Report text available as:

  • TXT
  • PDF   (PDF provides a complete and accurate display of this text.) Tip ?
                                                       Calendar No. 175
108th Congress                                                   Report
                                 SENATE
 1st Session                                                     108-81

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



 
  DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND 
               RELATED AGENCIES APPROPRIATION BILL, 2004
                                _______
                                

                 June 26, 2003.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                         [To accompany S. 1356]

    The Committee on Appropriations reports the bill (S. 1356) 
making appropriations for Departments of Labor, Health and 
Human Services, and Education and related agencies for the 
fiscal year ending September 30, 2004, and for other purposes, 
reports favorably thereon and recommends that the bill do pass.



Amount of budget authority

Total bill as reported to Senate........................$472,167,787,000
Amount of adjusted appropriations, 2003................. 430,990,474,000
Budget estimates, 2004.................................. 469,697,048,000
The bill as reported to the Senate:
    Over the adjusted appropriations for 2003........... +41,177,313,000
    Over the budget estimates for 2004..................  +2,470,739,000


                            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.......................    21
    Employee Benefit Security Administration.....................    31
    Pension Benefit Guaranty Corporation.........................    32
    Employment Standards Administration..........................    33
    Occupational Safety and Health Administration................    36
    Mine Safety and Health Administration........................    37
    Bureau of Labor Statistics...................................    38
    Office of Disability Policy..................................    38
    Departmental Management......................................    39
    Veterans Employment and Training.............................    41
    Office of the Inspector General..............................    41
Title II--Department of Health and Human Services:
    Health Resources and Services Administration.................    43
    Centers for Disease Control and Prevention...................    70
    National Institutes of Health................................   101
    Substance Abuse and Mental Health Services Administration....   176
    Agency for Healthcare Research and Quality...................   187
    Centers for Medicare & Medicaid Services.....................   190
    Administration for Children and Families.....................   194
    Administration on Aging......................................   213
    Office of the Secretary......................................   217
Title III--Department of Education:
    Education for the disadvantaged..............................   228
    Impact aid...................................................   234
    School improvement programs..................................   235
    Indian education.............................................   243
    Innovation and Improvement...................................   244
    Safe Schools and Citizenship Education.......................   252
    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.................................   273
    Student aid administration...................................   275
    Higher education.............................................   276
    Howard University............................................   383
    College housing and academic facilities loans................   284
    Historically black college and university capital financing 
      program....................................................   284
    Institute of Education Science...............................   284
    Departmental management:
        Program administration...................................   287
        Office for Civil Rights..................................   288
        Office of the Inspector General..........................   288
    General provisions...........................................   288
Title IV--Related agencies:
    Armed Forces Retirement Home.................................   290
    Domestic Volunteer Service Programs..........................   290
    Corporation for National and Community Service...............   290
    Corporation for Public Broadcasting..........................   292
    Federal Mediation and Conciliation Service...................   293
    Federal Mine Safety and Health Review Commission.............   293
    Institute of Museum and Library Services.....................   294
    Medicare Payment Advisory Commission.........................   295
    National Commission on Libraries and Information Science.....   296
    National Council on Disability...............................   296
    National Labor Relations Board...............................   296
    National Mediation Board.....................................   297
    Occupational Safety and Health Review Commission.............   297
    Railroad Retirement Board....................................   297
    Social Security Administration...............................   299
    U.S. Institute of Peace......................................   302
Title V--General provisions......................................   303
Budgetary impact of bill.........................................   304
Compliance with paragraph 7, rule XVI of the standing rules of 
  the Senate.....................................................   304
Compliance with paragraph 7(C), rule XXVI of the standing rules 
  of the Senate..................................................   305
Compliance with paragraph 12, rule XXVI of the standing rules of 
  the Sen- 
  ate............................................................   305
Comparative statement of new budget authority....................   307

       SUMMARY OF BUDGET ESTIMATES AND COMMITTEE RECOMMENDATIONS

    For fiscal year 2003, the Committee recommends total budget 
authority of $472,167,787,000 for the Departments of Labor, 
Health and Human Services, and Education, and Related Agencies. 
Of this amount, $137,601,000,000 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 
$5,115,588,000 for job training programs, an increase of 
$163,602,000 over the budget request.
    Worker Protection.--The Committee bill includes 
$1,493,485,000 to ensure the health and safety of workers, 
including $463,324,000 for the Occupational Safety and Health 
Administration and $270,711,000 for the Mine Safety and Health 
Administration. The recommendation is an increase of 
$33,841,000 over the 2003 level.
    Child Labor.--The Committee bill includes $108,000,000 for 
activities designed to end abusive child labor. This is 
$95,730,000 above the budget request.
    National Institutes of Health.--A total of $27,982,604,000 
is recommended to fund biomedical research at the 27 Institutes 
and Centers that comprise the NIH. This represents an increase 
of $1,000,000,000 over the fiscal year 2003 level and 
$318,613,000 over the budget request.
    Centers for Disease Control.--The Committee bill provides 
$4,432,496,000 for the Centers for Disease Control and 
Prevention, an increase of $147,856,000 over the fiscal 2003 
level. Included in this amount is $801,844,000 for chronic 
disease prevention and health promotion of which $50,000,000 
for obesity prevention.
    Physical Activity and Nutrition.--The Committee 
recommendation includes a total of $944,702,000 for programs to 
increase physical activity, improve nutrition, and reduce 
obesity and overweight, an increase of $34,221,000 over the 
fiscal year 2003 appropriation.
    Infectious Disease Initiative.--The Committee bill includes 
$2,138,960,000 for infectious disease research, prevention and 
control. Included in this amount is $422,760,000,000 for 
infectious disease control at the Centers for Disease Control 
of which $50,000,000 is targeted to areas where new infectious 
diseases tend to occur and $25,000,000 for containment of 
disease outbreaks such as SARS and monkeypox. For emerging 
infectious diseases at the National Institutes of Health, the 
Committee has included $1,686,200,000, an increase of 
$599,000,000 over the fiscal year 2003 appropriation.
    Preventing and Reversing Heart Disease.--The Committee bill 
includes $5,758,686,000 for research and prevention programs to 
address heart and related diseases. This amount is $166,497,000 
over the fiscal year 2003 level. Included in this amount is 
$2,897,595,000 for research programs at the National Heart, 
Lung and Blood Institute and $45,963,000 for programs at the 
Centers for Disease Control.
    Health Centers.--The recommendation includes $1,627,164,000 
for health centers, the same as the budget request and 
$122,358,000 over the fiscal 2003 level.
    AIDS.--The Committee bill includes $6,058,688,000 for AIDS 
research, prevention, and services. This includes 
$2,041,599,000 for Ryan White programs, an increase of 
$23,634,000 over the fiscal year 2003 level, $932,189,000 for 
AIDS prevention programs at the Centers for Disease Control and 
Prevention and $2,869,900,000 for AIDS research programs at the 
National Institutes of Health. For global AIDS programs, the 
bill includes $90,000,000 for international mother to child 
transmission prevention and $150,000,000 for the Global Fund 
for AIDS.
    Bioterrorism.--The Committee bill includes $1,896,149,000 
to fund efforts to address bioterrorism threats.
    Substance Abuse.--The Committee bill provides 
$3,274,590,000 for substance abuse prevention and treatment 
programs. Included in this amount is $2,051,803,000 for 
substance abuse treatment, $194,306,000 for substance abuse 
prevention and $855,711,000 for mental health programs.
    Head Start.--The Committee recommendation includes 
$6,815,570,000 for the Head Start Program. This represents an 
increase of $148,037,000 over the 2003 level and is the same as 
the request.
    Low-income Home Energy Assistance State Grants.--The 
Committee recommends $2,000,000,000 for heating and cooling 
assistance for low-income individuals and families, the same as 
the budget request and $311,050,000 more than the 2003 level.
    Persons With Disabilities.--To promote independent living 
in home and community-based settings, the Committee has 
included $6,671,308,000 for services to persons with 
disabilities. This includes $26,824,000 for programs authorized 
under the Assistive Technology Act. Also included is 
$47,333,000 for the Office of Disability Policy at the 
Department of Labor, $15,000,000 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 $14,103,356,000 in grants to enhance educational 
opportunities for disadvantaged children, an increase of 
$365,083,000 over the fiscal year 2003.
    Teacher Quality.--The Committee recommends $2,850,000,000 
for State grants to improve teacher quality. This is the same 
as the budget request.
    English Language Acquisition.--The Committee recommends 
$665,000,000 for bilingual education, the same as the budget 
request.
    Student Financial Aid.--The Committee recommends 
$14,174,115,000 for student financial assistance, the same 
level provided in 2003. 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 
$1,974,247,000 for initiatives to provide greater opportunities 
for higher education, including $840,000,000 for Federal TRIO 
programs and $300,000,000 for GEAR UP.
    Education for Individuals With Disabilities.--The Committee 
bill provides $11,027,464,000 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 
$993,547,000 over the 2003 level and $337,360,000 above the 
budget request.
    Rehabilitation Services.--The bill recommends 
$3,004,360,000 for rehabilitation services, an increase of 
$50,727,000 above the amount provided in 2003. 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 totals $2,924,508,000, 
an increase of $41,199,000 over the fiscal year 2003 level. 
This recommendation includes $216,619,000 for senior volunteer 
programs, $442,306,000 for community service employment for 
older Americans, $355,673,000 for supportive services and 
centers, $149,025,000 for family caregiver support programs and 
$716,974,000 for senior nutrition programs. For the medical 
research activities of the National Institute on Aging, the 
Committee recommends $1,031,411,000. The Committee 
recommendation also includes $12,500,000 for the Medicare 
insurance counseling program.
    Corporation for Public Broadcasting.--The Committee bill 
recommends an advance appropriation for fiscal year 2006 of 
$400,000,000 for the Corporation for Public Broadcasting. This 
amount is $10,000,000 over advance appropriation provided in 
fiscal year 2005. In addition, the Committee bill includes 
$55,000,000 for conversion to digital broadcasting and 
$10,000,000 for the replacement project of the interconnection 
system in fiscal year 2004 funding.

              Obesity Prevention and Nutrition Initiative

    Obesity has become our Nation's fastest rising public 
health threat with the disease affecting nearly one-third of 
the adult American population. The number of overweight and 
obese Americans have reached epidemic proportions. It is 
estimated 127 million people or 64.5 percent of adults are 
overweight and nearly 30.5 percent are obese. A recent study 
found that obesity is more detrimental to health than smoking 
and alcohol abuse and leads to increased risk for chronic and 
life-threatening diseases such as heart disease, stroke, cancer 
and diabetes. An estimated 300,000 premature deaths a year are 
associated with obesity and overweight, an amount second only 
to tobacco-related deaths. The total direct and indirect costs 
attributed to overweight and obesity totals $100,000,000,000 in 
annual health care costs.
    The problem is not limited to adults. Approximately 30.3 
percent of children, between the ages of 6 and 11, are 
overweight and 15.3 percent are obese. For adolescents, ages 12 
to 19, approximately 30.4 percent are overweight and 15.5 
percent are obese. Excess weight at these early ages has been 
found to predict overweight in adults. The prevalence of 
obesity in children and young adults has quadrupled over the 
past 25 years. In a recent study, hospital costs for diseases 
related to childhood obesity have increased threefold in the 
past 20 years. The study confirms that Americans are becoming 
obese at younger ages: approximately 27 percent of U.S. adults 
are obese by the time they reach their mid-30s, about twice the 
rate in the early 1960s.
    This dramatic upsurge in obesity has been associated with a 
nationwide increase in diabetes. At least 80 percent of 
patients with type 2 diabetes are overweight or obese. Type 2 
diabetes was commonly known in the past as ``adult onset'' 
diabetes. However, research is showing a dramatic escalation in 
the number of children diagnosed with type 2 diabetes. Problems 
with obesity and diabetes also disproportionately affect 
minority communities. According to the CDC, African Americans 
are considered to have the highest rates of both obesity and 
diabetes among all races and ethnic groups. Among all groups, 
however, Native Americans have some of the highest prevalence 
rates of overweight.
    The good news is that many of the chronic diseases linked 
to obesity are preventable. Recent studies provide strong 
evidence that prevention efforts focusing on diet, exercise and 
other lifestyle changes can result in substantially reduced 
risk among high-risk groups. A recent clinical trial reported 
that Americans at high risk for type 2 diabetes can 
dramatically reduce their risk of getting the disease with 
improvements to their diet and exercise.
    On February 17, 2003, the Subcommittee held a hearing on 
improving health through lifestyle modifications. Testimony was 
heard from medical professionals and community organizations on 
steps that can be taken to motivate people so that they can 
make responsible health choices. Witnesses agreed that there is 
a great need to increase prevention and research initiatives to 
address obesity and overweight through lifestyle modifications. 
Witnesses discussed the geography and demographics of obesity 
and highlighted the link between poverty and obesity. To 
address weight management programs for children, the 
Subcommittee heard from professionals who have designed 
successful programs utilizing a structured diet, exercise 
participation, parent support, and behavior modification. The 
program also has a counseling component to emphasize the 
importance of nutrition counseling and physical activity to 
teach children good eating habits. Community organizations also 
discussed the need to improve the availability of nutritious 
foods in public schools and for the food industry to adopt 
guidelines for responsible marketing of food and entertainment 
to eliminate promotion of unhealthy behaviors, and to provide 
healthy foods in our health care system.
    The Committee strongly believes a commitment to improving 
physical activity and nutrition is imperative if we are to 
reduce chronic disease, premature deaths and related health 
care costs. For this reason, the Committee has included a total 
of $944,702,000 for programs designed to increase physical 
activity, healthy lifestyles and nutrition, an increase of 
$34,221,000 over the fiscal year 2003 appropriation.
    The Committee urges agencies receiving funds for this 
purpose under this bill to take special measures to coordinate 
their activities. In particular, the CDC's Division of 
Nutrition and Physical Activity should develop mechanisms such 
as interagency committees to coordinate with the Department of 
Education in administering such programs as the Carol M. White 
Physical Education for Progress in order to leverage resources 
at the local level.
Nutrition and Physical Activity
    The Committee commends the substantial efforts that CDC is 
directing to stem the obesity epidemic across all life stages. 
CDC is coordinating national, State, and school-based programs 
to research and implement health promotion and public health 
education strategies and interventions to increase physical 
activity levels and good nutrition at all ages, to provide 
important health information, and to monitor health and healthy 
behaviors in the population. The Committee recommends 
$123,651,000 for primary prevention activities related to 
Nutrition, Physical Activity, and Obesity at CDC, an increase 
of $15,651,000 over fiscal year 2003. The Committee also 
includes $746,174,000, in the Administration on Aging for 
programs to address preventive health and nutrition of the 
elderly.
School Health
    Obesity rates were significantly reduced among girls in 
grades 6-8 who participated in a school-based intervention 
program. The Committee applauds CDC for establishing effective 
coordinated school health programs and has provided an increase 
of $5,227,000 for a total of $63,112,000 to expand these 
efforts. School health programs address risk behaviors such as 
tobacco use, unhealthy diets, and physical inactivity at CDC. 
The Committee urges CDC and the Department of Education to 
continue to coordinate activities relating to nutrition and 
physical activity which will help to reduce obesity and prevent 
heart disease.
Head Start
    The Committee commends the Department for its efforts to 
focus on prevention as a key to improving the overall health 
and well-being of our Nation. The Committee also recognizes the 
importance of good nutrition and physical activity among young 
children for developing a fertile atmosphere for cognitive 
development and school readiness. The Committee urges the Head 
Start Bureau to review the scope of good nutrition and physical 
activities which are presently being undertaken in response to 
the Head Start Performance Standards, as well as the current 
knowledge based on good nutrition and physical activities for 
young children. The Committee once again encourages the Head 
Start Bureau, in collaboration with the National Head Start 
Association, to devise a plan for implementing a locally-
determined but coordinated effort to achieve the goals of a 
stronger, more effective nutritional and physical activity 
component within Head Start programs.
Physical Education
    Despite the well-publicized benefits of exercise, more than 
60 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 American youths aged 12-21 years 
are not vigorously active on a regular basis. Physical 
education [PE] 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. In 
order to help reverse this trend, the Committee recommendation 
includes $70,000,000 for the Carol M. White Physical Education 
for Progress program. This is an increase of $10,390,000 over 
the fiscal year 2003 level and $70,000,000 over the request. 
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. The PEP program will help curb this 
Nation's increasing obesity problem, which will in turn reduce 
the risk of developing heart disease later in life.

