933,000. The comparable fiscal year 2004 funding 
level and the budget both are $95,933,000.
    These funds provide financial support to elementary and 
secondary school programs that serve Indian students, including 
preschool children. Funds are awarded on a formula basis to 
local educational agencies, schools supported and operated by 
the Bureau of Indian Affairs and in some cases directly to 
Indian Tribes.

Special Programs for Indian Children

    The Committee recommends $19,753,000 for special programs 
for Indian children. The comparable fiscal year 2004 funding 
level and the budget request both are $19,753,000.
    Funds are used for demonstration grants to improve Indian 
student achievement through early childhood education and 
college preparation programs, and for professional development 
grants for training Indians who are preparing to begin careers 
in teaching and school administration.

National Activities

    The Committee recommends $5,170,000 for national 
activities. The comparable fiscal year 2004 amount and the 
budget request both are $5,170,000 for authorized activities. 
Funds will be used to expand efforts to improve research, 
evaluation, and data collection on the status and effectiveness 
of Indian education programs.

                       Innovation and Improvement

Appropriations, 2004....................................  $1,102,627,000
Budget estimate, 2005...................................     885,181,000
Committee recommendation................................   1,144,346,000

    The Committee recommends an appropriation of $1,144,346,000 
for programs within the innovation and improvement account. The 
comparable fiscal year 2004 funding level for these programs is 
$1,102,627,000 and the budget request includes $885,181,000 for 
this account.

Troops-to-Teachers

    The Committee recommends an appropriation of $14,912,000 
for the Troops-to-Teachers program. The comparable funding 
level for fiscal year 2004 and the budget request both are 
$14,912,000 for this program.
    This program supports the Defense Department's Troops to 
Teachers program, which helps recruit and prepare retiring and 
former military personnel to become highly qualified teachers 
serving in high-poverty school districts. The Secretary of 
Education transfers program funds to the Department of Defense 
for the Defense Activity for Non-Traditional Education Support 
to provide assistance, including stipends of up to $5,000 and 
bonuses of up to $10,000, to eligible members of the Armed 
Forces so that they can obtain teacher certification or 
licensing. In addition, the program helps these individuals 
find employment in a school.

Transition to Teaching

    The Committee recommends $45,295,000 for the transition to 
teaching program. The comparable fiscal year 2004 funding level 
and the budget request both are $45,295,000 for this program. 
This program provides grants to help support efforts to 
recruit, train, and place nontraditional teaching candidates 
into teaching positions and to support them during their first 
years in the classroom. In particular, this program is intended 
to attract mid-career professionals and recent college 
graduates. Program participants are placed in high-need schools 
in high-need LEAs.

National Writing Project

    The Committee recommends $24,000,000 for the national 
writing project. The comparable funding level for fiscal year 
2004 is $17,894,000 and the budget request proposes to 
eliminate Federal funding for this program.
    These funds are awarded to the National Writing Project, a 
nonprofit organization that supports and promotes K-16 teacher 
training programs in the effective teaching of writing. From 
the funds provided by the fiscal year 2005 appropriation, the 
Committee intends that $500,000 shall be used to continue 
support for the pilot program on the integration of technology 
training in the NWP program.

Teaching of Traditional American History

    The Committee recommends $120,000,000 for the teaching of 
traditional American history program. The comparable fiscal 
year 2004 funding level and the budget request are both 
$119,292,000 for this activity. This program supports 
competitive grants to LEAs, and funds may be used only to 
undertake activities that are related to American history, and 
cannot be used for social studies coursework. Grant awards are 
designed to augment the quality of American history instruction 
and to provide professional development activities and teacher 
education in the area of American history. The Committee 
directs the Department to continue its current policy of 
awarding 3-year grants.

School Leadership

    The Committee recommends $16,000,000 for the school 
leadership program. The comparable fiscal year 2004 funding 
level is $12,346,000 and the budget request proposes to 
eliminate funding for this program. This program provides 
competitive grants to assist high-need LEAs to recruit and 
train principals and assistant principals through activities 
such as professional development and training programs. The 
Committee continues to recognize the critical role that 
principals and assistant principals play in creating an 
environment that fosters effective teaching and high academic 
achievement.

Advanced Credentialing

    The Committee recommends $17,000,000 for the advanced 
credentialing program. The comparable fiscal year 2004 funding 
level is $18,391,000 and the budget request includes $7,000,000 
for one component of the authorized program.
    The Committee recommendation includes $10,000,000 for the 
National Board for Professional Teaching Standards [NBPTS]. The 
comparable fiscal year 2004 funding level is $9,941,000 and the 
budget request proposes to eliminate funding for the National 
Board. Funds available assist the Board's work in providing 
financial support to States for teachers applying for 
certification, increasing the number of minority teachers 
seeking certification and developing outreach programs about 
the advanced certification program. The fiscal year 2005 
appropriation will support a new grant for the National Board 
for Professional Teaching Standards.
    The Committee notes that a new independent study, in part 
funded by the U.S. Department of Education and released in 
March 2004, found that the NBPTS assessment process is 
effectively identifying those teachers who contribute to 
relatively larger student learning gains, particularly in the 
early grades and among the poorest of students. The Committee 
continues its strong support for the NBPTS due to its proven 
success in identifying teachers who make significant gains in 
student learning and achievement, which has been established 
through a higher standard of research and validation than any 
other professional board in the United States. Federal funds 
are a critical supplement to the 50 States and more than 500 
school districts across the nation that have implemented 
policies, regulations and financial incentives to recruit, 
reward and retain National Board Certified Teachers.
    The Committee recommendation also includes $7,000,000 for 
the American Board for the Certification of Teacher Excellence 
[ABCTE] to continue development of its Initial Certification 
and Master Certification programs. Fiscal year 2005 funding 
represents the third year of a 5-year grant to the ABCTE. The 
Committee expects the Department to continue to prepare for an 
independent evaluation of the activities undertaken by the 
ABCTE. The Committee expects the Department to include 
information in the 2006 Congressional Justification about 
actions taken to evaluate ABCTE's activities.

Charter Schools Grants

    The Committee recommends $218,702,000 for the support of 
charter schools. The comparable fiscal year 2004 funding level 
and the budget request both are $218,702,000 for this program.
    This program supports the planning, development, and 
initial implementation of charter schools, which are public 
schools that receive exemption from many statutory and 
regulatory requirements in exchange for promising to meet 
agreed-upon accountability measures. State educational agencies 
that have the authority under State law to approve charter 
schools are eligible to compete for grants. If an eligible SEA 
does not participate, charter schools from the State may apply 
directly to the Secretary. The authorizing statute requires 
that amounts appropriated in excess of $200,000,000 and less 
than $300,000,000 be used for 5-year competitive grants to 
States that operate per-pupil facilities aid programs for 
charters schools. Federal funds are used to match State funded 
programs in order to provide charter schools with additional 
resources for charter school facilities financing.

Credit Enhancement for Charter School Facilities

    The Committee recommends $37,279,000 to assist charter 
schools with their facility needs. The comparable funding level 
for fiscal year 2004 is $37,279,000 and the budget request 
includes $100,000,000 for this purpose. The Committee notes 
that the authorization for this program expires during fiscal 
year 2004.
    This program provides assistance to help charter schools 
meet their facility needs. Funds are provided on a competitive 
basis to public and non-profit entitities, to leverage non-
Federal funds that help charter schools obtain school 
facilities through purchase, lease, renovation and 
construction.

Voluntary Public School Choice

    The Committee recommends $26,757,000 for the voluntary 
public school choice program. The comparable funding level for 
fiscal year 2004 and the budget request both are $26,757,000 
for this purpose.
    This program supports efforts by States and school 
districts to establish or expand State-or district-wide public 
school choice programs, especially for parents whose children 
attend low-performing public schools.

Magnet Schools Assistance

    The Committee recommends $108,640,000 for the magnet 
schools assistance program. The comparable fiscal year 2004 
funding level and the budget request are both $108,640,000 for 
this purpose.
    This program supports grants to local educational agencies 
to establish and operate magnet schools that are part of a 
court-ordered or federally approved voluntary desegregation 
plan. Magnet schools are designed to attract substantial 
numbers of students from different social, economic, ethnic, 
and racial backgrounds. Grantees may use funds for planning and 
promotional materials, teacher salaries, purchase of computers, 
and other educational materials and equipment.

Choice Incentive Fund

    The Committee does not recommend any funding for this 
proposed program, which is not specifically authorized. The 
budget request includes $50,000,000 for this purpose. Through 
this proposed program, funds would be used to award competitive 
grants to establish or expand public or private school choice 
opportunities.