                         Disability Initiative

    It will soon be 13 years since Congress passed the 
Americans with Disabilities Act. During that time, the Nation 
has made much progress in advancing the civil rights of 
individuals with disabilities. Americans living with 
disabilities are exercising their freedoms with continually 
expanding opportunities and a growing acceptance by the public 
at large. Services like curb cuts and closed captioning, once 
envisioned solely for use by individuals with disabilities, 
have proven a benefit to us all. And as the barriers have 
fallen for people with disabilities, the expertise, energy, and 
determination that these Americans have contributed to society 
has grown significantly.
    However, it is important to remember that these Americans 
still face significant challenges in their effort to 
participate fully in American life. The Committee strongly 
believes that it has a unique responsibility to ensure that all 
Americans experience the promise that has defined our Nation 
from its very inception--the promise of opportunity. The 
programs in this bill represent our effort to fulfill that 
responsibility. Many of them relate specifically to breaking 
down the barriers that impede the quality of life for Americans 
with disabilities. In this year's bill, the Committee has made 
a special effort to target resources to a few of the programs 
that are at a critical turning point in our national debate on 
disability. In addition to administrative funds allocated to 
the Social Security Administration for the processing of 
disability claims, the Committee dedicates $16,529,841,000 of 
its allocation to its major disability programs. A notable few 
are listed here.
Education
    The Individuals with Disabilities Education Act [IDEA] was 
first enacted in 1975. This landmark legislation was created to 
help States and school districts meet their legal obligations 
to provide children with disabilities with a free and 
appropriate public education. In this statute, Congress 
recognized that school districts would incur higher costs in 
educating children with disabilities. Despite the limited 
resources available in this bill, the Committee increased 
funding for IDEA grants to local school districts by 
$984,000,000.
Income
    In 2003, the Social Security Administration will distribute 
benefits to 5.5 million workers with disabilities and 1.7 
million dependents. These benefits are an irreplaceable source 
of income for those members of our society who are no longer 
able to work. While some of these disabilities stem from birth, 
studies show that a 20-year-old worker has a 3-in-10 chance of 
becoming disabled before reaching retirement age. The average 
processing time for initial disability claims is 104 days--over 
3 months with no income. If the case is appealed, an average of 
352 additional days is required, bringing the decision to 456 
days, or 15 months without income. More than 50 percent of the 
wait time is due to the backlog of cases. The Committee has 
provided a $636,000,000 increase, or 7.1 percent, in 
administrative funding to the SSA in order to work down this 
backlog.
Workforce
    When a worker with a disability is able to transition into 
employment, the individual experiences an increase in income, 
and self-sufficiency while contributing to the community and 
providing a positive learning experience for others in the 
workplace. In addition, the State saves money in benefit 
payments. For these reasons, the Committee created the Office 
of Disability Employment Policy [ODEP] in fiscal year 2001 with 
the goal of bringing a heightened and permanent long-term focus 
to the goal of increasing employment of persons with 
disabilities. The Committee has allocated $47,333,000 this year 
for this important office.
    Specifically, the Committee believes that telework and 
electronic networking can be of immense benefit to individuals 
with disabilities, opening employment opportunities to persons 
who cannot commute to their workplace. Within the Office of 
Disability Employment Policy, the Committee has funded 
$2,500,000 for increased telecommuting opportunities for 
individuals with disabilities so they can gain economic 
independence. These funds are to be used to enable Government 
agencies to explore the feasibility of employing home-based 
workers with significant disabilities.
Community Integration
    In 1999, the Supreme Court recognized in the Olmstead 
decision that needless institutionalization was discrimination 
and that States were continuing to segregate individuals with 
disabilities in institutional settings. According to the most 
recent data available, Medicaid funding continues to favor 
institutional care over community services. Data from 2001 
indicate that 70 percent of Medicaid funding for long-term 
services is spent on institutions and only 30 percent is spent 
on community-based services.
    Therefore, the Committee has allocated $40,000,000 for 
Systems Change grants in the Centers for Medicare and Medicaid 
Services [CMS] to continue the effort in States to develop and 
reform their service systems to encourage community-based 
services and supports.
Direct Service Workers
    The Committee recognizes that direct service workers are 
the backbone of the community service system, yet they face 
increasing challenges. The Bureau of Labor Statistics predicts 
a 39 percent growth in the need for direct service workers in 
the next 10 years. In order to meet this need, there must be 
improvements in recruitment, training, supervision, retention, 
and benefits.
    The Committee strongly believes that a commitment to 
improving the long-term community service system in States is 
imperative to allow individuals with disabilities to truly gain 
the freedom and independence envisioned in the Americans with 
Disabilities Act. For this reason, the Committee has funded 
$6,000,000 for the Service Worker Demonstration Projects, an 
increase of $3,000,000 over the President's budget request.
Developmental Disabilities
    Nearly 4 million Americans have developmental 
disabilities--severe, chronic disabilities attributable to 
mental and/or physical impairment, which manifest before age 22 
and are likely to continue indefinitely. The Committee is 
deeply committed to providing increased capacity for assisting 
the families and individuals with disabilities. For that 
reason, the Committee has restored the funding for these 
important programs and provided a 4 percent increase overall.
    Families of children with disabilities provide support, 
care, and training that not only encourages and enables their 
children to become active members of our communities but also 
save States millions of dollars. Unfortunately, most families 
of children with disabilities, especially families in 
underserved areas, do not have access to support services to 
help them in their efforts to care for such children at home. 
Within the Projects of National Significance, the Committee has 
provided $4,000,000 for family support services, recognizing 
that families often play a critical role in supporting 
individuals with disabilities so they can live in their home 
communities.
Disabled Voter Services
    There should be no issue of greater importance to a 
democratic government than the right to vote. The Help America 
Vote Act of 2002 had as its goal the improvement of access to 
voting places and the ability of communities to record and 
transmit the votes of their citizens. Persons with disabilities 
often experience barriers to voting that include proper 
physical access to polling places and voting machines that are 
not accessible to individuals with disabilities. The Committee 
strongly believes that any barrier to the right of citizens to 
vote endangers our democracy. For that reason, the Committee 
has included $15,000,000 in funding for the Disabled Voter 
Services program.
Gallaudet University
    Gallaudet University, founded in 1864, is the world's only 
university that brings together deaf, hard of hearing, and 
hearing students as well as faculty in the common pursuit of 
education. The Committee maintains its commitment to this 
institution by including funding for its operating budget and 
endowment and at an increase of $3,002,000.
American Printing House for the Blind
    The American Printing House for the Blind [APH] was founded 
in Louisville, Kentucky in 1858 and in 1879 became the official 
supplier of educational materials for students with visual 
impairments below the college level in the United States and 
its territories. The Committee recognizes the important role 
this institution plays in the lives of visually impaired 
Americans and therefore has provided an increase of 6 percent.
National Council on Disability
    The National Council on Disability [NCD] is an independent 
Federal agency making recommendations to the President and 
Congress on issues affecting Americans with disabilities. NCD 
is currently coordinating a multi-year study on the 
implementation and enforcement of the Americans with 
Disabilities Act and other civil rights laws. The Committee 
appreciates this work and has included an additional $500,000 
to continue and expand the survey.

           Preventing and Reversing Heart Disease Initiative

    Nearly 63 million Americans, young and old, live with the 
effects of cardiovascular disease. Heart disease and related 
disorders account for 960,000 deaths each year--the Nation's 
number one killer. The economic losses are more than any other 
disease costing society over $330,000,000,000 annually in 
medical costs and lost productivity. Challenges to combating 
this disease include persistent geographic, racial, and ethnic 
disparities, the increased prevalence of sedentary lifestyles, 
obesity rates, and deficiencies in the use of proven and 
effective treatments for those already afflicted with 
cardiovascular disease.
    On May 16, 2002, the Subcommittee on Labor, Health and 
Human Services and Education convened a hearing to more closely 
examine the factors contributing to cardiovascular disease, and 
to explore possible approaches to prevent, control, and reverse 
its effects. Testimony heard from a variety of top medical 
experts reflected a common theme: All agreed that stress 
management, in conjunction with diet modification, exercise, 
and pharmacological and/or surgical intervention, can 
significantly improve the quality of life for those confronted 
with cardiovascular disease. Witnesses confirmed that 
cardiovascular disease usually begins several years before 
symptoms appear. Due to the body's compensation mechanisms many 
individuals function normally for years in an asymptomatic 
state, unaware that the disease is taking hold. Once symptoms 
become apparent, a disproportionate amount of medical resources 
are devoted to dealing with those symptomatic events, rather 
than taking preventive measures at a much earlier stage. 
Integrating technology, behavioral and metabolic medicine, and 
lifestyle modifications at an early age would shift that focus 
from reactive medicine to preventive medicine. For example, 
relatively simple lifestyle modifications, including exercise, 
nutrition plans and learning a relaxation response to stress, 
such as yoga techniques, have led to successful outcomes for 
individuals who are otherwise at risk. Individuals who have 
adopted these changes have experienced positive results, 
including weight loss, lower blood pressure and cholesterol 
levels, improved clinical symptoms and reduction in 
psychological distress. For many years the National Heart, 
Lung, and Blood Institute has supported a vigorous program of 
research on the behavioral and psychological impact of 
cardiovascular disease. Data obtained by NHLBI confirmed that 
mental stress could cause myocardial ischemia or reduced blood 
flow.
    Current evidence suggests that all individuals at risk for 
cardiovascular disease can benefit from stress reduction, but 
that general health and well-being are greatly improved if the 
first steps are taken during childhood. Among children, in 
fact, stress management programs have been shown to improve 
self-esteem, grade-point average and work habits while reducing 
violent behavior. To that end, the educational system in this 
country should be encouraged to incorporate stress management 
programs into school curriculum.
    To address the prevention and reversing heart disease 
initiative, the Committee has included $5,758,686,000 in 
addition to the amounts provided as part of the physical 
activity and nutrition initiative.
    Obesity and nutrition programs work hand in hand in 
preventing and reducing heart disease. The Committee encourages 
the Departments of Health and Human Services and Education to 
coordinate the above programs and activities to address both 
initiatives.
Fund for Innovative Education
    As part of the preventing and reversing heart disease 
initiative, the Committee has included $1,000,000 to design 
programs to teach school children and teachers coping skills to 
help ease both the short- and long-term effects of stress. The 
Committee directs the Department to implement this initiative 
as soon as possible. Programs such as these have been 
scientifically proven to improve students' self-esteem, self-
efficacy, control, grade point average, work habits, memory and 
cooperation.
National Heart, Lung, and Blood Institute
    For research into the prevention, causes and cures for 
heart disease and related disorders at the National Heart, 
Lung, and Blood Institute, the Committee has included 
$2,897,595,000, an increase of $103,862,000 over the fiscal 
year 2003 level.
    The Committee strongly encourages the NHLBI, in conjunction 
with Walter Reed Medical Center, to conduct a controlled, 
prospective, randomized trial to compare the outcomes of 
utilizing a demanding vegetarian diet versus a more liberal 
diet that would also utilize lipid-lowering drugs, as well as 
the impact of relaxation response-based stress management 
programs. Such a trial could take place over a long period of 
time to allow a long-term assessment of outcomes.
Centers for Medicare and Medicaid Service
    The Committee commends the Centers for Medicare and 
Medicaid Service [CMS] for continuing their work on a lifestyle 
modification study comparing the efficacy and costs of two 
cardiac approaches to reversing heart disease.
    The Committee understands that recent research indicates 
there are significant health and economic benefits from 
incorporating psychological interventions, such as stress 
management and other cognitive behavioral interventions, in the 
overall treatment of cardiovascular disease. If proven, this 
would greatly benefit Medicare and Medicaid Services patients 
with heart disease while saving money. Heart disease is the 
number one cause of death in the Nation and is particularly 
prevalent among the elderly. A demonstration of this research 
is critically important. Therefore, the Committee expects the 
Centers for Medicare & Medicaid Services to conduct a study of 
the cost savings and quality of care benefits from 
incorporating stress management and other cognitive behavioral 
interventions in the treatment of Medicare beneficiaries with 
cardiovascular disease.
Centers for Disease Control
    The Committee has provided $45,963,000 to increase CDC's 
cardiovascular programs as part of the Committee's initiative 
to prevent and reverse heart disease. The Committee urges the 
CDC to initiate research to examine strategies to prevent and 
reverse heart disease, including mind/body approaches to stress 
management, yoga, diet modifications, and exercise programs.
    To improve the health of racial and ethnic populations 
through the development of effective health policies and 
programs to eliminate disparities in health, the Committee has 
provided $192,824,000 for the National Center on Minority 
Health and Health Disparities and $37,561,000 to eliminate 
racial and ethnic health disparities. Also included, to address 
areas hardest hit by the HIV-AIDS epidemic, is $131,884,000 
specifically targeted for minority AIDS programs and 
$585,900,000 for minority AIDS research at the National 
Institutes of Health.
    To aid institutions with a significant percentage of 
financially needy students, the Committee has provided an 
increase of $487,519,000, an increase of $15,196,000 over the 
fiscal year 2003 appropriation. Included in this amount is 
$81,467,000 for strengthening institutions, $93,551,000 for 
Hispanic-serving institutions, $224,086,000 for historically 
black colleges and universities, $53,415,000 for strengthening 
historically black graduate institutions, and Native Alaskan 
and Native Hawaiian institutions are funded at $11,000,000.
    To assist States, colleges, middle and high schools serving 
high percentages of low income students and improve 
postsecondary education opportunities for low-income 
individuals and first-generation college students, the 
Committee has included $840,000,000 for TRIO and $300,000,000 
for GEAR UP programs. To assist Howard University with academic 
programs and the administration of the University hospital, the 
Committee recommends $238,440,000.
    The increases provided for the above-mentioned programs, 
along with funding for the National Institutes of Health, the 
Centers for Disease Control and Prevention, and education 
programs will go a long way towards eliminating health and 
education disparities.