Fund for the Improvement of Education

    The Committee recommends an appropriation of $446,746,000 
for the Fund for the Improvement of Education [FIE]. The 
comparable funding level for fiscal year 2004 is $430,270,000 
and the budget request includes $120,185,000 for comparable 
activities.
    The Committee recommendation includes $700,000 for the 
National Institute of Building Sciences to continue operation 
of the National Clearinghouse for Educational Facilities, the 
Nation's sole source for comprehensive information about school 
planning, design, financing, construction and maintenance. The 
Committee recommends an additional $300,000 for this purpose 
within Safe and Drug-Free Schools and Communities National 
Programs to address issues related to school safety and healthy 
school buildings.
    The Committee recommends $27,000,000 to award a contract to 
Reading Is Fundamental, Inc. [RIF] to provide reading-
motivation activities. The comparable funding level for fiscal 
year 2004 and the budget request both are $25,185,000 for this 
purpose. RIF, a private nonprofit organization, helps prepare 
young children and motivate older children to read, through 
activities including the distribution of books. Federal funds 
provide up to 75 percent of the costs of books, except for 
migrant and seasonal farmworker programs which may receive up 
to 100 percent of the costs of books.
    The administration proposes $10,000,000 for a military 
families initiative under the fund for the improvement of 
education program. Under this new categorical grant program, 
the Department of Education would make competitive grants to 
consortia of States, local educational agencies, and other 
public and non-profit organizations, to address the challenges 
faced by students from military families and ease their 
transitions to new schools. Due to budget constraints, the 
Committee recommendation does not include funds for this 
purpose.
    The administration proposes $40,000,000 for a new adjunct 
teacher corps initiative. Through this new categorical grant 
program, the Department of Education would make competitive 
grants to partnerships of school districts and public and 
private institutions to create opportunities for professionals 
to teach secondary-school courses in the core academic 
subjects, particularly math and science. Due to budget 
constraints, the Committee recommendation does not include 
funds for this purpose.
    The administration recommended eliminating funding for 
activities listed below.
    The Committee recommends $24,000,000 for the Star Schools 
program. The comparable funding level for fiscal year 2004 is 
$20,362,000. The Star Schools program is designed to improve 
instruction in math, science, foreign languages, and other 
areas such as vocational education, to underserved populations 
by means of telecommunications technologies.
    The Committee recommends $14,500,000 for the Ready to Teach 
program. The comparable funding level for fiscal year 2004 is 
$14,321,000. Ready to Teach is the successor to the Public 
Broadcasting Service's Mathline program, which was one of the 
first to provide online professional development and continuing 
education for teachers. Ready to Teach was reauthorized by the 
No Child Left Behind Act of 2001 and continues to evolve to 
enhance teacher quality and meet the goals of that Act. Ready 
to Teach encompasses funding for PBS TeacherLine and one or 
more nonprofit entities, for the purpose of continuing to 
develop telecommunications-based programs to improve teacher 
quality in core areas. It also includes digital educational 
programming grants, which encourages community partnerships 
among local public television stations, State and local 
educational agencies, and other institutions to develop and 
distribute digital instructional content based on State and 
local standards.
    The Committee recommendation for FIE includes $10,000,000 
for the Education through Cultural and Historical Organizations 
[ECHO] Act of 2001, as authorized by Public Law 107-110. 
Activities authorized under ECHO provide a broad range of 
educational, cultural and job training opportunities for 
students from communities across the Nation, including Alaska, 
Hawaii, and Massachusetts. The comparable funding level for 
fiscal year 2004 is $8,450,000.
    The Committee has included $40,500,000 for arts in 
education. The comparable funding level for fiscal year 2004 is 
$35,071,000. Within the total, $6,420,000 is for the John F. 
Kennedy Center for the Performing Arts; $7,500,000 is for VSA 
arts; $14,100,000 is for the competitive art education model 
grant program for the development of model projects that 
effectively strengthen and integrate arts and cultural 
partnerships into the core curriculum, of which not less than 
$3,500,000 shall be for new awards under a grant competition 
conducted during fiscal year 2005; $8,000,000 is for grants for 
professional development for music, dance, drama, and visual 
arts educators to be administered by the U.S. Department of 
Education; $500,000 is for the evaluation and national 
dissemination of information regarding model programs and 
professional development projects funded through the Arts in 
Education section, including dissemination of information 
regarding projects which received awards in fiscal year 2001, 
fiscal year 2002, and subsequent years. Such information should 
include resources regarding effective self-evaluation methods 
for model arts programs; and $3,980,000 is for cultural 
partnerships for at-risk youth.
    The Committee again recommends additional funding for 
evaluation and national dissemination activities as specified 
in the previous paragraph. The Committee urges the Department 
to focus first on dissemination activities related to model 
programs before using these resources for other purposes. The 
Committee directs that such information include resources 
regarding effective self-evaluation methods for model arts 
programs.
    The Committee recommends $41,975,000 for Parental 
Information and Resource Centers, which provide training, 
information, and support to parents, State and local education 
agencies, and other organizations that carry out parent 
education and family involvement programs. The comparable 
funding level for fiscal year 2004 is $41,975,000. The 
Committee notes that research overwhelmingly demonstrates that 
parent involvement in children's learning is positively related 
to student achievement.
    The Committee also notes that the No Child Left Behind Act 
requires grantees to use at least 30 percent of their awards to 
establish, expand, or operate Parents as Teachers, Home 
Instruction Program for Preschool Youngsters, or other early 
childhood parent education programs.
    The Committee includes $3,000,000 for the women's 
educational equity program. The comparable funding level for 
fiscal year 2004 is $2,962,000. This program supports projects 
that assist in the local implementation of gender equity 
policies and practices.
    The Committee recommendation also includes resources for 
the following activities: $9,517,000 to support teacher quality 
initiatives; $74,073,000 for comprehensive school reform 
demonstration grants; $10,000,000 requested by the 
administration to continue support for Reach Out and Read; 
$1,500,000 for activities authorized by the Excellence in 
Economics Education Act; and $13,260,000 for discretionary 
grants and associated expenses, including voter participation 
programs authorized under the Fund for the Improvement of 
Education.
    The Committee strongly believes that parental involvement 
is a key to the success of No Child Left Behind Act. The 
Committee urges the Department, in carrying out discretionary 
parental involvement initiatives, to engage groups that are 
committed to improving public schools and are experienced in 
carrying out grassroots efforts with parents in local school 
districts.

Ready to Learn Television

    The Committee recommends an appropriation of $24,000,000 
for the Ready to Learn Television program. The comparable 
funding level for fiscal year 2004 and the budget request both 
are $22,864,000 for this purpose.
    Ready to Learn Television supports the development and 
distribution of educational television programming designed to 
improve the readiness of preschool children to enter 
kindergarten and elementary school. The program also supports 
the development, production, and dissemination of educational 
materials designed to help parents, children, and caregivers 
obtain the maximum advantage from educational programming.
    The Committee continues to strongly support the educational 
and outreach objectives of the ``Ready to Learn'' television 
program. The Committee is especially pleased that television 
programs such as ``Dragon Tales'' and ``Between the Lions'' 
developed with funding from Ready to Learn have been recognized 
with national parent and television production awards. The 
Committee reiterates the unique mission of Ready to Learn, 
which is to use the television medium to help prepare pre-
school age children for school. The television programs that 
must fulfill this mission are to be specifically designed for 
this purpose, with the highest attention to production quality 
and validity of research-based educational objectives, content, 
and materials. Therefore, the Committee expects that the grant 
competition administered for a new award under this program 
will emphasize the importance of investing Ready to Learn 
resources in those programs that have proven to fulfill this 
mission, acquiring new programs with scrutiny, and 
distinguishing Ready to Learn programs from content easily 
available on commercial and cable television.

Dropout Prevention

    The Committee recommendation includes $10,000,000 for the 
dropout prevention program. The comparable funding level for 
fiscal year 2004 is $4,970,000 and the budget request did not 
include any funding for the dropout prevention program. These 
funds are used to help schools implement effective school 
dropout prevention and re-entry programs.
    In addition, the Committee notes that in fiscal year 2003, 
States reserved roughly $96,000,000 from their Title I, Part A 
allocations to operate State-administered projects in LEAs with 
the highest dropout rates and in areas serving a large number 
of children in local correctional facilities, as is required by 
law.
    Under the No Child Left Behind Act, each State agency and 
local educational agency that conducts dropout prevent and 
reentry programs under Part D of Title I is required to submit 
evaluation results to the State educational agency and the 
Secretary and use the results of such evaluations to plan and 
improve subsequent programs for participating children and 
youth. The Committee strongly urges the Department to utilize 
required evaluation reports in providing technical assistance 
and support to State and local educational agencies to ensure 
that these reserved funds are targeted to and effectively used 
in preventing school dropout and promoting successful reentry. 
The Committee requests that the Department provide a letter 
report to the Committee on actions it has taken and developed 
for addressing this issue, which also was raised in the fiscal 
year 2004 Committee report. The Committee expects to receive 
this report not later than March 1, 2005.