                Prostate Cancer Research and Prevention

    Prostate cancer is the most common cancer, with the 
exception of skin cancer, in men. It is the second leading 
cause of cancer death in American men, exceeded only by lung 
cancer. This year over 198,100 new cases of prostate cancer 
will be diagnosed and 31,500 men will die from it. African-
American men are more likely both to have prostate cancer and 
twice as likely to die from it than are white or Asian men. 
Among men diagnosed with prostate cancer, 97 percent survive at 
least 5 years, 79 percent survive at least 10 years, and 57 
percent survive at least 15 years.
    The Committee commends the National Institutes of Health 
for preparing a prostate cancer research plan which will enable 
the National Cancer Institute and the other institutes at the 
NIH to respond to new discoveries and research opportunities. 
The Committee supports the goals and objectives outlined in the 
plan which focus on discovering genetic, biochemical, 
environmental, and lifestyle factors and how they relate to 
prostate cancer risks.
    Over the past decade, significant progress has been made in 
characterizing molecular and cellular changes and the 
mechanisms responsible for malignant transformation and cancer 
progression. Progress is also being made in understanding the 
interactions between the cancer cell and its environment that 
influence organ invasion, metastases, hormone-independent 
growth, and resistance to cell death.
    The Committee is strongly committed to improving research 
and prevention efforts in the area of prostate cancer and has 
included $4,770,519,000, an increase of $178,171,000 over the 
fiscal year 2003 appropriation, for cancer research programs at 
the National Institutes of Health. The Committee understands 
that of this amount, the National Cancer Institute plans to 
devote approximately $399,900,000 specifically for prostate 
cancer research.
Prostate Cancer and Minority Health
    The Committee is also encouraged by the efforts of the 
National Center on Minority Health and Health Disparities to 
collaborate with the National Human Genome Research Institute 
to fund research to determine the environmental and familial/
genetic risk factors for prostate cancer. This collaborative 
effort will lead to a better understanding of the genetic basis 
of this disease and its disproportionate impact on African 
Americans.
    The Centers for Disease Control and Prevention is also 
working to better understand prostate cancer. The CDC is also 
emphasizing the high incidence of the disease in the African-
American community. The Committee is supportive of CDC's 
efforts to enhance prostate cancer data in State cancer 
registries, especially with regard to stage of diagnosis, 
quality of care and racial and ethnic information. To address 
prostate cancer initiatives at the CDC, the Committee has 
included $15,583,000, an increase of $1,628,000 over the fiscal 
year 2003 appropriation.
Diet and Prostate Cancer
    The Committee is interested in the correlation between diet 
and prostate cancer. Some studies suggest that saturated fat or 
red meat maybe associated with a higher risk of prostate 
cancer. But so far, studies have not proven components in meat 
or dairy foods could cause prostate cells to go haywire. In a 
Harvard study, conducted in 1993, researchers reported that men 
who ate red meat most frequently had more than double the risk 
of advanced prostate cancer compared to men who ate little or 
no red meat.
    Increasing scientific evidence indicates that what you 
include in your diet may be as important as what you exclude. 
Scientists estimate that at least 30-40 percent of all cancers 
are linked to diet and related lifestyle factors. Some foods 
contain substances known to increase the risk of cancer, 
including saturated fat, cholesterol, and oxidants. Avoiding 
these foods may reduce the risk of many of the most common 
forms of cancer, including prostate cancer, breast cancer, and 
colon cancer. Other foods contain substances that help protect 
against cancer and heart disease, and these are sometimes known 
as functional foods. These include phytochemicals, 
bioflavinoids, retinols, isoflavones, genestein, lycopene 
(found in tomatoes), and sulforaphanes (in broccoli). With few 
exceptions, these protective substances are found in fruits, 
vegetables, whole grains, legumes, and soy products. A growing 
number of compounds in fruits, vegetables, and cereal grains 
have been found to interfere with the process of cancer 
development in laboratory research. Epidemiologists have found 
that populations that consume large amounts of plant-derived 
foods have lower incidence rates of some types of cancer. 
Eating vegetables and fruits is associated with a decreased 
risk of cancers of the esophagus, oral cavity, stomach, colon, 
rectum, lung, prostate, and larynx and possibly other cancers.
    The Committee is aware of randomized controlled trials that 
are being conducted to determine if prostate cancer may be 
affected by making changes in diet and lifestyle. In these 
studies 90 men with biopsy-proven prostate cancer--who had 
elected not to undergo conventional treatment--for reasons 
unrelated to the study were randomly assigned into experimental 
groups--one group was asked to make comprehensive lifestyle 
changes and the other group was assigned to a non-intervention 
control group. The study found that the progression of prostate 
cancer may be stopped or perhaps even reversed by making 
comprehensive lifestyle changes alone. After 1 year, PSA levels 
worsened in the control group but improved in the experimental 
group. These differences were statistically significant after 1 
year. Also, tumor growth in tissue culture was inhibited nine 
times more in the experimental group than in the control group. 
There was a strong and statistically significant correlation 
between adherence to the lifestyle program and changes in PSA 
across both groups after 1 year. The more people changed, the 
more their PSA decreased. This is the first time that a diet 
and lifestyle intervention has been demonstrated to affect the 
progression of any type of cancer in a randomized controlled 
trial.
    If these trials prove to be effective, and heart disease 
and prostate cancer can be stopped or reversed, then the 
implications for preventing them in the next generation may be 
even more important. Also, it may not require such intensive 
changes in diet and lifestyle to prevent these diseases as it 
does to stop or reverse their progression once a person has 
already developed them. These patients will be followed for at 
least 5 more years to determine the long-term effects of diet 
and lifestyle changes on rate of recurrence, metastasis, number 
of patients requiring conventional treatment, and survival.
    The Committee encourages the National Institutes to monitor 
the trials currently being conducted and to support research in 
the area of diet and lifestyle modifications to prevent or 
reverse prostate cancer.

                     Infectious Disease Initiative

    Infectious diseases are a leading cause of death worldwide 
and contribute significantly to the escalating costs of health 
care. Earlier predictions of the elimination of infectious 
diseases often did not take into account changes in 
demographics and human behaviors and the extraordinary ability 
of microbes to adapt, evolve, and develop resistance to drugs. 
More than 35 newly emerging infectious diseases were identified 
between 1973 and 2002, and new infectious diseases continue to 
be identified. Disease outbreaks endanger U.S. citizens at home 
and abroad. To address these needs the Committee has included 
$2,238,960,000 to improve this Nation's research capabilities 
and to detect and control emerging infectious disease threats 
in the United States and around the world.
Emerging Infectious Disease
    Emerging infectious diseases, like West Nile virus, SARS 
and monkeypox, continue to pose a serious threat to the 
public's health. Outbreaks of these diseases cause great 
suffering and death and impose an enormous financial burden on 
societies around the world. The Committee recognizes the 
necessity of a strong domestic public health infrastructure and 
robust partnerships between CDC, the National Institutes of 
Health, the World Health Organization, and other global 
stakeholders to counter the threat posed by emerging 
infections. Recent experiences with SARS, West Nile virus and 
monkeypox illustrate the vital necessity of strengthening this 
Nation's capacity to identify and combat emerging infectious 
diseases. The Committee had included $372,760,000,000 for 
infectious disease control at the Centers for Disease Control 
including $25,000,000 for containment of disease outbreaks such 
as SARS and monkeypox. For emerging infectious diseases at the 
National Institutes of Health, the Committee has included 
$1,686,200,000, an increase of $599,000,000 over the fiscal 
year 2003 appropriation.
Public Health Research
    Our Nation's substantial economic investment in biomedical 
research has identified causes of and methods to prevent 
illness, allowing medical practitioners to diagnose and treat 
an astonishing array of medical conditions. In order to have a 
public health impact commensurate with this level of 
investment, however, the information generated in biomedical 
laboratories must be translated into effective public health 
programs. Public health research conducted by CDC is solution-
oriented, designed to bridge the gap between medical research 
discoveries and behaviors people adopt. Specifically, public 
health research helps to define 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. This kind of 
practical, applied research seeks to overcome barriers that 
prevent people from adopting healthy behaviors proven effective 
by biomedical research. The Committee has included $30,000,000 
for public health research to improve the health status of the 
Nation.
Global Disease Detection System
    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 West Nile virus, 
SARS, monkeypox, pandemic flu and bioterrorism. CDC's Global 
Disease Detection System, designed to provide worldwide 
technical support to ensure rapid and accurate diagnoses of 
emerging infectious disease events, is integral to these 
efforts. 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. The Committee has 
provided $50,000,000 for CDC to develop the Global Disease 
Detection System to full capacity to assure a rapid and 
appropriate response to global infectious disease threats.
Pandemic Flu
    Pandemic influenza represents both a naturally-occurring 
and potentially man-made threat to our Nation's health. The 
influenza pandemic of 1918 claimed more than 25 million lives 
globally and more than 500,000 in the United States in less 
than 10 months. Most scientists agree that it is not a question 
of whether there will be another influenza pandemic, but rather 
when it will occur. Once a pandemic begins, it will be too late 
to accomplish the activities required to minimize its toll. 
Vaccines cannot be prepared in advance and stockpiled, but 
planning and implementation of preparatory activities can be 
started well in advance. Currently, the Nation's influenza 
vaccine supply totals about 90 million doses. Preparing for a 
severe pandemic could require more than 280 million doses of 
vaccine. The Committee has included $100,000,000 to provide 
resources to produce an adequate supply of vaccine in the event 
of a severe flu outbreak.

              REPROGRAMMING AND INITIATION OF NEW PROGRAMS

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

                           TRANSFER AUTHORITY

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

                      TITLE I--DEPARTMENT OF LABOR

                 Employment and Training Administration

                    TRAINING AND EMPLOYMENT SERVICES

Appropriations, 2003....................................  $5,200,161,000
Budget estimate, 2004...................................   4,951,986,000
Committee recommendation................................   5,115,588,000

    The Committee recommends $5,115,588,000 for this account in 
2004 which provides funding authorized primarily by the 
Workforce Investment Act [WIA]. This is $84,573,000 less than 
the 2003 level, and $163,602,000 above 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 2004 will support 
the program from July 1, 2004, through June 30, 2005.
    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, beginning 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 
2004, 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.
    Adult Employment and Training Activities.--For Adult 
Employment and Training Activities, the Committee recommends 
$900,000,000. This program is authorized by the Workforce 
Investment Act and is formula-funded to States and further 
distributed to local workforce investment boards. Services for 
adults will be provided through the One-Stop system and most 
customers receiving training will use their individual training 
accounts to determine which programs and providers fit their 
needs. The Act authorizes core services, which will be 
available to all adults with no eligibility requirements, and 
intensive services, for unemployed individuals who are not able 
to find jobs through core services alone.
    Dislocated Worker Employment and Training Activities.--For 
Dislocated Worker Employment and Training Activities, the 
Committee recommends $1,431,760,000. Of the total, 
$1,155,152,000 is designated for State formula grants, the same 
as the fiscal year 2003 level. This program, authorized by WIA, 
is a State-operated effort which provides core services, 
intensive services, training, and supportive services to help 
permanently separated workers return to productive, 
unsubsidized employment. In addition, States use these funds 
for rapid response assistance to help workers affected by mass 
layoffs and plant closures. The recommendation includes 
$276,608,000 available to the Secretary for activities 
specified in WIA, primarily to respond to mass layoffs, plant 
and/or military base closings, and natural disasters across the 
country, which cannot be otherwise anticipated, as well as 
technical assistance and training and demonstration projects.
    The Committee 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.
    The Committee recommendation includes, as it has in past 
years, funding for dislocated worker projects aimed at 
assisting the long-term unemployed.
    The Committee expects the Department to abide by its August 
2002 agreement to provide sufficient funds to the State of 
Alaska from within available amounts to mitigate negative 
effects on Alaskan fishermen stemming from passage of the Trade 
Adjustment Assistance Act in 2002 as provided in the agreement 
with the Secretary.
    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 substantial worker 
dislocation brought on by the closure of sugarcane plantations 
and the rapidly increasing demand for food safety training at 
all levels of food production. To meet these needs, the 
Committee reiterates its recommendation in last year's report 
to provide on-farm and off-farm food safety training for 
dislocated sugarcane workers employed in the agricultural and 
food sector. To facilitate the transition from large-scale 
plantation agriculture to smaller scale diversified 
agricultural operations, workers displaced by plantation 
closures must be trained in both the production and financial 
aspects of agricultural businesses. The Committee recommends 
continuing funding for the programs to provide agricultural 
production and business training to dislocated sugarcane 
workers.
    The Committee is 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 expects the Department to submit a report to the 
Committee on the timeline of the National Emergency Grant 
process over the last 3 fiscal years. The report should detail 
the length of time between the Department's receipt of a 
National Emergency Grant application to the decision to award 
that grant and finally to the release of those funds. The 
Committee is also concerned by a shortfall in the Trade 
Adjustment Assistance program over the last few years and would 
like the report to include the percentage of National Emergency 
Grant funding that has been awarded to Trade Adjustment 
Assistance-eligible entities over the same period of time. The 
Department should submit this report to the Committee within 90 
days after enactment of this bill.
    Youth Activities.--For Youth Activities, the Committee 
recommends $1,000,965,000. The Committee recommendation does 
not address the administration's legislative proposals for 
these activities. Youth Activities, authorized by WIA, 
consolidates the Summer Youth Employment and Training Program 
under JTPA Title IIB, and Youth Training Grants under JTPA 
Title IIC. In addition to consolidating programs, WIA also 
requires Youth Activities to be connected to the One-Stop 
system as one way to link youth to all available community 
resources. The purpose of Youth Activities is to provide 
eligible youth with assistance in achieving academic and 
employment success through improving educational and skill 
competencies and providing connections to employers. Other 
activities include providing mentoring opportunities, 
opportunities for training, supportive services, summer 
employment opportunities that are directly linked to academic 
and occupational learning, incentives for recognition and 
achievement, and activities related to leadership development, 
citizenship, and community service.
    Youth Opportunity Grants.--For Youth Opportunity Grants, 
the Committee the concurs with the budget request discontinuing 
funding for this demonstration program. During its 5 year 
demonstration period, Youth Opportunity Grants were aimed at 
increasing the long-term employment of youth who live in 
empowerment zones, enterprise communities, and other high-
poverty areas.
    Job Corps.--For Job Corps, the Committee recommends 
$1,541,216,000. This is $24,667,000 less than the budget 
request, but $28,045,000 more than the 2003 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 should continue its efforts to upgrade its vocational 
offerings and curricula to reflect industry standards and skill 
shortages. Job Corps, authorized by WIA, is a nationwide 
network of residential facilities chartered by Federal law to 
provide a comprehensive and intensive array of training, job 
placement and support services to at-risk young adults. The 
mission of Job Corps is to attract eligible young adults, teach 
them the skills they need to become employable and independent, 
and place them in meaningful jobs or further education. 
Participation in the program is voluntary and is open to 
economically disadvantaged young people in the 16-24 age range 
who are unemployed and out of school. Most Job Corps students 
come from disruptive or debilitating environments, and it is 
important that they be relocated to residential facilities 
where they can benefit from the highly structured and carefully 
integrated services provided by the Job Corps program. A 
limited number of opportunities are also available for non-
residential participation.
    The Committee encourages Job Corps to strengthen working 
relationships with work force development entities, including 
employers, that will enhance services to students and increase 
students' career opportunities. The Department is encouraged to 
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 encourage the Department of Labor's Employment and Training 
Administration to encourage Job Corps centers to coordinate 
with community-based organizations, such as substance abuse 
treatment centers, in innovative ways.
    The Committee supports the goal of the Workforce Investment 
Act of 1998 to integrate our Nation's many diverse job training 
programs, and its approach of retraining the national character 
of the Job Corps program within the new framework. The 
Committee encourages the Department to continue its work to 
develop national partnerships with major regional and national 
employers to increase employment opportunities for Job Corps 
graduates. The Department should also continue to establish 
connections between Job Corps and State workforce development 
programs, and between Job Corps and other national and 
community partners, to provide the most efficient, cost-
effective services possible.
    The Committee recognizes 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 vibrant industry's workforce and 
spur the nation's economy.
    The Committee believes that Job Corps' partnerships with 
National Training Contractors, such as the Home Builders 
Institute [HBI], the workforce development arm of the National 
Association of Home Builders, are essential to the success of 
Job Corps. The Committee commends HBI for its proven record in 
providing at-risk youth with the craft skills training and 
employment opportunities they need to succeed while helping the 
building industry meets its workforce needs. As such, the 
Committee encourages the Department to expand its Job Corps 
partnership with the building industry in order to ensure the 
continued availability of skilled workers for this thriving 
industry.
    The Committee commends the Job Corps program for 
establishing cost-effective national and local partnerships 
with the United States Army, Navy, and Coast Guard to recruit 
high quality military personnel. Job Corps students' average 
scores on military entrance exams exceed the national average. 
Last year, the Army recruited more than 2,000 Job Corps 
graduates. The Committee also recognizes that the Job Corps is 
training young people with skills that are in high demand by 
civilian support contractors who service the military, 
including computer technology, nursing, and welding.
    Responsible Reintegration for Youthful Offenders.--The 
Committee recommends $54,642,000 for Responsible Reintegration 
for Youthful Offenders, the same as the fiscal year 2003 level, 
to address youth offender issues. This large scale WIA Pilot 
and Demonstration initiative will link offenders under age 35 
with essential services that can help make the difference in 
their choices in the future, such as education, training, job 
placement, drug counseling, drug demand reduction activities, 
and mentoring, in order to reintegrate them into the mainstream 
economy. Through local competitive grants, this program would 
establish partnerships between the criminal justice system and 
local workforce investment systems, complementing a similar 
program in the Department of Justice. To maximize the impact of 
these initiatives, the Labor and Justice Department funds will 
be targeted to the same communities and populations. An 
estimated 10,400 youth will be served, and it is expected that 
65 percent of program graduates will get jobs, re-enroll in 
high school, or be enrolled in post-secondary education or 
training.
    Native Americans.--For Native Americans, the Committee 
recommends $55,636,000. This is the same as the 2003 comparable 
level. This program, authorized by WIA, is designed to improve 
the economic well-being of Native Americans (Indians, Eskimos, 
Aleuts, and Native Hawaiians) through the provision of 
training, work experience, and other employment-related 
services and opportunities that are intended to aid the 
participants to secure permanent, unsubsidized jobs.
    Migrant and Seasonal Farmworkers.--For Migrant and Seasonal 
Farmworkers, the Committee recommends $77,330,000. This is the 
same as the 2003 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 
under-employment 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 has rescinded funds available to the 
Department of Labor from farmworker housing for program year 
2003 because the Department proposed to use them in a manner 
inconsistent with the intent of Congress. It continues to be 
the intention of the Committee that funds appropriated for 
farmworker housing, that is an authorized supportive service 
under the Workforce Investment Act, be used to develop 
permanent housing for eligible migrant and seasonal 
farmworkers.
    The Committee has included language that re-appropriates 
the funds rescinded as well as provides an appropriation for 
program year 2004. In doing so, the Committee has earmarked the 
program year 2003 funds for use of farmworker housing 
organizations with grants expiring June 30, 2003. The principal 
purpose of these funds is to develop permanent housing and 
related facilities for migrant and seasonal farmworkers.
    The Committee recommendation of $77,330,000 for program 
year 2004 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 $72,213,000. The Committee recommendation 
includes bill language directing that $4,610,000 of this amount 
be used for migrant and seasonal farmworker housing grants, 
including activities to develop permanent housing. The 
recommendation also provides that the remaining amount 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 $507,000 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 the budget 
request level of $3,000,000 for the provision of technical 
assistance and staff development. This includes the current 
level of $993,000 for technical assistance to employers and 
unions to assist them in training, placing, and retraining 
women in nontraditional jobs and occupations.
    Pilots, Demonstrations, and Research.--The Committee 
recommends $35,000,000, the same as 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 $7,000,000 for the 
Denali Commission for job training in rural Alaska. Funding 
will allow un- 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 $9,039,000 to provide 
for the continuing evaluation of programs conducted under WIA, 
as well as of federally-funded employment-related activities 
under other provisions of law.
    Women in Apprenticeship.--The Committee concurs with the 
administration request to discontinue separate funding of 
$933,000 for the Women in Apprenticeship and Nontraditional 
Occupations program. This activity is continued with technical 
assistance funding under the Workforce Investment Act, to 
assist employers and unions in training, placing, and 
retraining women in nontraditional jobs and occupations.

            COMMUNITY SERVICE EMPLOYMENT FOR OLDER AMERICANS

Appropriations, 2003....................................    $442,306,000
Budget estimate, 2004...................................     440,200,000
Committee recommendation................................     442,306,000

    The Committee recommends $442,306,000, the same as the 
program year 2003 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 2004 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.
    The Committee urges the Department to consider allowing 
sponsoring organizations within their awarded grants to 
participate in section 502(e) innovative projects designed to 
assure second career training and placement of eligible 
individuals in employment opportunities with private business 
concerns.
    The Committee is deeply concerned that the Labor Department 
is instituting massive changes, on very short notice, that have 
the potential to seriously disrupt the services to participants 
in the Senior Community Service Employment Program [SCSEP]. 
Several organizations currently serving these participants have 
expressed grave concern over the process by which the Labor 
Department has awarded national SCSEP grants for the program 
year commencing July 1, 2003. The Committee expects the Labor 
Department to give top priority attention to assuring that 
there will be no disruption of existing program operations 
while these concerns are being addressed. If necessary, these 
changes should be put on hold to prevent any possibility of 
disrupting the vital services being provided to senior 
citizens. Prior to this change, the Committee expects the Labor 
Department to work with the new grantees' to allow for 
subcontracting of services and programs and reallocating of 
unspent State allocations to the existing grantees. If the 
Department does proceed with these changes, the Committee 
expects the Department to provide a complete report regarding 
the transition of SCSEP participants to new grantees, including 
the nature and extent of any disruption that may have affected 
participants or community service organizations, any decline in 
the quantity or quality of services delivered, and the specific 
and total expenses incurred by grantees or the Department in 
effecting the transition of SCSEP participants.

              FEDERAL UNEMPLOYMENT BENEFITS AND ALLOWANCES

Appropriations, 2003....................................    $972,200,000
Budget estimate, 2004...................................   1,338,200,000
Committee recommendation................................   1,338,200,000

    The Committee recommends $1,338,200,000, the same as the 
budget estimate for fiscal year 2004, an increase of 
$366,000,000 over the fiscal year 2003 appropriation for 
Federal Unemployment Benefits and Allowances. Trade 
Readjustment Allowance [TRA] weekly benefits are estimated to 
increase from 2.5 million in fiscal year 2003 to 4.2 million in 
fiscal year 2004. Fiscal year 2004 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. This is an entitlement program.
    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, 2003....................................  $3,595,381,000
Budget estimate, 2004...................................   3,646,783,000
Committee recommendation................................   3,620,552,000

    The Committee recommends $3,620,552,000 for this account. 
This is $26,231,000 below the budget request and $25,171,000 
above the 2003 comparable level. Included in the total 
availability is $3,478,032,000 authorized to be drawn from the 
``Employment Security Administration'' account of the 
unemployment trust fund, and $142,520,000 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 
$2,645,424,000. This includes $2,634,924,000 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. 
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 $791,557,000 which includes $23,300,000 in general 
funds together with an authorization to spend $768,257,000 from 
the ``Employment Security Administration'' account of the 
unemployment trust fund. These funds are available for the 
program year of July 1, 2004, through June 30, 2005.
    The recommendation includes $64,351,000 for national 
activities, an increase of $14,000,000 over the fiscal year 
2003 level. This recommendation provides increased funding of 
the foreign labor certification program, but not the full 
amount requested by the Administration. The recommendation 
includes $20,000,000 for the work opportunity tax credit 
program.
    The recommendation also includes $99,350,000 for One-Stop 
Career Centers. This 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 $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, 2003....................................    $463,000,000
Budget estimate, 2004...................................     467,000,000
Committee recommendation................................     467,000,000

    The Committee recommends $467,000,000, the same as the 
budget estimate for fiscal year 2004, an increase of $4,000,000 
over 2003. 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 2004 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, 2003....................................    $174,511,000
Budget estimate, 2004...................................     183,365,000
Committee recommendation................................     178,961,000

    The Committee recommendation includes $115,824,000 in 
general funds for this account, as well as authority to expend 
$63,137,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund, for a total of 
$178,961,000.
    The Committee recommendation provides a portion of the 
increase requested to reduce the backlog of applications for 
the permanent labor certification program.
    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 expects the Labor Department to conduct a 
comprehensive study, detailing the changing composition of our 
manufacturing workforce, including job loss or gain by industry 
sector in the United States over the last 10 years.
    The study should take 1993 as a base year and include such 
normal components as the duration of post lay-off job searches, 
health insurance coverage, as well as industry, occupation and 
earnings of the old and new jobs. The study should examine 
occupational employment based on national trends, taking into 
account, in reasonable detail, the level of education by 
industry group and any changes in those levels from the base 
year to the most recently available data. The study should also 
provide information on the composition of full and part-time 
employment in manufacturing for past years and, based on that 
empirical evidence, to the extent possible determine what 
percentage of the manufacturing workforce will be employed full 
vs. part-time as of 2012. Also to the extent possible, the 
study should provide a projection as to the overall 
contribution of manufacturing to the U.S. GDP out to, or as of, 
2012. The study should be completed by May, 2004.

                Employee Benefit Security Administration


                         SALARIES AND EXPENSES

Appropriations, 2003....................................    $116,283,000
Budget estimate, 2004...................................     128,605,000
Committee recommendation................................     121,316,000

    The Committee recommendation provides $121,316,000 for this 
account, formerly the Pension and Welfare Benefits 
Administration, which is $5,033,000 above the 2003 comparable 
level. This includes partial funding of requested program 
increases to enhance confidence in the private sector employee 
benefits system, and provide interpretive guidance to 
employers.
    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]. 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 
2004 include single employer benefit payments of 
$2,961,000,000, multiemployer financial assistance of 
$13,730,000 and administrative expenses of $228,772,000. 
Administrative expenses are comprised of three activities: (1) 
pension insurance activities, $16,553,000; (2) operational 
support, $80,054,000; and (3) pension plan terminations 
expenses, $132,165,000. 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.
    Unlike the 2003 budget, the 2004 budget does not recommend 
a discretionary limit on administrative expenditures [LAE] for 
PBGC. In 2004 and subsequent years, the PBGC's budget will 
reflect--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 million 
participants in about 35,000 defined benefit pension plans. The 
multi-employer insurance program protects about 8.8 million 
participants in about 1,700 plans.

                  Employment Standards Administration


                         SALARIES AND EXPENSES

Appropriations, 2003....................................    $381,113,000
Budget estimate, 2004...................................     397,753,000
Committee recommendation................................     392,061,000

    The Committee recommendation includes $392,061,000 for this 
account. The bill contains authority to expend $2,016,000 from 
the special fund established by the Longshore and Harbor 
Workers' Compensation Act; the remainder are general funds. In 
addition, an amount of $32,004,000 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. It rejects the administration's 
proposed legislation that would have established a surcharge on 
the amount billed to Federal agencies for workers' compensation 
benefits to finance Labor Department administrative expenses of 
$87,573,000. It restores proposed program reductions, including 
the equal pay initiative and includes recommended program 
increases.
    The President's budget included a legislative proposal 
under the jurisdiction of the Senate Committee on Health, 
Education, Labor, and Pensions to charge individual agencies, 
starting in fiscal year 2003, the administrative cost of the 
Federal Employees' Compensation Act [FECA] program. Currently 
Federal agencies are budgeted for and billed each year for 
monetary and medical benefits that have been paid to their 
employees under FECA, while the program's discretionary 
administrative costs are financed in the Department of Labor 
[DOL]. The authorizing committee has not acted on this 
legislation, therefore the Senate Appropriations Committee will 
continue to fund this administrative cost through this account.
    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, 2003....................................    $163,000,000
Budget estimate, 2004...................................     163,000,000
Committee recommendation................................     163,000,000

    The Committee recommends $163,000,000, the same as the 
budget estimate for fiscal year 2004, and fiscal year 2003. 
This appropriation primarily provides benefits under the 
Federal Employees' Compensation Act [FECA]. The payments are 
prescribed by law. In fiscal year 2004, an estimated 155,000 
injured Federal workers or their survivors will file claims; 
55,500 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, 2003: Transferred from SSA..............    $300,177,000
Appropriations, 2004: Transferred from SSA..............      97,000,000
Budget estimate, 2004...................................     300,000,000
Budget estimate, 2005...................................      88,000,000
Committee recommendation, 2004..........................     300,000,000
Committee recommendation, 2005..........................      88,000,000

    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 
2004, an estimated 56,000 beneficiaries (7,000 miners and 
49,000 survivors) will receive benefits.
    The Committee recommends an appropriation of $300,000,000 
in fiscal year 2004 for special benefits for disabled coal 
miners. This is in addition to the $97,000,000 appropriated 
last year as an advance for the first quarter of fiscal year 
2004. 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 
$88,000,000 for the first quarter of fiscal year 2005, 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, 2003....................................    $104,867,000
Budget estimate, 2004...................................      55,074,000
Committee recommendation................................      55,074,000

    The Committee recommends $55,074,000, the same as the 
budget estimate for fiscal year 2004, and $49,793,000 below 
2003.
    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 $385,000,000 are 
anticipated in fiscal year 2004.
    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.
    The Committee is very disappointed at the lack of progress 
in completing dose reconstructions more than 2\1/2\ years after 
the Energy Employees Occupational Illness Compensation Program 
Act was enacted. The Committee urges the Secretary to expedite 
collection of necessary information and performance of dose 
reconstructions, and to set verifiable performance targets and 
appropriate timelines for when claimants can expect the work on 
their cases to be completed.

                    BLACK LUNG DISABILITY TRUST FUND

Appropriations, 2003 (Definite).........................     $55,629,000
Appropriations, 2003 (Indefinite).......................     979,371,000
Budget estimate, 2004 (Definite)........................      56,099,000
Budget estimate, 2004 (Indefinite)......................     986,901,000
Committee recommendation (Definite).....................      56,099,000
Committee recommendation (Indefinite)...................     986,901,000

    The Committee recommends $1,043,000,000 for this account in 
2004, of which $56,099,000 is definite authority and 
$986,901,000 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 2004 will 
provide $346,901,000 for benefits payments, and $56,099,000 for 
administrative expenses for the Department of Labor. Also, 
included is $640,000,000 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 44,500 people will be receiving black 
lung benefits financed through the end of the fiscal year 2004, 
compared to an estimated 49,000 receiving benefits in fiscal 
year 2003.
    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, 2003....................................    $450,310,000
Budget estimate, 2004...................................     450,008,000
Committee recommendation................................     463,324,000

    The Committee recommendation includes $463,324,000 for this 
account. This is an increase of $13,316,000 over the budget 
request and an increase of $13,014,000 above the 2003 
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 $7,175,000 in additional funds to restore the Susan 
Harwood training grant program to $11,175,000. 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 funding to maintain 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.
    The Committee has become increasingly concerned about a 
Department of Labor reorganization proposal, which would close 
the Occupational Safety and Health Administration [OSHA] 
offices in Bangor and Portland, Maine, and would consolidate 
the activities of those offices in Augusta, Maine. The 
Committee expects the Department of Labor to maintain the 
existing organizational structure with offices in Bangor and in 
Portland; this includes the provision of adequate office space 
for the current Bangor OSHA staff.

                 Mine Safety and Health Administration


                         SALARIES AND EXPENSES

Appropriations, 2003....................................    $272,956,000
Budget estimate, 2004...................................     266,767,000
Committee recommendation................................     270,711,000

    The Committee recommendation includes $270,711,000 for this 
account, an increase of $3,944,000 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 to establish a new 
office to provide 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 2003 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, 2003....................................    $492,233,000
Budget estimate, 2004...................................     512,262,000
Committee recommendation................................     515,223,000

    The Committee includes $515,223,000 for this account, 
$22,990,000 more than the 2003 comparable level. This includes 
$75,110,000 from the ``Employment Security Administration'' 
account of the unemployment trust fund, and $440,113,000 in 
Federal funds. This funding level will cover the agency's 
built-in increases.
    The Bureau of Labor Statistics is the principal fact 
finding agency in the Federal Government in the broad field of 
labor economics.
    The recommendation includes an increase of $7,710,000 over 
the budget request to provide full year funding of Occupational 
Employment Statistics; the President's budget only provided 
funding for 3 months. To partially offset this increase, 
reductions below the request are recommended in the 
``Compensation and Working Conditions'' and ``Productivity and 
Technology'' activities, but still providing more than the 
current levels.

                      Office of Disability Policy

Appropriations, 2003....................................     $47,178,000
Budget estimate, 2004...................................      47,333,000
Committee recommendation................................      47,333,000

    The Committee recommends $47,333,000 for this account in 
2004. This is the same as the President's request and $155,000 
above 2003.
    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 new 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 
Policy, the Committee has included $2,500,000 to expand the 
telework feasibility program and to increase the number of 
demonstration projects. These funds are to be used to enable 
Government agencies to explore the feasibility of employing 
home-based workers with significant disabilities.

                        Departmental Management


                         SALARIES AND EXPENSES

Appropriations, 2003....................................    $387,841,000
Budget estimate, 2004...................................     273,536,000
Committee recommendation................................     351,609,000

    The Committee recommendation includes $351,609,000 for this 
account, which is $78,073,000 more than the budget request and 
$36,232,000 less than the 2003 comparable level. In addition, 
an amount of $23,401,000 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 $26,296,000 for 
Executive Direction, the same as the fiscal year 2003 
comparable level.
    The Committee recommendation includes $8,926,000 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.
    The Committee is disappointed that the Department of Labor 
has once again put forward a budget for the coming year that 
eliminates all funding for the initiatives within the 
International Labor Affairs Bureau [ILAB] working with the 
International Labor Organization to combat abusive and 
exploitative child labor. Over the past decade the United 
States has been the leader in helping to reduce abusive and 
exploitative child labor around the world. As a result of the 
consistent and combined efforts of U.S. governmental agencies, 
appropriately led by the Department of Labor and with the 
strong support of Congress and specifically this Committee, the 
issue of abusive and exploitative child labor has received 
heightened international attention and programs have been 
instituted to rehabilitate these vulnerable children. ILAB 
projects funded through the ILO have given hundreds of 
thousands of children the opportunity to attend school rather 
than engage in hazardous work. These projects have also helped 
their families break the cycle of poverty by providing the 
children with an education and giving underemployed parents the 
opportunity of employment. ILAB also works with governments to 
help them build institutional capacity to combat abusive and 
exploitative child labor and improve access to quality 
education so that in time they will be able to become better 
trading partners. This positive activity clearly needs to be 
augmented, not stopped. The Committee strongly believes that 
ILAB's core mandate is very much intertwined with the broader 
trade agenda and as this trade agenda grows, ILAB's work 
necessarily will grow as well. Therefore, the Committee 
recommendation includes $108,000,000 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]. Within ILAB 
funds, $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 notes that in the fiscal year 2003 
appropriation, ILAB asked for and was granted 2 year obligating 
authority due to a belief that ILAB could not obligate the 
funds in a timely manner. The Committee is disappointed to see 
that the Department responded to this authority by reducing the 
staffing at ILAB by 40 FTEs. This reduction in staffing is 
detrimental to the effort to obligate funds in a timely manner. 
Therefore, the Committee has reverted to 1-year oligating 
authority and expects the Secretary to allocate the appropriate 
staffing levels to ILAB in order to process grant competitions 
within that time frame.
    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 as 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 
expects $5,000,000 to be spent for this purpose.
    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.
    Acknowledging the need to upgrade the information 
technology capability in the Department of Labor, the Committee 
provides $48,565,000 for the information technology fund, and 
$10,000,000 for management cross cut activities. The total 
provided includes support for cross-cutting investments such as 
common office automation suite implementation, architecture 
requirements, and web services as well as human resource 
management. In addition, $9,700,000 is recommended for a 
separate Working Capital Fund appropriation, to begin 
implementation of a new core accounting system for the 
Department of Labor.
    The Committee is concerned that lower wage Department of 
Labor employees are eligible for a maximum monthly transit 
subsidy of $65, compared to $100 for management employees. This 
disparity does not exist in the Departments of Education and 
Health and Human Services, nor does it exist for the Senate 
Appropriations Committee. The Committee hopes this matter can 
be resolved expeditiously to provide equitable treatment for 
all employees of the Labor Department.
    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 continues to urge the Department to 
investigate the impact of the nursing shortage on the overall 
health care labor market across the country, and engage in 
constructive problem solving on the issue.