Close Up Fellowships

    The Committee recommendation includes $1,481,000. The 
comparable funding level for fiscal year 2004 is $1,481,000 and 
the budget request did not include any funds for this purpose. 
The Close Up Fellowships, formerly called Ellender, which is 
administered by the Close Up Foundation of Washington, DC, 
provides fellowships to students from low-income families and 
their teachers to enable them to attend 1 week in Washington 
attending seminars and meeting with representatives of the 
three branches of the Federal Government.
    In response to congressional interest, the Committee is 
aware that the Close Up Foundation has undertaken actions to 
identify and develop non-Federal sources of funding for 
sustaining its operations. The Committee notes that, according 
to the Department of Education, the amount of funding allocated 
for teachers and economically disadvantaged students available 
from non-Federal sources increased more than 10 percent 
annually in each year 1999-2002.
    The Committee also notes that the Close Up Foundation, in 
collaboration with the Secretary of Education, is required to 
develop and implement procedures for measuring the efficacy of 
the Foundation's authorized programs, including the extent to 
which the programs are providing young people with an increased 
understanding of the Federal Government; heightening a sense of 
civic responsibility among young people; and enhancing the 
skills of educators in teaching young people about civic 
responsibility, the Federal Government, and attaining 
citizenship competencies. The Committee expects to see a more 
complete discussion of the actions taken to meet this statutory 
requirement, as well as program performance information, in the 
fiscal year 2006 congressional justification.

Advanced Placement

    The Committee recommends $33,534,000 for Advanced 
Placement. The comparable funding level for fiscal year 2004 is 
$23,534,000 and the budget request includes $51,534,000 for the 
Advanced Placement program.
    The first priority of the program is to subsidize test fees 
for low-income students who are enrolled in an Advanced 
Placement class and plan to take an Advanced Placement test. 
The balance of the funds are allocated for Advanced Placement 
Incentive Program grants, which are used to expand access for 
low-income individuals to Advanced Placement programs. Eligible 
activities include teacher training and participation in online 
Advanced Placement courses, among other related purposes.

                 Safe Schools and Citizenship Education

Appropriations, 2004....................................    $855,775,000
Budget estimate, 2005...................................     838,897,000
Committee recommendation................................     902,008,000

Safe and Drug-Free Schools and Communities

    The Committee recommends a total of $902,008,000 for 
activities to promote Safe Schools and Citizenship Education. 
The comparable fiscal year 2004 funding level is $855,775,000 
and the budget request includes $838,897,000 for these 
activities.
    State Grant Program.--The Committee recommends $440,908,000 
for the safe and drug-free schools and communities State grant 
program. The comparable fiscal year 2004 funding level and 
budget request are both $440,908,000. The State grant program 
is the backbone of youth drug prevention efforts in the United 
States. This formula-based State grant program provides 
resources to Governors, State educational agencies and local 
educational agencies for developing and implementing activities 
that help create and maintain safe and drug-free learning 
environments in and around schools.
    National Programs.--The Committee has included $156,219,000 
for the national programs portion of the safe and drug-free 
schools program. The comparable funding level for fiscal year 
2004 is $153,767,000 and the budget request includes 
$175,069,000 for these programs. The Committee does not 
recommend additional funding for Project SERV (School Emergency 
Response to Violence), which provides education-related 
services to LEAs in which the learning environment has been 
disrupted due to a violent or traumatic crisis. The budget 
request included $5,000,000 for Project SERV. However, the 
Committee notes that the Department currently has roughly 
$8,000,000 available for this purpose. These funds are 
available until expended. The Committee will monitor the 
availability of funding and consider action in subsequent 
appropriations bills.
    The Committee continues to be concerned about the 
increasing problem of alcohol and drug abuse on college 
campuses. The Committee has included bill language requiring 
the Department to spend $850,000 on this program under the 
guidelines in section 120(f) of Public Law 105-244. This 
program identifies and provides models of alcohol and drug 
abuse prevention and education programs in higher education.
    The Committee expects that the Department will provide 
$300,000 for the continued operation of the National 
Clearinghouse for Educational Facilities. These funds will be 
used to address issues related to school safety and healthy 
school buildings. The Committee has included additional funds 
for the Clearinghouse through the Fund for the Improvement of 
Education.
    The Committee recommendation includes $10,000,000 for 
school-based drug testing programs for students. This amount is 
$8,012,000 more than the comparable funding level for fiscal 
year 2004 and $15,000,000 less than the budget request. The 
Committee expects that funding should be awarded only to LEAs 
or other entities that require the written consent of the 
student and his or her parent or guardian. In addition, 
students who do not consent to random drug testing should not 
be prohibited from participating in school or extracurricular 
activities. Participating school districts should be prohibited 
from disclosing drug test results to law enforcement officials, 
and all results relating to drug testing of a student should be 
destroyed when the student graduates or otherwise leaves the 
LEA or private school involved. Finally, the testing agency in 
programs that receive Federal drug testing funds should be 
prohibited from disclosing to school officials any information 
about legal medications that the students may be taking.
    The Committee is deeply concerned that between 5 percent to 
9 percent of all children suffer from a mental, behavioral or 
emotional disorder which, if undiagnosed and untreated, can 
substantially interfere with academic achievement, or lead to 
student drop-out, substance abuse, violent behavior, or 
suicide. The Committee notes that, in its July 2003 report, the 
President's New Freedom Commission on Mental Health concluded 
that greater reliance on early detection, assessment and links 
with adequate treatment and support systems can help avoid or 
ameliorate these outcomes. The report concluded that schools 
are in a unique position to identify mental health problems in 
their early stages, and to provide a link to appropriate 
services, citing examples of evidence-based screening 
techniques and tools already being utilized by some schools. 
The Committee reiterates language contained in the fiscal year 
2004 Committee report with respect to this issue, and calls 
upon the Office of Safe and Drug-Free Schools to work with the 
Substance Abuse and Mental Health Services Administration to 
take concrete steps to promote and help implement early 
detection and assessment programs in our Nation's schools.

Integration of Schools and Mental Health Systems

    The Committee has included $10,548,000 for the integration 
of schools and mental health systems, a program that was 
authorized in the No Child Left Behind Act but has not yet been 
funded. This is a competitive grant program designed to promote 
school-wide mental health strategies, provide training to 
elementary school and secondary school personnel to recognize 
early warning signs of mental illness, and increase student 
access to high-quality mental health services. Research has 
found that early detection, assessment, and linkage with 
treatment and supports can prevent mental health problems and 
encourage high-risk children to develop into good students, 
workers, and members of their families and communities. 
Unfortunately, many children and their families do not know 
where to turn for services. Integrating mental health services 
in schools would increase the likelihood that they will receive 
the treatment they need. Schools are encouraged to work with 
community health systems as well as institutions of higher 
learning and/or other relevant entities. The Committee urges 
the Department to give preference to applicants that intend to 
use evidence-based or promising early interventions.

Alcohol Abuse Reduction

    The Committee recommends $35,000,000 for grants to LEAs to 
develop and implement programs to reduce underage drinking in 
secondary schools. The comparable funding level for fiscal year 
2004 is $29,823,000 and the budget request did not include any 
funds for this purpose. The Committee directs the Department 
and the Substance Abuse and Mental Health Services 
Administration [SAMHSA] in the Department of Health and Human 
Services to work together on this effort.

Mentoring

    The Committee recommends $65,000,000 to support mentoring 
programs and activities for children who are at risk of failing 
academically, dropping out of school, getting involved in 
criminal or delinquent activities, or who lack strong positive 
role models. The comparable fiscal year 2004 funding level is 
$49,705,000 and the budget request includes $100,000,000 for 
this purpose.

Character Education

    The Committee recommends $24,691,000 to provide support for 
the design and implementation of character education programs. 
The comparable funding level for fiscal year 2004 and the 
budget request both are $24,691,000 for this purpose.

Elementary and Secondary School Counseling

    The Committee recommends $36,000,000 to establish or expand 
counseling programs in elementary schools. The comparable 
fiscal year 2004 funding level is $33,799,000 and the 
President's budget proposes to eliminate funding for this 
program. As authorized by the No Child Left Behind Act, all 
amounts appropriated up to $40,000,000 are used only for 
elementary school counseling programs.
    The No Child Left Behind Act [NCLBA] requires the Secretary 
to produce a report on school counseling programs ``not later 
than 2 years after assistance is made available to local 
educational agencies.'' The Committee is disappointed that this 
deadline has not been met, and it urges the Secretary to 
fulfill this requirement as soon as possible. As described in 
the NCLBA, the report should evaluate the counseling programs 
that receive funds and contain information from LEAs regarding 
the ratios of students to school counselors, school social 
workers, and school psychologists. The Committee also 
encourages the Department to include questions in the Schools 
and Staffing Survey that would allow the collection and 
publication of accurate and timely data about the ratios of 
students to each of the following: school counselors, school 
social workers, and school psychologists.

Carol M. White Physical Education for Progress Program

    The Committee recommends $75,000,000 to help LEAs and 
community-based organizations initiate, expand and improve 
physical education programs for students in grades K-12. The 
comparable funding level for fiscal year 2004 and the budget 
request both are $69,587,000 for this program. The Carol M. 
White Physical Education for Progress Program, authorized by 
the NCLB Act, established funding for physical education 
programs for students in grades K-12. Provision of this funding 
will help schools and communities nationwide improve their 
structured physical education programs for students and help 
children develop healthy lifestyles to combat the epidemic of 
obesity in the Nation.
    The budget request also includes bill language earmarking 
$2,000,000 to support Special Olympics' mission of promoting 
access to physical education for mentally disabled persons 
through sports training and competition, health initiatives, 
and other services. The Committee supports this request. This 
funding should be used for the Special Olympics National Summer 
Games, to be held in 2006. This will be the first event of its 
kind in the United States, and it represents a unique physical 
education opportunity for young people with disabilities across 
the Nation.
    The Committee notes that in the past 15 years, obesity has 
increased by over 50 percent among adults and in the past 20 
years, obesity has increased by 100 percent among children and 
adolescents. A recent analysis by the National Institute of 
Child Health and Human Development [NICHD] Study of Early Child 
Care and Youth Development found that third grade children in 
the study received an average of 25 minutes per week in school 
of moderate to vigorous activity, while experts in the United 
States have recommended that young people should 
participate in physical activity of at least moderate intensity 
for 30 to 60 minutes each day. While not nationally 
represented, this information is consistent with the 2002 Youth 
Risk Behavior Surveillance System which found that only roughly 
one-half of all students report attending a physical education 
class one or more time a week. The Committee believes Federal 
funding is critical to the effort to reducing these trends and 
helping improve the health of the American public.