                    Veterans Employment and Training

Appropriations, 2003....................................    $212,819,000
Budget estimate, 2004...................................     219,993,000
Committee recommendation................................     219,993,000

    The Committee recommendation includes $219,993,000 for this 
account, including $26,550,000 in general revenue funding and 
$193,443,000 to be expended from the ``Employment Security 
Administration'' account of the unemployment trust fund. This 
is $7,174,000 more than the 2003 comparable level.
    For State grants the bill provides $83,481,000 for the 
Disabled Veterans Outreach Program and $78,934,000 for the 
Local Veterans Employment Representative Program. The Committee 
did not act on the request to consolidate these programs.
    For Federal administration, the Committee recommends 
$29,028,000, 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 
an effective program. 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 understands the Labor Department is 
experimenting with displaying budget justification material of 
appropriations estimates on a performance budgeting basis. 
While this is a commendable goal, the Committee nevertheless 
continues to rely on the traditional display of appropriations 
account information provided prior to fiscal year 2004, and 
expects the Department to work with the Committee to make sure 
that the fiscal year 2004 budget justifications meet Committee 
needs.
    The Committee recommendation includes $19,000,000 for the 
Homeless Veterans Program, the same as the budget request. Also 
included is $7,550,000 for the Veterans Workforce Investment 
Program, the same as the budget request.

                    Office of the Inspector General

Appropriations, 2003....................................     $61,852,000
Budget estimate, 2004...................................      66,795,000
Committee recommendation................................      64,852,000

    The bill includes $64,852,000 for this account, $3,000,000 
above the 2003 comparable level. The bill includes $59,291,000 
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 $338,000 is 
available by transfer from the black lung disability trust 
fund.
    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).
    Permit transfers of up to 1 percent between appropriations 
(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).
    Rescind $210,833,000 in unspent funds from the expiring 
Welfare-to-Work program (sec. 105).

           TITLE II--DEPARTMENT OF HEALTH AND HUMAN SERVICES

              Health Resources and Services Administration

                     HEALTH RESOURCES AND SERVICES

Appropriations, 2003....................................  $6,455,558,000
Budget estimate, 2004...................................   5,665,996,000
Committee recommendation................................   5,906,322,000

    The Committee provides a program level of $5,906,322,000 
for the Health Resources and Services Administration. The 
Committee recommendation includes $5,881,322,000 in budget 
authority and an additional $25,000,000 via transfers available 
under section 241 of the Public Health Services Act. The fiscal 
year 2003 comparable program level was $6,455,558,000 and the 
administration request program level was $5,665,996,000.
    Health Resources and Services Administration [HRSA] 
activities support programs to provide health care services for 
mothers and infants; the underserved, elderly, homeless; 
migrant farm workers; and disadvantaged minorities. This 
appropriation supports cooperative programs in community 
health, AIDS care, health provider training, and health care 
delivery systems and facilities.

                FREE CLINIC MEDICAL MALPRACTICE COVERAGE

    The Committee provides $10,000,000 in first-time 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. As required by the statute, the Secretary 
shall establish a fund for the purposes of this program.
    This appropriation will 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. Such coverage is currently 
provided in the Public Health Service Act to certain community 
and other health centers. 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.

                             HEALTH CENTERS

    The Committee provides $1,627,164,000 for the consolidated 
health centers. The fiscal year 2003 comparable program level 
was $1,504,806,000 and the administration request program level 
was $1,627,164,000. This group of programs includes community 
health centers, migrant health centers, health care for the 
homeless, and public housing health service grants. The 
Committee has provided increased funding in fiscal year 2004 
to: (1) continue the economic stabilization efforts for 
existing health centers, (2) expand existing health centers, 
and (3) fund new health center sites.
    The Committee commends HRSA for its work to stabilize 
centers in fiscal year 2003, and urges the continuation of this 
important effort. Health centers, like all health providers, 
have experienced growth in their costs of providing care, 
including the care provided to the 5 million uninsured health 
center patients that is not borne by other revenue sources. 
This situation has placed many centers in declining financial 
conditions and has slowed the expansion effort among existing 
grantees. The Committee urges HRSA to increase these 
stabilization efforts so that existing grantees can expand as 
needed.
    While the Committee has provided annual increases for the 
consolidated health center program in order to serve more 
patients across the country, the Committee is very concerned by 
reports that States are reducing their support for the program, 
which could negatively impact the expansion initiative. The 
Committee requests that HRSA conduct a survey of State funding 
for health centers, to include recent and/or proposed funding 
changes, and fully assess the impact of these actions on the 
expansion initiative. The Committee requests that these 
findings be reported to the Committee by April 1, 2004.
    The Committee is concerned that a significant portion of 
the medically underserved population in Illinois continues to 
lack necessary access to community or migrant health center 
services. The underserved populations of Kankakee, Jefferson, 
Saline, Sangamon, McHenry, Peoria, St. Clair, Menard, 
Whiteside, Massac, DuPage, and Adams and the South side of 
Chicago, the underserved Asian Americans and Pacific Islanders 
population on the North side of Chicago, and the underserved 
Latino population within suburban Cook County need new and 
expanded access points to health services. The Committee 
strongly urges HRSA to identify proposals from these and other 
underserved areas, and work with the applicants to improve 
their proposals. The Committee expects HRSA to inform the 
Committee of the status of this effort no later than September 
15, 2004.
    The Committee urges HRSA to give full and fair 
consideration to proposals to expand health access in 
underserved communities in Missouri and other States.
    The Committee limits the amount available for payment of 
claims under the Federal Tort Claims Act to $45,000,000, which 
is the same as the administration request and $5,000,000 more 
than the amount provided for last year. The continued viability 
of the FTCA judgment fund is critical to the continued 
expansion of the health center program and the Committee renews 
its request that the Department recommend future legislative 
alternatives for the Fund.
    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 are forced to travel long 
distances by boat or plane even in emergency situations. The 
Committee is aware that efforts are now underway 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 commends HRSA for its efforts over the past 
year to visit and evaluate many of the rural underserved areas 
across the country. The Committee continues to believe that to 
expand services offered by these centers more nurse 
practitioners have to be utilized. Specifically, opportunities 
that are developed for the increased use of nurses in community 
health centers in collaboration with the National Institute of 
Nursing Research are recommended as highly beneficial to the 
underserved.
    The Committee is aware 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 urges HRSA to 
work with existing NMHCs to enable them to qualify for 
participation in the Community Health Center program (Public 
Health Service Act, section 330) and to expand both the numbers 
of students educated and the numbers of patients cared for at 
NMHCs.
    The Committee recognizes the critical role that translation 
services, as well as culturally sensitive health care delivery, 
plays in ensuring comprehensive care to patients who do speak 
English as a second language. It is often the case that grants 
to health centers under section 330 do not adequately cover the 
full costs of providing translation services to the growing 
range of diverse populations and languages these centers 
target. The Committee encourages HRSA to award grants to health 
centers to provide translation services or to compensate 
bilingual or multilingual staff for providing language 
assistance to those patients not fluent in English.
    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 the CHC Program to expand its 
efforts to provide mental and behavioral health services by 
increasing the number of psychologists in CHCs Nation wide.
    The Committee recognizes that asthma is a growing problem 
nationwide, particularly among minorities and the underserved. 
The Committee encourages HRSA, through its Community Health 
Centers program, to enhance its efforts aimed at reducing the 
incidence of asthma among ethnic and racial minorities and 
other medically underserved populations.

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.

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 2004.

Other Native Hawaiian and Pacific Islander Health Issues

    The Committee remains committed to the concept of a 
demonstration project for American Samoans in Hawaii at the 
Waimanalo Health Center that will integrate social services, to 
include traditional health, prevention and disease management, 
and address the health disparities among Native Hawaiians and 
other minority populations.
    In addition, as emphasized again last year, the Committee 
strongly supports the establishment of a Center of Excellence 
for Indigenous Health and Healing at the University of Hawaii 
and other 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, CDC, and 
SAMSHA to support these concepts in their awarding of grants 
wherever native and indigenous people reside.
    The Committee believes that community health centers are a 
critical source of care for the underserved, particularly in 
remote rural areas in States such as Alaska and Hawaii. New 
health centers in remote communities are critically needed. 
Nurse practitioners could be instrumental in expanding these 
critical health care services. Telemedicine technology should 
be emphasized whenever possible to maximize resources and 
collaborative communication. The Committee wants to applaud 
HRSA for the work that has been done to re-examine regulations 
and the creation of an on-line grant application process.

National Health Service Corps: Field Placements

    The Committee provides $45,948,000 for field placement 
activities. The fiscal year 2003 comparable level was 
$45,948,000 and the administration request was $45,305,000. 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 
requests that HRSA identify any potential problems with the 
implementation of the new automatic Health Professional 
Shortage Area [HPSA] designation for all health centers, and 
also how the new designation process will enhance the placement 
opportunities for health centers.

National Health Service Corps: Recruitment

    The Committee provides $125,140,000 for recruitment 
activities. The fiscal year 2003 comparable level was 
$125,140,000 and the administration request was $167,542,000. 
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. The Committee reiterates its intention that funds support 
multi-year, rather than single-year, commitments.
    The Committee commends the NHSC for its focus on ensuring a 
health 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 
and increase the number of psychologists in the Loan Repayment 
Program and begin, for the first time, to support psychology 
students in the Scholarship Program.

                           HEALTH PROFESSIONS

    The Committee provides $423,765,000 for all HRSA health 
professions programs. The fiscal year 2003 comparable level was 
$711,305,000 and the administration request was $308,372,000.
    The Committee commends HRSA for its efforts to address the 
gap between the size of the Nation's aging baby boom population 
and the number of pulmonary/critical care physicians. HRSA is 
presently developing a report on the workforce shortage issue. 
The Committee understands that a portion of this report will be 
informed, in part, by the research efforts of the American 
College of Chest Physicians [ACCP] and the members of the 
Critical Care Workforce Partnership through its COMPACCS study. 
Given the efforts of the ACCP and the members of the Critical 
Care Workforce Partnership, the Committee encourages HRSA to 
use the pulmonary/critical care specialty as a model for 
developing and testing policy options to address workforce 
shortage issues.
    Recognizing previous direction from the Committee that HRSA 
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.
    The Committee expresses concern about the increasing 
population of children with complex neurological disorders and 
the number of pediatric neurologists available to treat them. 
The Committee therefore urges HRSA to consult with the Child 
Neurology Society to develop a comprehensive action plan to 
address this critical shortage.
    The Committee recognizes that hospitals and health 
facilities across the United States have been deeply impacted 
by declines among nurses, pharmacists, radiology, and 
laboratory technicians, and other workers. This health care 
workforce shortage is a long-term problem, and most States are 
looking for ways to address such shortages. Therefore, in an 
effort to attract new entrants to the health professions by 
focusing attention on young people, the Committee recommends 
that the Secretary of Health and Human Services, acting through 
the Bureau of Health Professions of the Health Resources and 
Services Administration, award grants to accredited 
universities and/or community colleges for the establishment of 
summer health career introductory programs for middle and high 
school students.
    The Committee recommends consolidated funding for Health 
Professions programs authorized under titles VII and VIII of 
the Public Health Service Act. The following clusters and their 
associated programs are included in this consolidated account:

A. Training for Diversity

            Centers of Excellence
    This program was established to fund institutions that 
train a significant portion of the Nation's minority health 
professionals. Funds are used for the recruitment and retention 
of students, faculty training, and the development of plans to 
achieve institutional improvements. The institutions that are 
designated as centers of excellence are private institutions 
whose mission is to train disadvantaged minority students for 
service in underserved areas. Located in poor communities and 
usually with little State funding, they serve the health care 
needs of their patients often without remuneration.
    The Committee is pleased that 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 encourages 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
    This program provides funds to medical and other health 
professions schools for recruitment of disadvantaged students 
and pre-professional school preparations. The Committee is 
pleased that HRSA has given priority consideration for H-COP 
grants to minority health professions institutions, and 
recommends that grant review committees have proportionate 
representation from these institutions. 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.
            Faculty Loan Repayment
    This program provides for the repayment of education loans 
for individuals from disadvantaged backgrounds who are health 
professions students or graduates, and who have agreed to serve 
for not less than 2 years as a faculty member of a health 
professions school.
            Scholarships for Disadvantaged Students
    The Committee intends that this program receive at least 
the level of funding requested by the administration from the 
consolidated health professions appropriations. 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.

B. Training in Primary Care Medicine and Dentistry

            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 at least $5,500,000 from the consolidated health 
professions appropriation be used to continue and expand the 
Pediatric Dental Program.

C. Interdisciplinary, Community-based Linkages

            Area Health Education Centers
    This program links university health science centers with 
community health service delivery systems to provide training 
sites for students, faculty, and practitioners. The program 
supports three types of projects: Core grants to plan and 
implement programs; special initiative funding for schools that 
have previously received Area Health Education Centers [AHEC] 
grants; and model programs to extend AHEC programs with 50 
percent Federal funding.
            Health Education and Training Centers
    These centers provide training to improve the supply, 
distribution, and quality of personnel providing health 
services in the State of Florida or along the border between 
the United States and Mexico and in other urban and rural areas 
with populations with serious unmet health care needs.
            Allied Health and Other Disciplines
    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
    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
    This program addresses shortages of health professionals in 
rural areas through interdisciplinary training projects that 
prepare students from various disciplines to practice together, 
and offers clinical training experiences in rural health and 
mental health care settings to expose students to rural 
practice.
    The Committee supports addressing the issue of how the 
delivery of chiropractic health care can be enhanced in rural 
areas, and how more women and minorities can be recruited as 
chiropractic health care practitioners in rural areas. The 
Committee also expects the Bureau to expand its support for 
telecommunications and telehealth initiatives for providing 
distance education and training for nurses and allied health 
professionals serving rural areas.
            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.

D. Workforce Information and Analysis

            Health Professions Data and Analysis
    This program supports the collection and analysis of data 
on the labor supply in various health professions and on future 
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.

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

F. Children's Hospital Graduate Medical Education Program

    The Committee intends that the Children's Hospital Graduate 
Medical Education [GME] program receive at least $290,102,000 
from the consolidated health professions appropriation. The 
administration requested $199,258,000 and the fiscal year 2003 
comparable level was $290,102,000.
    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.
    The Committee recognizes the success of the Children's 
Hospitals Graduate Medical Education Payment Program in 
providing critical support for training pediatric and other 
residents in graduate medical education programs in teaching 
hospitals that do not receive support through the Medicare 
program. It has come to the Committee's attention that a 
limited number of free-standing perinatal hospitals and 
children's psychiatric hospitals have been excluded from 
participation in this program despite the fact that these 
teaching institutions are not eligible for Graduate Medical 
Education funding under Medicare. The Committee expects HRSA to 
study and report back to the Committee on this matter by April 
1, 2004. The Committee expects HRSA to explore the 
appropriateness of including these hospitals in the Children's 
Hospitals Graduate Medical Education Program and to offer 
recommendations that might allow for their inclusion.

G. Nursing Education Programs

    The Committee intends that these programs be funded through 
the consolidated health profession appropriation and continue 
with at least the level of funding provided in fiscal year 
2003. The fiscal year 2003 comparable level was $112,763,000 
and the administration requested $98,214,000 for fiscal year 
2004.
    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.
            Advanced Education Nursing
    The Committee intends that this program be funded through 
the consolidated health profession appropriation and continue 
with at least the level of funding provided in fiscal year 
2003, which was $50,174,000. The administration requested 
$26,548,000 for fiscal year 2004. 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.
            Basic Nurse Education and Practice
    The Committee intends that this program be funded through 
the consolidated health profession appropriation and continue 
with at least the level of funding provided in fiscal year 
2003, which was $26,824,000. The administration requested 
$24,202,000 for fiscal year 2004. Authorized by Public Law 105-
392, the goal of this program is to improve the quality of 
nursing practice. Activities under this program will initiate 
new projects that will change the educational mix of the basic 
nursing workforce and empower the workforce to meet the demands 
of the current health care system.
            Nursing Workforce Diversity
    The Committee intends that this program be funded through 
the consolidated health profession appropriation and continue 
with at least the level of funding provided in fiscal year 
2003, which was $9,935,000. The administration requested 
$20,564,000 for fiscal year 2004. 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.
            Nurse Loan Repayment for Shortage Area Service
    The Committee intends that this program be funded through 
the consolidated health profession appropriation and continue 
with at least the level of funding provided in fiscal year 
2003, which was $19,870,000. The administration requested 
$26,900,000 for fiscal year 2004. 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.
            Comprehensive Geriatric Education
    The Committee intends that this program be funded through 
the consolidated health profession appropriation and continue 
with at least the level of funding provided in fiscal year 
2003, which was $2,980,000. The administration did not request 
funding for fiscal year 2004.
            Nursing Faculty Loan Program
    The Committee intends that this program be funded through 
the consolidated health profession appropriation and continue 
with at least the level of funding provided in fiscal year 
2003, which was $2,980,000. The administration did not request 
funding for fiscal year 2004.

                          OTHER HRSA PROGRAMS

Hansen's Disease Services

    The Committee has included $17,570,000 for the Hansen's 
Disease Program. The fiscal year 2003 comparable level was 
$18,024,000 and the administration request was $17,570,000. 
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.

Maternal and Child Health Block Grant

    The Committee provides $731,565,000 for the maternal and 
child health [MCH] block grant. The fiscal year 2003 comparable 
level was $729,965,000 and the administration request was 
$750,831,000.
    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, 
12.75 percent of funds over $600,000,000 are used for 
community-integrated service systems [CISS] programs. Of the 
remaining funds, 15 percent is used for special projects of 
regional or national significance [SPRANS] while 85 percent is 
distributed on the same percentage split as the basic block 
grant formula.
    The Committee has again provided $5,000,000 more for SPRANS 
activities than would otherwise be the case under the statutory 
formula for oral health demonstration programs and activities 
in the States. The Committee understands that such programs 
will include grants designed to reduce the incidence of early 
childhood caries and baby bottle tooth decay, community water 
fluoridation, school-linked dental sealant programs and to 
implement State-identified objectives for improving oral 
health.
    The Committee notes that there has been a steady decline in 
oral health leadership and personnel within HRSA. At the HRSA 
central and regional office level, the number of dental health 
professionals has declined from more than 100 to less than 20. 
Of those remaining, 33 percent will reach the 30-year mandatory 
retirement level for commissioned corps officers this year. The 
Committee is concerned about this situation in light of recent 
decreases in State dental programs and an increase in dental 
disease and oral health disparities for the Nation's most 
vulnerable populations. Therefore, the Committee requests that 
HRSA report by April 1, 2004 on what actions it has taken to 
address this situation. The Committee would like included in 
the report HRSA's response to a January 2002 report submitted 
by HRSA Regional Dental consultants and any other relevant 
actions taken to enhance dental programs within HRSA.
    The Committee also provides an additional $1,600,000 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. One out of every ten new mothers suffers from 
postpartum depression [PPD], a treatable condition that 
presents a range of emotional and physical changes. 
Unfortunately, half of these women never get help. One reason 
for the low treatment rate is that only approximately 10 
percent of women with postpartum depression discuss their 
symptoms with a health care professional. This is an important 
problem with devastating affects on America's children and 
families. Research shows that postpartum depression is a 
significant contributing factor in child abuse and neglect.
    Screening tools need to be developed for the detection of 
PPD in perinatal women. In addition, recent extreme cases of 
PPD involving mother-child violence illustrate the need for a 
national, multilingual public education campaign to reduce the 
stigma of seeking treatment for PPD. Treatment of PPD focuses 
on: the development of support groups; the training of health 
providers such as obstetricians, gynecologists, pediatricians, 
low-income clinic general practitioners, and emergency room 
nurses; the development of hotlines for women to receive 
referrals to treatment; and the training of public assistance 
staff (eg. HUD, WIC, Medicaid) and home health visiting 
organizations to recognize symptoms and provide referrals to 
women suffering from PPD. The Committee encourages the Bureau 
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. Parents are often unaware that 
while nearly all babies born in the United States undergo 
newborn screening tests for genetic birth defects, the number 
and quality of these tests vary from State to State. The 
Committee supports efforts to implement 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 
program evaluation of testing programs with the goal of 
implementing cost-effective public health screening programs 
for these and other disorders.
    The Committee notes that the Maternal and Child Health 
Bureau has issued a program announcement that will extend 
support for comprehensive treatment centers for Cooley's anemia 
patients under SPRANS through fiscal year 2005. The Committee 
applauds the bureau's responsiveness to earlier expressions of 
interest in this program. The Committee urges the bureau to 
continue to coordinate its activities with the Cooley's Anemia 
Foundation and seek opportunities to expand the program to 
other centers throughout the country.
    The Committee also commends the Maternal and Child Health 
Bureau for its support of the Sudden Infant Death Syndrome 
Program Support Center, and encourages the bureau to continue 
its efforts in this important area of service, and is pleased 
that the SIDS and Other Infant Death Support Center is 
collaborating with the National Institutes of Health to address 
the disproportionately high incidence of SIDS among African 
Americans.
    The Committee remains very concerned about the impact of 
level funding of hemophilia treatment centers on access to 
needed comprehensive care for persons with bleeding disorders. 
The Committee encourages HRSA to commit additional resources to 
this model disease management network.
    The Committee recognizes epilepsy, a chronic neurological 
condition, as a significant public health concern affecting 
over 2.5 million 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 a 
model demonstration program that would improve access to health 
and other services to encourage early detection and treatment 
for children and others residing in medically underserved 
areas. The Committee encourages HRSA to partner with a national 
voluntary epilepsy agency to implement an epilepsy public 
awareness campaign directed toward underserved populations.
    The Committee is aware that diabetes and asthma 
disproportionately affect minority populations in medically 
under-served areas. Rates of severe asthma continue to 
disproportionately affect poor, minority, and inner-city 
populations. For example, African Americans visit emergency 
departments, are hospitalized, and die due to asthma at rates 
three times higher than rates for white Americans. Diabetes, 
now the sixth leading cause of death in America, has its 
greatest effect on the elderly and certain racial and ethnic 
groups. The Committee encourages HRSA to partner with 
organizations, such as the Visiting Nurse Associations of 
America, to implement programs that address these growing 
epidemics.
    The Committee recognizes that children's physiological and 
psychological needs are often different from adults. The 
``Bioterrorism and Emergency Preparedness and Response Act of 
2001'' called for preparedness and response efforts which 
addressed children's unique needs. The Committee believes that 
a pediatric network on bioterrorism and emergency preparedness 
could provide this focus and quickly deepen and extend both 
expertise and resources to providers, States, and localities 
across the country. The Committee urges HRSA to identify the 
key steps, costs, and authorities necessary to establish a 
national network of Pediatric Centers for Public Health and 
Bioterrorism Preparedness, and report its findings to the 
Committee by April 1, 2004.

Healthy Start Initiative

    The Committee provides $98,346,000 for the healthy start 
infant mortality initiative. The fiscal year 2003 comparable 
level was $98,346,000 and the administration request was 
$98,729,000.
    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.

Universal Newborn Hearing Screening and Early Intervention

    The Committee provides $9,935,000 for universal newborn 
hearing screening and early intervention activities. The fiscal 
year 2003 comparable level was $9,935,000 and the 
administration did not request funds for this program in fiscal 
year 2004. The Committee again rejects the administration 
proposal to consolidate this program into the Maternal and 
Child Health Block Grant program.
    The Committee continues to strongly support the initiative 
it began 2 years ago to provide grants to States to establish 
universal newborn hearing screening and early intervention 
programs. This initiative has been quite successful and the 
response from States has been substantial. Numerous studies 
have demonstrated that newborn hearing screening followed by 
early intervention services can greatly improve health and 
educational outcomes for children.
    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.

Organ Procurement and Transplantation

    The Committee provides $24,828,000 for organ transplant 
activities. The fiscal year 2003 comparable level was 
$24,828,000 and the administration request was $24,924,000. 
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 considers increasing the supply of organs 
available from voluntary donations to be a top public health 
priority and expects that funds be committed to those 
activities having the greatest demonstrable impact on donation 
rates.
    The Committee continues to encourage the agency to 
establish linkages with State and Federal transportation 
officials to improve coordination of donation following 
vehicular accidents, through the establishment of donor 
registries.
    The Committee commends HRSA for its leadership in promoting 
increased organ and tissue donations across the Nation. The 
Committee encourages the Division of Transplantation to enhance 
its partnership with the pulmonary hypertension community aimed 
at increasing awareness about the need for increased heart and 
lung donations.
    The Committee is encouraged by the growing number of 
transplants using living donors who contribute a portion of 
their liver to a recipient. HRSA is urged to study the outcomes 
for both donors and recipients, define the optimal surgical 
procedure and identify eligibility criteria. Additionally, to 
maximize donation of cadaveric organs for transplantation, 
research is needed to study the outcomes of: preservation 
modalities, preservation times, and donor and recipient risk 
factors. The Agency is urged to study various models for 
presumed consent and, in cooperation with nonprofit health 
organizations to investigate the feasibility of implementing 
presumed consent in the United States.
    The Committee is aware of reports that fewer than 2,000 
cadaver pancreata are available each year for transplantation 
and research purposes, far fewer than other organs. Clinical 
trials involving pancreatic beta cells to cure juvenile 
diabetes have shown great promise, and approximately 80 percent 
of patients who have received the transplants remain free from 
insulin injections 1 year after transplant. The Committee urges 
HRSA to develop and implement policies to encourage the 
retrieval of pancreata so that additional transplants can be 
conducted.

National Bone Marrow Donor Program

    The Committee provides $21,891,000 for the National Bone 
Marrow Donor Program. The fiscal year 2003 comparable level was 
$21,891,000 and the administration request was $22,013,000. 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.

National Cord Blood Stem Cell Bank Program

    The Committee has strongly supported medical research and 
the translation of medical research into treatments and cures. 
The Committee has led the way in doubling the budget of the 
National Institutes of Health over 5 years and supporting 
groundbreaking technologies that have the potential to relieve 
the suffering of millions of Americans. The Committee strongly 
supports embryonic and adult stem cell research. Adult stem 
cells, including stem cells collected from umbilical cords, 
have been the subject of research at the NIH for many years. 
Although these cord blood stem cells are still more limited in 
their ability to transform into other cell types and 
proliferate indefinitely than embryonic stem cells, the 
technology is useful for a range of blood disorders and 
cancers. Therefore, the Committee has provided $10,000,000 to 
create a National Cord Blood Stem Cell Bank with the aim of 
building an inventory of the highest quality, fully 
characterized cord blood units for use as unrelated donor 
grafts for patients who need transplantation therapy but lack 
suitably matched conventional bone marrow donors. The Committee 
understands that this Cord Blood Stem Cell Bank will serve 
patients suffering from high risk and refractory malignancies 
(leukemia, lymphoma, myelodysplasia, neuroblastoma), congenital 
and acquired bone marrow failure syndromes (aplastic anemia, 
fanconi anemia), congenital immunodeficiency syndromes (SCID, 
Wiscott Aldrich Syndrome CID), inborn errors of metabolism and 
hemoglobinopathies (sickle cell anemia and thalassemia). The 
inventory will be constructed so as to provide equal access to 
this therapy for members of all the ethnic groups in the United 
States, which will be further facilitated by the suitability of 
partially matched cord blood stem cell grafts. These features 
of the National Program will overcome the lower probabilities 
of finding matched bone marrow donors for patients with rare 
tissue types and members of ethnic minorities. Cord Blood Stem 
cells will also serve patients who, because of the advanced 
stage of their disease, must undergo transplantation therapy 
within days or weeks, requiring rapid donor procurement. The 
inventory will also be available for the performance of pre-
clinical and clinical research focusing on cord blood stem cell 
biology and the use of umbilical cord blood stem cells for 
human transplantation and cellular therapies.

Rural Health Outreach Grants

    The Committee provides $39,850,000 for health outreach 
grants. The fiscal year 2003 comparable level was $58,410,000 
and the administration request was $37,752,000. This program 
supports projects that demonstrate new and innovative models of 
outreach in rural areas such as integration and coordination of 
health services.
    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 Initiative, which is a collaboration 
involving Delta State University, Mississippi State University, 
the University of Mississippi Medical Center, and the 
Mississippi State Department of Health.
    The Committee is also supportive of non-profit 
organizations, such as the Children's Health Fund, that offer 
mobile comprehensive medical care to uninsured and medically 
underserved children. The fund is currently implementing state-
of-the-art electronic patient record systems at its project 
sites and to assist Delta State University and Mississippi 
Delta community health centers to implement mobile health in 
this critically underserved area.
    The Committee appreciates innovative programs to address 
health care needs in rural underserved areas and supports the 
efforts of Schools of Nursing in establishing nurse-managed 
clinics. The Committee further recognizes the value of 
collaborative projects involving Schools of Pharmacy, along 
with rural clinics and hospitals.
    The Committee understands that many primary care clinics in 
isolated, remote locations are providing extended stay services 
and are not staffed or receiving appropriate compensation to 
provide this service. The Committee encourages the agency to 
undertake a demonstration project 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.

Rural Health Research

    The Committee provides $9,935,000 for the Rural Health 
Policy Development Program. The fiscal year 2003 comparable 
level was $10,630,000 and the administration request was 
$5,984,000. The funds provide support for the Office as the 
focal point for the Department's efforts to improve the 
delivery of health services to rural communities and 
populations. Funds are used for rural health research centers, 
the National Advisory Committee on Rural Health, and a 
reference and information service.

State Offices of Rural Health

    The Committee provides $8,445,000 for the State Offices of 
Rural Health. The fiscal year 2003 comparable level was 
$8,445,000 and the administration request was $3,990,000. 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.

Telehealth

    The Committee provides $3,973,000 for telehealth 
activities. The fiscal year 2003 comparable level was 
$26,686,000 and the administration request was $5,594,000. The 
telehealth program promotes the use of technologies to improve 
access to health services and distance education for health 
professionals.
    The Committee strongly supports HRSA's numerous rural 
telehealth initiatives and continues to encourage the agency to 
work in partnership with medical librarians, the National 
Library of Medicine, and other health information specialists 
in the development and implementation of its telehealth 
projects.
    The Committee also commends the Office for the Advancement 
of Telehealth for its support of information infrastructure 
development at minority health professions institutions and 
encourages continued support for this high priority activity in 
fiscal year 2004.
    The Committee supports efforts to bridge the gap in 
availability of clinical services between the resource-rich 
metropolitan center of Shelby County, Tennessee, with the 
medically underserved counties of Tennessee, Mississippi, and 
Arkansas.
    The Committee recognizes the efforts of organizations that 
have worked to provide greater access to health care services 
and providers for all patients, including rural and urban 
underserved populations.

Native and Rural Alaskan Health Care

    The Committee provides $40,000,000 for the Denali 
Commission. The fiscal year 2003 comparable level was 
$27,321,000 and the administration did not request funds for 
this program in fiscal year 2004. 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 so that health and social services may be 
provided to Alaskans in remote rural communities as they are in 
other communities throughout the country.
    The Committee expects the Denali Commission to allocate 
funds to a mix of rural hospital, clinic, long-term care and 
social service facilities, rather than focusing exclusively on 
clinic funding.