Civic Education

    The Committee recommends $30,642,000 for grants to improve 
the quality of civics and government education, to foster civic 
competence and responsibility, and to improve the quality of 
civic and economic education through exchange programs with 
emerging democracies. The comparable fiscal year 2004 funding 
level and the budget request both are $28,642,000 for this 
purpose.
    Civic Education program funds support both the We the 
People programs and the Cooperative Education Exchange. The 
Committee recommends $17,970,000 for the nonprofit Center for 
Civic Education to support the We the People programs. We the 
People has two primary components: the Citizen and the 
Constitution which provides teacher training, curriculum 
materials, and classroom instruction for upper elementary, 
middle and high school students; and Project Citizen, a program 
for middle school students that focuses on the role of State 
and local governments in the American Federal system.
    Within the amount for the We the People program, the 
Committee recommends the following: that $3,170,000 be reserved 
to continue the comprehensive program to improve public 
knowledge, understanding, and support of American democratic 
institutions which is a cooperative project among the Center 
for Civic Education, the Center on Congress at Indiana 
University, and the Trust for Representative Democracy at the 
National Conference of State Legislatures; and that $1,585,000 
be used for continuation and expansion of the school violence 
prevention demonstration program including the Native American 
program.
    The Committee recommends $12,672,000 for the Cooperative 
Education Exchange program. Within this amount, the Committee 
has included $4,752,000 for the Center for Civic Education and 
$4,752,000 for the National Council on Economic Education. The 
remaining $3,168,000 should be used for a competitive grant 
program for civics and government education, and for economic 
education.

State Grants for Incarcerated Youth Offenders

    The Committee has included $28,000,000 for education and 
training for incarcerated youth offenders. The comparable 
funding level for fiscal year 2004 is $24,853,000. The 
administration, once again, proposes to eliminate funding for 
these activities. 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 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 notes that State performance information 
derived from annual performance reports indicate that the 
percentage of students obtaining vocational skill certificates 
in 2001 was 60 percent and that less than 10 percent of program 
participants returned to prison within 1 year of release. 
According to the Bureau of Justice Statistics, most former 
State prisoners were rearrested shortly after getting out of 
prison: 30 percent within 6 months, 44 percent within 1 year, 
59 percent within 2 years and 67 percent by the end of 3 years. 
This important program not only helps make the Nation's streets 
safer for all Americans, but it reduces pressure on taxpayers 
as fewer contacts are made with the more expensive criminal 
justice system and former prisoners become employed, tax-paying 
and productive members of society.
    The Committee encourages the Department to continue to work 
toward developing a more consistent and reliable system for 
collecting performance outcome data. The Committee believes 
that additional training and technical assistance for States 
would help improve the collection by which the effectiveness of 
this program can be measured. The Committee is disappointed by 
the lack of a sufficient response to language included in last 
year's Committee report regarding the actions planned and taken 
by the Department to meet this goal. The Committee requests a 
letter report, not later than March 1, 2005, from the 
Department which includes a detailed discussion of actions 
planned and taken by the Department to meet this goal.
    Within the appropriation for State grants for incarcerated 
youth offenders, the Committee includes $5,000,000 to continue 
the prisoner literacy 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 such literacy 
programs across the country.

                      English Language Acquisition

Appropriations, 2004....................................    $681,215,000
Budget estimate, 2005...................................     681,215,000
Committee recommendation................................     700,000,000

    The Committee recommends an appropriation of $700,000,000 
for English language acquisition. The comparable funding level 
for fiscal year 2004 and the budget request both are 
$681,215,000 for authorized activities. The Department makes 
formula grants to States based on each State's share of the 
Nation's limited-English-proficient and recent immigrant 
student population. The program is designed to increase the 
capacity of States and school districts to address the needs of 
these students. The No Child Left Behind Act also requires that 
6.5 percent of the appropriation be used to support national 
activities, which include professional development activities 
designed to increase the number of highly qualified teachers 
serving limited English proficient students; a National 
Clearinghouse for English Language Acquisition and Language 
Instructional Programs; and evaluation activities.
    At the level of the Committee recommendation, the State 
grant portion of this account will increase by more than 
$56,000,000, as funding for expiring projects is redirected to 
the State grant program. These additional funds will help 
States improve the educational outcomes for limited English 
proficient students.

                           Special Education

Appropriations, 2004.................................... $11,160,707,000
Budget estimate, 2005...................................  12,176,101,000
Committee recommendation................................  12,406,516,000

    The Committee recommends $12,406,516,000 for special 
education programs authorized by the Individuals with 
Disabilities Education Act [IDEA]. The comparable fiscal year 
2004 funding level is $11,160,707,000 and the budget request 
includes $12,176,101,000 for such programs.
    The Committee recognizes that Fetal Alcohol Spectrum 
Disorders [FASD], the most common known cause of mental 
retardation, result from maternal alcohol consumption during 
pregnancy. Affected children have a lifelong disability of 
mental impairments, behavioral problems, and developmental 
delays that reduce their ability to respond to the educational 
system. The burden to society is estimated at $5,400,000,000 
from Fetal Alcohol Syndrome, one type of FASD alone, in 2003. 
The Committee is pleased with the efforts of the Office of 
Special Education and Rehabilitative Services to collaborate 
with other Federal agencies represented on the Interagency 
Coordinating Committee on Fetal Alcohol Syndrome, especially 
with respect to the involvement of educational psychologists 
and other educational and childcare professionals in developing 
awareness about FASD. The Committee encourages the Department 
of Education to expand activities related to FASD, specifically 
the early identification and care plan development of affected 
children.

Grants to States

    The Committee recommends $11,228,981,000 for special 
education grants to States, as authorized under part B of the 
IDEA. The comparable fiscal year 2004 funding level is 
$10,068,106,000 and the budget request includes 
$11,068,106,000. This program provides formula grants to assist 
States in meeting the costs of providing special education and 
related services for children with disabilities.
    The Committee's recommended funding level represents more 
than 20 percent of the average per-pupil expenditure, compared 
with almost 19 percent under the fiscal year 2004 
appropriation. Since fiscal year 2000, increasing 
appropriations have raised the Federal share of average per 
pupil expenditures from 12 percent to an estimated 20 percent 
in fiscal year 2005--half way to the 40 percent maximum 
established in the IDEA.