Critical Care Programs

    The Committee has grouped the following ongoing and 
proposed activities: emergency medical services for children, 
the traumatic brain injury program, trauma care/emergency 
medical services, and poison control centers.

Emergency Medical Services for Children

    The Committee provides $20,000,000 for emergency medical 
services for children. The fiscal year 2003 comparable level 
was $19,373,000 and the administration requested $18,943,000 
within the Public Health and Social Services Emergency Fund in 
the Office of the Secretary. The Committee continues to fund 
this program within HRSA. The program supports demonstration 
grants for the delivery of emergency medical services to 
acutely ill and seriously injured children.
    The Committee is pleased with the efforts made for the 
emergency medical services for children. The Committee would 
like an update on this program. The 10 year Institute of 
Medicine [IOM] report and study was extremely helpful and the 
Committee strongly urges a 20 year program study and update to 
the IOM report.

Poison Control Centers

    The Committee provides $22,354,000 for poison control 
center activities. The fiscal year 2003 comparable level was 
$22,354,000 and the administration requested $21,166,000 within 
the Public Health and Social Services Emergency Fund in the 
Office of the Secretary. The Committee continues to fund this 
program within HRSA. 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. 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.

Traumatic Brain Injury Program

    The Committee provides $9,438,000 for the traumatic brain 
injury program. The fiscal year 2003 comparable level was 
$9,438,000 and the administration requested $7,479,000. 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.

Black Lung Clinics

    The Committee provides $6,000,000 for black lung clinics. 
The fiscal year 2003 comparable level was $5,961,000 and the 
administration requested $6,000,000. 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.

Trauma Care

    The Committee provides $3,476,000 for trauma/emergency 
medical services. The fiscal year 2003 comparable level was 
$3,476,000 and the administration did not request funds for 
this program in fiscal year 2004. The Committee again rejects 
the administration proposal to consolidate this program into 
the Maternal and Child Health Block Grant program. 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, such as: earthquakes; 
mass violence; riots; school shootings; motor vehicle crashes; 
and terrorist attacks.

Payment to Hawaii, Hansen's Disease Treatment

    The Committee provides $2,045,000 for Hansen's disease 
services. The fiscal year 2003 comparable level was $2,032,000 
and the administration requested $2,045,000.

                  ACQUIRED IMMUNE DEFICIENCY SYNDROME

Ryan White AIDS Programs

    The Committee provides $2,041,599,000 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 2003 comparable level was $2,017,965,000 and 
the administration request was $2,009,549,000.
    Within the total provided, $131,884,000 is for 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.
    Recent advances in diagnosis, treatment, and medical 
management of HIV disease has resulted in dramatic improvements 
in individual health, lower death rates and transmission of HIV 
from mother to infant. The Committee recognizes, however, that 
not all HIV-infected persons have benefited from these medical 
advances and expects that the Ryan White CARE Act programs 
provide social and other support services with the specific 
intent of obtaining and maintaining HIV-infected individuals in 
comprehensive clinical care.
    The Department is encouraged to identify obstacles 
confronting people with HIV/AIDS in receiving medical care 
funded through the Ryan White programs and to 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 $618,693,000 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 $1,077,027,000 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 $739,000,000 for AIDS medications.
    The Committee further urges HRSA to encourage States to 
utilize Federal ADAP funding in the most cost-effective manner 
to maximize access to HIV drug therapies and to eliminate cost-
shifting from Medicaid to the State ADAP programs. States with 
ADAP funding should be allowed the flexibility to purchase and 
maintain insurance policies for eligible clients including 
covering any costs associated with these policies, or continue 
to pay premiums on existing insurance policies that provide a 
full range of HIV treatments and access to comprehensive 
primary care services, as determined by a State. Funds should 
not be committed to purchase insurance deemed inadequate by a 
State in its provision of primary care or in its ability to 
secure adequate access to HIV treatments.

Early Intervention Program--Title III-B

    The Committee provides $198,374,000 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.
    The Committee encourages HRSA to fairly allocate the 
increase for title III-B between existing grantees and new 
providers. By providing additional funds to current grantees, 
the Committee intends to strengthen the HIV care infrastructure 
already established in title III-B clinics. The Committee also 
supports expansion of the number of communities receiving 
assistance from this title.
    Priority should be placed on funding existing and new 
projects in rural, medically underserved areas, and secondary 
cities outside of major metropolitan areas in order to build 
clinical capacity for the delivery of HIV care among clinicians 
serving high-risk populations, minorities, and those who are 
unable to access clinical HIV care for economic reasons. In 
building capacity, the goal is to develop knowledgeable 
clinicians to improve access to quality HIV treatment based 
upon the evolving HIV treatment guidelines of DHHS.

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

    The Committee provides $73,551,000 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.
    The Committee intends that at least 90 percent of total 
title IV funding be provided to grantees. With the exception of 
funds provided through the Minority HIV/AIDS Initiative, the 
Committee expects the funds will be used to support maintenance 
of existing care services because of the rising costs of 
providing comprehensive care. HRSA should also use a 
significant portion of the remaining funds to expand existing 
comprehensive services programs for youth. Due to the 
longstanding accomplishments by title IV programs in reduction 
of mother-to-child HIV transmission [MTCT] through family-
centered care models, the Committee expects HRSA to develop 
linkages between title IV programs and international MTCT 
initiatives as well as domestic MTCT programs funded by CDC. 
The Committee is concerned that the existing ban on travel by 
project officers is inhibiting the effectiveness of title IV 
programs and urges HRSA to reevaluate this policy.
    Some 5 percent of the funds appropriated under this section 
may be used to provide peer-based technical assistance. The 
Committee expects any funds used for peer-based technical 
assistance will be primarily provided to existing Title IV 
grantees. Within this amount, sufficient funds are available to 
maintain and expand work being done to create a national 
consumer and provider education center on the use of various 
strategies and planning in the care of children, youth, women, 
and families infected with or affected by HIV and AIDS.

AIDS Dental Services

    The Committee provides $13,405,000 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.

AIDS Education and Training Centers

    The Committee provides $35,549,000 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.

Family Planning

    The Committee provides $283,350,000 for the title X family 
planning program. The fiscal year 2003 comparable level was 
$273,350,000 and the administration request was $264,808,000.
    Title X grants support primary health care services at more 
than 4,500 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 (4.4 million 
each year, many of whom are uninsured) low-income and uninsured 
women. 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). The Committee recognizes that due to 
these financial pressures, it will be difficult for Title X 
clinics to serve the current number of patients 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.

Community Based Abstinence Education Program

    The Committee provides $73,044,000 for this program, which 
provides support for the development and implementation of 
abstinence education programs for adolescents, ages 12 through 
18. The fiscal year 2003 comparable level was $54,642,000 and 
the administration request was $73,044,000. These programs are 
unique in that their entire focus is to educate young people 
and create an environment within communities that support teen 
decisions to postpone sexual activity until marriage. The 
Committee intends that the Secretary fund grantees who are 
currently receiving section 510 funds, but whose project 
periods were scheduled to expire at the end of fiscal year 
2003.

Health Care Facilities

    The Committee has provided no funding for health care 
facilities. The fiscal year 2003 comparable level was 
$294,700,000 and the administration did not request funds for 
this program in fiscal year 2004. This account makes funds 
available to public and private entities for construction and 
renovation of health care and other facilities. The reduction 
below last year's level is due to the funding of one-time 
projects.

Buildings and Facilities

    The Committee provides $248,000 for buildings and 
facilities. The fiscal year 2003 comparable level was $248,000 
and the administration request was $250,000.

Rural Hospital Flexibility Grants

    The Committee provides $39,740,000 for rural hospital 
flexibility grants. The fiscal year 2003 comparable level was 
$39,740,000 and the administration request was $29,921,000. 
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 $20,000,000 
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.

Rural Access to Emergency Devices

    The Committee provides $8,000,000 for rural access to 
emergency devices. The fiscal year 2003 comparable level was 
$12,419,000 and the administration request was $2,009,000. This 
program, which is to be administered through the Rural Health 
Outreach Office, provides grants to expand placement of 
automatic external defibrillators [AEDs] in rural areas and to 
ensure that first responders and emergency medical personnel 
are appropriately trained.

Radiogenic Diseases

    The Committee provides $1,987,000 for the Radiation 
Exposure Compensation Act. The fiscal year 2003 comparable 
level was $1,987,000 and the administration request was 
$4,006,000. 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.

National Practitioner Data Bank

    The Committee provides $17,000,000 for the national 
practitioner data bank. The fiscal year 2003 comparable level 
was $19,500,000 and the administration request was $17,000,000. 
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. 
Traditional bill language is included to ensure that user fees 
are collected to cover all costs of processing requests and 
providing such information to data bank users.

Health Care Integrity and Protection Data Bank

    The Committee provides $4,000,000 for the health care 
integrity and protection data bank. The fiscal year 2003 
comparable level was $5,600,000 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.

Healthcare Access for the Uninsured/Community Access Program

    The Committee provides no funding for this activity. The 
fiscal year 2003 comparable level was $119,219,000 and the 
administration did not request funds for this program in fiscal 
year 2004. This program is designed to increase the capacity 
and effectiveness of community health care institutions and 
providers who serve patients, regardless of their ability to 
pay.

Program Management

    The Committee provides $146,686,000 for program management 
activities for fiscal year 2004. The fiscal year 2003 
comparable level was $156,974,000 and the administration 
request was $151,115,000.

               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 2003 
comparable level was $7,000,000 and the administration request 
was $4,000,000. For administration of the HEAL Program 
including the Office of Default Reduction, the Committee 
provides $3,389,000. The fiscal year 2003 comparable level was 
$3,889,000 and the administration request was $3,389,000.
    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, 2003....................................     $88,890,000
Budget estimate, 2004...................................      68,991,000
Committee recommendation................................      68,972,000

    The Committee provides that $68,972,000 be released from 
the vaccine injury compensation trust fund in fiscal year 2004, 
of which $2,972,000 is for administrative costs. The total 
fiscal year 2003 comparable level was $88,890,000 and the total 
administration request was $68,991,000.
    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, 2003....................................  $4,495,039,000
Budget estimate, 2004...................................   4,319,312,000
Committee recommendation................................   4,644,630,000

    The Committee provides a program level of $4,644,630,000 
for the Centers for Disease Control and Prevention. The 
Committee recommendation includes $4,432,496,000 in budget 
authority and an additional $212,134,000 via transfers 
available under section 241 of the Public Health Services Act. 
The fiscal year 2003 comparable program level was 
$4,495,039,000 and the administration request program level was 
$4,319,312,000.
    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.

    BIRTH DEFECTS, DEVELOPMENTAL DISABILITIES, DISABILITY AND HEALTH

    The Committee recommends $110,639,000 for birth defects, 
developmental disabilities, disability and health. The fiscal 
year 2003 comparable level was $98,040,000 and the 
administration request was $87,462,000.
    Within the total provided, the following funding levels are 
for the specific program activities: autism, $12,311,000; birth 
defects, $18,694,000; fetal alcohol syndrome, $12,908,000; 
folic acid, $2,484,000; infant health, $11,740,000; attention 
deficit resource centers, $1,748,000; spina bifida, $5,128,000; 
muscular dystrophy, $4,974,000; Healthy Athletes, $4,775,000; 
Paralysis Resource Center, $5,981,000; disability prevention, 
$14,238,000; newborn infant hearing, $7,211,000; limb loss, 
$3,580,000; facial reconstruction, $500,000; and child 
development studies, $4,367,000.
    Attention Deficit Hyperactivity Disorder.--The Committee 
commends CDC for its Resource Center on AD/HD and has included 
increased funding in fiscal year 2004 to expand the activities 
at the Resource 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.--Within the total provided, $4,110,000 above the 
President's request has been provided to expand the Center's 
autism epidemiology program. This is $1,500,000 over last 
year's level. The Committee is concerned that the data 
collection and analysis within this program is not progressing 
at the anticipated pace and urges the agency within the funds 
provided to allocate the resources necessary to release the 
data and conclusions in a timely manner. The Committee expects 
a status report on autism data before April 1, 2004.
    Craniofacial Malformation.--The Committee recognizes the 
importance of helping the families of children with 
craniofacial malformation. These malformations include major 
conditions such as cleft lip and palate; hemifacial microsomia; 
atresia/microtia; hemangiomas and vascular malformations; 
Pfeiffer Syndrome, Crouzon Syndrome, and Pierre Robin 
Malformation Sequence as well as rarer, or orphan conditions. 
The Committee encourages CDC to conduct research on the 
incidence of birth defects including abnormalities of 
structure, function, or body metabolism, the cost of 
appropriate medical treatment, availability of insurance 
coverage, and insurance coverage policies. The Committee has 
included $500,000 for CDC to create a registry and database of 
children nationwide with craniofacial malformation and 
development of plan for an information clearinghouse for 
parents and physicians regarding appropriate medical treatment. 
The Center is encouraged to work with the National Foundation 
for Facial Reconstruction or other such private foundation 
representing children with such malformations and their 
parents.
    Diamond Blackfan Anemia.--The Committee understands that 
the detailed evaluation of Diamond Blackfan Anemia [DBA] 
patients may serve as an important model for understanding the 
genetics of birth defects. The Committee has learned that more 
than 50 percent of patients with DBA have a variety of 
congenital malformations involving the face and head, upper arm 
and hand, genitourinary, and the heart, with 21 percent of 
patients having more than one birth defect. The Committee also 
understands that breakthroughs in this disorder may lead to 
important strides in other 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 bone 
marrow failure syndromes. The CDC is encouraged to establish a 
Diamond Blackfan Anemia Clinical Care Center, which would 
gather and analyze extensive data on this disease to be used 
for research initiatives involving the genetics of birth 
defects, cancer predisposition, gene discovery, red cell 
differentiation, and a comparison of treatment approaches and 
patient response to therapeutic treatments including blood 
transfusion, steroids and bone marrow transplants.
    Disabilities Prevention.--The Committee continues to 
strongly support the CDC disabilities prevention program which 
provides support to states and academic centers to reduce the 
incidence and severity of disabilities, especially 
developmental and secondary disabilities.
    Down Syndrome.--The Committee is aware that anecdotal 
evidence suggests that the number of persons with Down syndrome 
who also have autism or other mental disorders may be on the 
rise. Reliable data on these occurrences would help researchers 
identify areas of further research and could indicate whether 
the prevalence of certain dual diagnoses indicate certain risk 
factors that require assessment. The Committee encourages the 
CDC to assess the feasibility and goals of a national 
epidemiological study for Down syndrome that would identify and 
the number of persons with the disorder, and whether these 
persons have also been diagnosed with either autism or other 
mental disorders. This knowledge may inform research decisions 
aimed at the identification of modifiable risk factors and the 
possible development of interventions and approaches for 
evaluating such interventions.
    Duchenne and Becker Muscular Dystrophies.--Within funds 
provided, the Committee has included $2,998,000 above the 
administration's request for the Center's epidemiological 
program in Duchenne and Becker muscular dystrophy. This is 
$1,000,000 over the fiscal year 2003 level. The Committee 
expects these efforts to include comparison of treatment 
approaches and a plan for disseminating such information to 
patients and families.
    Folic Acid Education Campaign to Prevent Birth Defects.--
Within the total provided, sufficient funds have been provided 
to continue the national public and health professions 
education campaign designed to increase the number of women 
taking folic acid daily at the same level as in fiscal year 
2003. Each year, an estimated 2,500 babies are born with neural 
tube defects [NTDs], birth defects of the brain and spinal 
cord, including anencephaly and spina bifida. The Committee is 
aware that CDC estimates that up to 70 percent of NTDs could be 
prevented if all women of childbearing age consume 400 
micrograms of folic acid daily, beginning before pregnancy.
    Fetal Alcohol Syndrome.--Within the total provided, 
$1,263,000 above the budget request is to expand activities 
related to Fetal Alcohol Syndrome [FAS]. The Committee supports 
CDC's efforts to reduce the rates of Fetal Alcohol Syndrome 
[FAS] through surveillance and prevention programs. FAS, the 
country's leading known cause of mental retardation and birth 
defects, devastates the lives of as many as 12,000 newborn 
children and their families each year, and is completely 
preventable. This increase will allow CDC to expand 
surveillance activities to document the magnitude of the 
problem and to develop and implement prevention strategies.
    Fragile X.--The Committee believes that the Center's focus 
on maximizing prevention potential, minimizing impact on 
families and promoting early intervention through developmental 
screening should be expanded to incorporate individuals 
affected by fragile X. The Center is encouraged to expand its 
collaboration with the National Fragile X Foundation to 
establish and strengthen a link between researchers and 
families and to provide for the distribution of educational 
materials to clinicians, educators and parents. The Committee 
acknowledges the fine work being carried out by the Center in 
the area of autism surveillance and research and the Center is 
encouraged to broaden the scope of this work to include fragile 
X, the most common known cause of autism. The Center's fine 
work to improve the lives of young adults with developmental 
disabilities is recognized and the Committee recommends that 
these efforts to eliminate barriers to optimal functioning and 
address preventable secondary or spillover conditions 
specifically include fragile X.
    Newborn Screening.--Title XXVI of the Children's Health Act 
of 2000 provides that the Secretary shall award grants to 
improve or expand the ability of State and local public health 
agencies to provide screening to newborns and children having 
or at risk for heritable disorders. The Committee supports 
further research and demonstration projects to facilitate the 
translation of new scientific knowledge into applied public 
health screening programs. The Committee urges CDC to 
coordinate with HRSA in translating the results of these 
efforts, particularly in the areas of Autism, Duchenne and 
Becker Muscular Dystrophies, Down Syndrome, fragile X Syndrome, 
and Cystic Fibrosis, into guidance for public health programs, 
including State newborn screening programs.
    The Committee commends CDC for its early hearing detection 
and intervention [EHDI] program for newborns, infants and young 
children with hearing loss. These grants ensure that infants 
referred from newborn hearing screening programs receive 
appropriate and timely diagnostic and early intervention 
services. The Committee is concerned that of babies who were 
screened, only 56 percent who needed diagnostic evaluations 
actually received them by 3 months of age. Moreover, only 53 
percent of those diagnosed with hearing loss were enrolled in 
early intervention programs by 6 months of age. The Committee 
believes that increased funding is required to ensure that 
States develop appropriate surveillance and tracking systems to 
provide timely and appropriate diagnostic and intervention 
services to infants and toddlers.
    The Committee encourages the National Center on Birth 
Defects and Developmental Disabilities to provide clarification 
and guidance to States regarding how EHDI surveillance, 
tracking, and data management programs are affected by the 
Health Insurance Portability and Accountability Act and the 
Family Education Rights and Privacy Act.
    To avoid duplication and interference, the Committee 
expects CDC to coordinate projects funded with this 
appropriation with EHDI projects conducted by the Health 
Resources Services Administration, 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.
    Paralysis Resource Center.--More than 2 million Americans 
live with paralysis, including spinal cord injury, stroke, 
multiple sclerosis, cerebral palsy, spina bifida, and ALS or 
Lou Gehrig's disease. Those living with paralysis have a 
desperate need for information and support to improve their 
health and quality of life. Hospital and rehabilitation stays 
have sharply reduced over the last decade and those living with 
paralysis face astronomical medical costs, are often unemployed 
and have poor health outcomes, including skin breakdowns, 
obesity, pneumonia, bladder and bowel infections and 
depression. 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 date, more than 160,000 people have 
received services and information from the Resource Center's 
web portal, from information specialists and from library and 
print materials. More than 90 organizations have benefited from 
health promotion grants provided by the Center, such as 
wheelchair basketball programs, caregiver support services and 
the placing of canine companions in the home. To keep up with 
the exploding demand for information and support services, the 
Committee has included $3,017,000 above the administration's 
request to expand the Paralysis Resource Center capacity; 
provide distance learning and training; support additional 
health promotion grants; and enhance university-based research. 
This is $3,000,000 above the fiscal year 2003 level. Sufficient 
resources are included for CDC to fund several model state 
demonstration programs on paralysis and physical disability.
    Regional Centers for Birth Defects Research and 
Prevention.--Within the total provided, $2,284,000 above the 
budget request is to expand research activities conducted by 
the regional Centers for Birth Defects Research and Prevention. 
This is $1,500,000 above the fiscal year 2003 level. These 
centers, which are located in Arkansas, California, Georgia, 
Iowa, Massachusetts, New Jersey, New York, North Carolina, 
Texas, and Utah, conduct epidemiological research on the 
prevention of birth defects. These centers identify cases and 
obtain data for inclusion in the National Birth Defect 
Prevention Study, the largest case-control study of birth 
defects ever conducted. This increase will allow these centers 
to expand and intensify the study of genetic and environmental 
causes of birth defects and thereby increase our understanding 
of key underlying factors that may cause birth defects.
    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. Two years ago, this Committee established a Special 
Olympics Healthy Athletes Initiative at CDC to support these 
efforts. The Committee has included $2,009,000 above the 
administration's request for this initiative, which is 
$1,000,000 above the fiscal year 2003 level.
    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 has included $3,035,000 over the administration's 
request to expand the National Spina Bifida Program in 
coordination with a leading national voluntary health agency 
which exists to promote the prevention of, and enhance the 
lives of all those affected by, spina bifida. This is 
$1,000,000 over the fiscal year 2003 level.
    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. CDC is now assisting 28 States 
with cooperative agreements.
    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.