Preschool Grants

    The Committee recommends $390,000,000 for preschool grants. 
The comparable fiscal year 2004 funding level and the budget 
request both are $387,699,000. The preschool grants program 
provides formula grants to States to make available special 
education and related services for children with disabilities 
aged 3 through 5.

Grants for Infants and Families

    The Committee recommends $444,363,000 for grants for the 
infants and families program under part C of the IDEA. The 
comparable fiscal year 2004 funding level is $444,363,000 and 
the budget request includes $466,581,000 for this activity. 
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 2 
and under, and their families.

State Program Improvement

    The Committee recommends $51,061,000 for State program 
improvement grants. The comparable fiscal year 2004 funding 
level and the budget request both are $51,061,000 for these 
grants. This program provides 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.

Research and Innovation in Special Education

    The Committee recommends $78,125,000 for research and 
innovation in special education. The comparable funding level 
for fiscal year 2004 and the budget request both are 
$78,125,000 for this purpose. This program supports competitive 
awards to produce and advance the use of knowledge to improve 
services and results for children with disabilities.

Technical Assistance and Dissemination

    The Committee recommends $54,000,000 for technical 
assistance and dissemination. The comparable fiscal year 2004 
funding level and the budget request both are $52,819,000 for 
these activities. Awards support institutes, regional resource 
centers, clearinghouses, and other efforts to build State and 
local capacity to make systemic changes and improve results for 
children with disabilities.

Personnel Preparation

    The Committee recommends $93,357,000 for the personnel 
preparation program. The comparable fiscal year 2004 funding 
level and the budget request both are $91,357,000 for this 
program. Funds support competitive awards to help address 
State-identified needs for personnel who are qualified to work 
with children with disabilities, including special education 
teachers and related services personnel.
    The Committee continues to be particularly concerned about 
the shortages of qualified special education teachers and of 
higher education faculty to train those teachers. It intends 
that these funds be used to address both shortages.

Parent Information Centers

    The Committee recommends $27,500,000 for parent information 
centers. The comparable fiscal year 2004 funding level and the 
budget request both are $26,173,000 for authorized activities. 
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 $39,129,000 for technology and 
media services. The comparable fiscal year 2004 funding level 
is $39,129,000 and the budget request includes $32,305,000 for 
such activities. 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 recommendation includes $11,400,000 for 
Recording for the Blind and Dyslexic, Inc. (RFB&D;). These funds 
support the continued production and circulation of recorded 
textbooks, increased outreach activities to print-disabled 
students and their teachers, and accelerated use of digital 
technology. The administration proposed eliminating support of 
RFB&D; for these activities.
    The Committee also recommends $1,500,000 to continue 
support of the Reading Rockets program. Last year, this program 
received $1,491,000. The administration proposed eliminating 
support for this program.
    This activity is authorized by section 687(b)(2)(G) of the 
Individuals with Disabilities Education Act, as amended. The 
Committee recognizes the progress of the Reading Rockets 
program, which is developing a wide range of media resources to 
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. These resources include an 
extensive web site, videos, and programming for television and 
radio broadcast. The Committee includes funding for the 
continued development and distribution of media resources to 
reach the parents and teachers of children with reading 
disabilities.

            Rehabilitation Services and Disability Research

Appropriations, 2004....................................  $3,011,270,000
Budget estimate, 2005...................................   3,047,197,000
Committee recommendation................................   3,077,328,000

    The Committee recommends $3,077,328,000 for rehabilitation 
services and disability research. The comparable fiscal year 
2004 funding level is $3,011,270,000 and the budget request 
includes $3,047,197,000 for programs in this account.

Vocational Rehabilitation State Grants

    The Committee provides $2,635,845,000 for vocational 
rehabilitation grants to States. The Committee recommendation 
provides the full amount authorized by the Rehabilitation Act 
of 1973. The comparable funding level for fiscal year 2004 is 
$2,584,162,000. The budget request proposes to eliminate 
separate funding of several categorical programs and redirect 
these resources to the State grant program. The Committee 
rejects this approach and believes changes of this nature 
should be considered during reauthorization of the Act.
    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. 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 percent 
and not more than 1.5 percent of the appropriation in fiscal 
year 2004 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 recommends $13,000,000 for the client 
assistance program. The comparable fiscal year 2004 funding 
level and the budget request both are $11,997,000 for 
authorized activities.
    The client assistance program funds State formula grants to 
assist vocational rehabilitation clients or client applicants 
in understanding the benefits available to them and in their 
relationships with service providers. Funds are distributed to 
States according to a population-based formula, except that 
increases in minimum grants are guaranteed to each of the 50 
States, the District of Columbia, and Puerto Rico, and 
guaranteed to each of the outlying areas, by a percentage not 
to exceed the percentage increase in the appropriation. States 
must operate client assistance programs in order to receive 
vocational rehabilitation State grant funds.

Training

    The Committee recommends $39,139,000 for training 
rehabilitation personnel. The comparable fiscal year 2004 
funding level and the budget request both are $39,139,000 for 
training activities.
    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 remains concerned over the reduction in 
funding for rehabilitation long-term training programs, and in 
particular those that require orthotic and prosthetic care. 
Therefore, the Committee urges RSA to utilize available funds 
to support not less than four university orthotics and 
prosthetics programs.

Demonstration and Training Programs

    The Committee bill includes $24,286,000 for demonstration 
and training programs for persons with disabilities. The 
comparable fiscal year 2004 funding level is $24,286,000 and 
the budget request includes $18,784,000 for authorized 
activities. 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. Demonstration 
programs support projects for individuals with a wide array of 
disabilities. Within the Committee recommendation, $1,000,000 
supports continuation of activities designed to establish an 
applied research agenda, improve the quality of applied 
orthotic and prosthetic research and help meet the increasing 
demand for provider services. Funds are to be used to further 
develop the orthotic and prosthetic awareness campaign, which 
includes an educational outreach initiative designed to recruit 
and retain professionals and develop a series of consensus 
conferences and disseminate the resulting best practices to the 
field.

Migrant and Seasonal Farmworkers

    The Committee recommends $2,500,000 for migrant and 
seasonal farmworkers. The comparable fiscal year 2004 funding 
level is $2,321,000. The Department proposes eliminating 
separate funding for this program.
    This program provide grants limited to 90 percent of the 
costs of the projects providing 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 $2,750,000 for recreational 
Programs. The comparable fiscal year 2004 funding level is 
$2,564,000 and the budget request does not include funding for 
this program.
    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 $18,000,000 for protection and 
advocacy of individual rights. The comparable fiscal year 2004 
funding level is $16,790,000 and the budget request includes 
$19,570,000. However, included in the budget request is 
$2,780,000 to continue funding for the Protection and Advocacy 
for Assistive Technology program. This amount is less than the 
$4,419,000 for such activities provided in fiscal year 2004.
    This program provides grants to agencies to protect and 
advocate for the legal and human rights of persons with 
disabilities who are not eligible for protection and advocacy 
services available through the Developmental Disabilities 
Assistance and Bill of Rights Act or the Protection and 
Advocacy for Individuals with Mental Illness Act.

Projects with Industry

    The Committee recommends $22,000,000 for projects with 
Industry. The comparable fiscal year 2004 funding level is 
$21,799,000 and the administration proposes eliminating 
separate funding for this program.
    The projects with industry [PWI] program promotes 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 $38,000,000 for the supported 
employment State grant program. The comparable fiscal year 2004 
funding level is $37,680,000 and the administration proposes 
eliminating separate funding for this program.
    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 $23,000,000 for independent living 
State grants. The comparable funding level for fiscal year 2004 
and the budget request both are $22,020,000 for authorized 
activities.
    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

    The Committee recommends $75,000,000 for independent living 
centers. The comparable fiscal year 2004 funding level and the 
budget request both are $73,563,000 for the centers.
    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 $31,811,000 for independent living 
services to older blind individuals. The comparable fiscal year 
2004 funding level and the budget request both are $31,811,000 
for these activities. Through this program, 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 services, 
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.

Program Improvement Activities

    The Committee recommends $850,000 for program improvement 
activities. The comparable fiscal year 2004 funding level is 
$889,000 and the budget request includes $850,000. In fiscal 
year 2005, 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. The funds provided are 
sufficient to support ongoing program improvement activities 
and to support ongoing dissemination and performance 
measurement activities.

Evaluation

    The Committee recommends $1,500,000 for evaluation 
activities. The comparable fiscal year 2004 funding level is 
$988,000 and the budget request includes $1,500,000 for such 
activities.
    These funds support evaluations of the impact and 
effectiveness of programs authorized by the Rehabilitation Act. 
The Committee recommendation provides the requested increase 
for the initiation of a new longitudinal study of the State 
Vocational Rehabilitation Services program. 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 recommends $9,000,000 for the Helen Keller 
National Center for Deaf-Blind Youth and Adults. The comparable 
fiscal year 2004 funding level and the budget request both are 
$8,666,000 for this purpose.
    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 agencies. At 
the recommended level, the center would serve more than 110 
persons with deaf-blindness at its headquarters facility and 
provide field services to approximately 2,150 individuals and 
families and more than 1,000 organizations.

National Institute on Disability and Rehabilitation Research

    The Committee recommends $109,152,000 for the National 
Institute on Disability and Rehabilitation Research [NIDRR]. 
The comparable fiscal year 2004 funding level and the budget 
request both are $106,652,000 for authorized activities.
    NIDRR develops and implements a comprehensive and 
coordinated approach to the conduct of research, demonstration 
projects, and related activities that enable 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.
    The Committee recommendation includes $2,500,000 above the 
budget request to support NIDRR's model spinal cord injury 
centers program. These funds, in addition to the $7,200,000 
available within the budget request, will support $8,500,000 in 
new awards in fiscal year 2005. The Committee intends that 
these funds should be used to support investments that would 
facilitate multi-center research and encourages NIDRR to 
continue its collaboration with other Federal agencies in order 
to leverage Federal investments in this area.
    The Committee acknowledges that physical rehabilitation 
services are essential to the functional status and 
independence of individuals, particularly those dealing with 
musculoskeletal conditions. The Committee directs the 
Interagency Committee on Disability Research to report on the 
existing, agency-wide research activities relating to physical 
rehabilitation, opportunities for future physical 
rehabilitation research, and recommendations on how physical 
rehabilitation research can be enhanced within the departments 
and agencies, including suggestions for those areas that need 
to be addressed through statutory changes.

Assistive Technology

    The Committee recommends $31,495,000 for assistive 
technology. The comparable fiscal year 2004 funding level is 
$25,943,000 and the budget request includes $15,000,000 for the 
alternative financing program, but does not request funding for 
title I State tech act projects or protection and advocacy for 
assistive technology. However, under the PAIR program, the 
administration proposes to fund protection and advocacy 
activities previously funded through this program at 
$2,780,000.
    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.
    The Committee recommendation includes $26,000,000 for 
activities authorized under title I of the Assistive Technology 
Act [AT Act]. The Committee has included bill language which 
allows all State projects funded currently under title I of the 
AT Act to receive not less than the amount they received in 
fiscal year 2004 and supports continued funding under this 
program for protection and advocacy for assistive technology. 
The Committee expects funds to be allocated under title I, 
consistent with the way in which they were allocated during 
implementation of the fiscal year 2004 bill.
    The Committee recommendation also includes $5,495,000 for 
the alternative financing program. The Committee recommendation 
includes bill language requested by the administration designed 
to encourage States to support alternative financing programs. 
These changes allow States to receive less than $500,000 for an 
award, requires a match of 25 percent and enables States to 
receive more than one grant. The Committee urges