Chronic Disease Prevention and Health Promotion

    The Committee recommends $801,884,000 for chronic disease 
prevention and health promotion for fiscal year 2004. The 
fiscal year 2003 comparable level was $789,972,000 and the 
administration requested $834,047,000 for fiscal year 2004.
    Within the total provided, the following funding levels are 
for the specific program activities: heart disease and stroke, 
$45,963,000; diabetes, $69,000,000; cancer prevention and 
control, $316,625,000; arthritis, $14,612,000; epilepsy, 
$8,478,000; iron overload, $476,000; tobacco, $100,411,000; 
nutrition, physical activity, and obesity, $50,000,000; health 
promotion, $24,249,000; school health, $63,112,000; safe 
motherhood, $53,962,000; oral health, $12,710,000; prevention 
centers, $26,830,000; and Steps to a Healthier U.S., 
$15,416,000.
    The unprecedented commitment to biomedical research in 
recent years represents a critical investment in the future 
health of our Nation. The Committee recognizes, however, that 
the benefits of basic research alone cannot be fully realized 
unless results of this important work are effectively 
translated into public health interventions to address costly 
and prevalent conditions such as chronic diseases.
    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.
    Alpha-1 Antitypic Deficiency.--The Committee is aware that 
Alpha-1 Antitypic disease is often misdiagnosed as asthma or as 
Chronic Obstructive Pulmonary Disease. Individuals with Alpha-1 
exhibit symptoms of advanced emphysema between 30 and 50 years 
of age, even in the absence of tobacco use. As with many rare 
chronic disorders, Alpha-1 patients commonly see five 
physicians over 7 years, from the onset of symptoms to an 
appropriate diagnosis. Early detection allows individuals to 
engage in preventative health measures and receive appropriate 
therapies, significantly improving their health status. The 
Committee encourages CDC to promote an Alpha-1 screening and 
detection program that utilizes public and professional 
education regarding lung disease, both genetic and tobacco 
related.
    Behavioral Risk Factor Surveillance System.--The Committee 
has provided $8,400,000 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 previous 5 years have 
seen a major increase in the Nation's investment in medical 
research at the NIH, resulting in significant breakthroughs for 
cancer and other serious diseases. The need to reach the 
public, particularly medically underserved populations, with 
the message of prevention and early detection of cancer cannot 
be overstated.
    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 funding levels 
are for the specific program activities: breast and cervical 
cancer, $210,929,000; cancer registries, $50,000,000; 
colorectal cancer, $15,000,000; comprehensive cancer, 
$12,000,000; ovarian cancer, $4,950,000; prostate cancer, 
$15,555,000; skin cancer, $2,197,000; Geraldine Ferraro Cancer 
Education Program, $5,000,000; and lupus, $994,000.
    Cancer Registries.--The Committee recognizes the importance 
of data collection for all brain tumors, including data on 
malignant and benign brain tumors, through the National Program 
of Cancer Registries. Comprehensive data collection enhances 
our understanding of brain tumors and their burden and supports 
a strong research effort. The Committee commends the CDC for 
moving forward with implementation of the Benign Brain Tumor 
Cancer Registries Act in fiscal year 2003 (Public Law 107-260) 
and strongly urges that adequate funds be provided for benign 
brain tumor data collection and training in fiscal year 2004.
    Cancer Survivorship.--The Committee applauds the 
partnership between CDC and the Lance Armstrong Foundation 
[LAF] to address the needs of the over 9 million Americans 
living with, through and beyond cancer by expanding CDC's 
State-based comprehensive cancer program to address cancer 
survivorship, including clinical trials information and access, 
quality of life issues and late effects of the disease. The 
Committee supports efforts to develop a National Cancer 
Survivorship Action Plan.
    In addition, the Committee is aware of the need for 
additional information and support for cancer survivors, from 
time of diagnosis through treatment, recovery, and long-term 
care issues. There are more than 9 million cancer survivors in 
the United States today, and more than half have either 
completed treatment or are long-term (over 5 years) survivors. 
Further, more than 1.3 million people will be diagnosed with 
cancer in 2003. Recognizing the significant need of this 
growing population, the Committee encourages CDC to develop a 
cancer survivorship resource center focused on post-treatment 
needs and long-term survivorship/quality of life issues, in 
partnership with the Lance Armstrong Foundation and other non-
profit organizations solely dedicated to promoting the optimal 
physical, psychological, and social recovery and care of cancer 
survivors and their families.
    Cardiovascular and Other Chronic Diseases in African-
American Populations.--The Committee recognizes the high 
prevalence and incidence of cardiovascular and other chronic 
diseases in the Mississippi Delta's minority populations. The 
Committee also recognizes the work of the Jackson Heart Study 
and the Delta Health Alliance in research on cardiovascular and 
other chronic diseases in minority populations. A needed 
component of this research is the examination of 
epidemiological risk factors contributing to the extremely high 
prevalence and incidence of cardiovascular and other chronic 
diseases in the Mississippi Delta. The Committee encourages the 
CDC to establish a cardiovascular and chronic disease research 
prevention center in the Mississippi Delta region for the 
purpose of fostering epidemiological research among minorities 
with chronic diseases. The prevention center would allow 
collaboration with ongoing research activities to combat these 
chronic diseases through the epidemiological identification of 
risk factors and disease predictors.
    Colorectal Cancer.--Colorectal cancer is the third most 
commonly diagnosed cancer for both men and women in the United 
States, and the second leading cause of cancer related deaths. 
In 2001, approximately 148,000 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 very 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 CDC 
to continue to expand its partnerships with State health 
departments, professional and patient organizations, and 
private industry to combat this devastating disease.
    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 has established an archive of tested and 
analyzed blood samples. As the program moves forward and one 
time start-up costs are reduced, the Committee believes that a 
growing percentage of the money should be used by the centers 
and the Foundation to assure the highest quality services are 
available to the largest number of patients possible.
    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 Initiative 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 Initiative in addressing the 
chronic health issues of the Mississippi Delta.
    Diabetes.--The Committee is concerned about the over 17 
million Americans currently living with diabetes, a number that 
is estimated to increase to 9 percent of the U.S. population by 
2025. The Committee is aware of the Secretary's recently 
announced Diabetes Detection Program, and is concerned about 
meeting the treatment needs of all the newly diagnosed patients 
with diabetes. The Committee is aware of the valuable services 
that 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 CDC to partner with organizations with 
expertise in providing diabetes education and diabetes self-
management training as a necessary step to ensuring not only 
the success of diagnosing people with diabetes, but also to 
ensuring the best possible treatment and care of the newly 
diagnosed.
    The high incidence of diabetes among Native American, 
Native Alaskan, and Native Hawaiian populations persists, and 
the Committee is pleased CDC's efforts to target this 
population, in particular, to assist the leadership of Native 
Hawaiian and Pacific Basin Islander communities. It is 
important to incorporate traditional healing concepts and to 
develop partnerships with community centers, and the Committee 
encourages CDC to build on all its historical efforts in this 
regard.
    Epilepsy.--The Committee recognizes epilepsy, a chronic 
neurological condition, as a significant public health concern 
affecting over 2.5 million persons in the United States 
including 300,000 American seniors over the age of 65. For a 
long time epilepsy has been seen as a condition that affects 
young people, often starting in early childhood; sometimes 
lasting throughout life. The U.S. population is aging and 
stroke, cardiovascular disease, brain tumors and Alzheimer's 
disease are all causes of epilepsy in the elderly. Further, the 
Committee acknowledges that the CDC has worked diligently over 
the last couple of years to promote better public education and 
treatment of people with epilepsy. Therefore, the Committee has 
provided $1,965,000 above the administration's request for the 
CDC to enhance its epilepsy efforts in partnership with a 
leading non-profit that works on behalf of children and adults 
affected by seizures through research, education, advocacy and 
service. These efforts should include activities addressing the 
relationship between older adults and epilepsy; and maximizing 
public and provider health education programs.
    Geraldine Ferraro Cancer Education Program.--In May 2002, 
Congress approved and the President signed into law the 
Hematological Cancer Research Investment and Education Act. 
This Act authorizes the Geraldine Ferraro Cancer Education 
Program, administered by the Department of Health and Human 
Services. The Committee provides $5,000,000 to the CDC to 
implement the Geraldine Ferraro program of education and 
support services to individuals with blood-related cancers and 
their families and caregivers. The Committee is aware that a 
number of private organizations currently serve the blood 
cancer community with educational and support services, and the 
Committee encourages CDC to enter into partnerships with these 
organizations to expand and strengthen their programs, ensuring 
that all individuals with blood cancers receive the support and 
educational resources they need.
    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 $2,085,000 for CDC to expand vision 
screening and education programs in partnership with national 
voluntary health agencies and for CDC 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 $200,000 above the 
administration's request for a total of $2,984,000 to expand a 
model project that is testing and evaluating the efficacy of 
glaucoma screening using mobile units.
    Heart Disease and Stroke.--The Committee understands that 
cardiovascular diseases remain the Nation's No. 1 killer in 
every State, and believes that each State should receive 
funding for basic implementation of a State Heart Disease and 
Stroke Prevention Program. Currently only 8 States receive 
implementation-level funding from the CDC. An additional 22 
States, including the District of Columbia, receive funding to 
undertake planning processes, which prepare them to implement 
this critical and first-ever public health program to prevent 
and control our Nation's leading cause of death. Nearly 62 
million Americans live with the often-disabling effects of 
cardiovascular diseases at an estimated cost of 
$352,000,000,000 in medical expenses and lost productivity this 
year--more costly than any other disease. The Committee 
recommendation includes $5,824,000 above the administration's 
request for CDC's cardiovascular programs, for a total of 
$45,963,000.
    Stroke remains America's No. 3 killer, a major cause of 
permanent disability and a key contributor to late-life 
dementia. This year, about 700,000 Americans will suffer a 
stroke and nearly 170,000 will die. About 50 percent of stroke 
deaths occur out of the hospital. An estimated 4.7 million 
Americans live with the consequences of stroke. About 1 of 4 
stroke survivors is permanently disabled. Stroke will cost this 
Nation an estimated $51,000,000,000 in medical expenses and 
lost productivity this year. The drug TPA is the only FDA-
approved emergency treatment for clot-based stroke. Yet, less 
than 5 percent of those eligible for TPA receive it. 
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 supports 
activities to develop and test prototypes for this registry in 
eight sites. The Committee encourages CDC to continue this 
initiative by implementing a statewide model stroke registry 
and data-based intervention plans among three State health 
departments 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 strongly encourages the CDC to 
continue to work with the National Institute of Neurological 
Disorders and Stroke, and the National Heart, Lung, and Blood 
Institute at the National Institutes of Health, the Brain 
Attack Coalition, and other pertinent professional 
organizations, including hospitals, universities, State and 
local health departments, and other appropriate partners 
experienced in the treatment of stroke to further implement 
this registry.
    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, about 12,000 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.
    Hemophilia.--The Committee encourages CDC to continue 
working closely with the National Hemophilia Foundation to 
strengthen its disease management, prevention, outreach, and 
blood safety surveillance programs for meeting the needs of 
persons with hemophilia, other bleeding and clotting disorders, 
and, particularly, women with bleeding disorders. The Committee 
has received the report on genotyping the hemophilia community, 
and urges CDC to provide the additional resources necessary to 
implement this important initiative.
    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]. For the past 4 years, the Committee has 
encouraged CDC to work in partnership with the IBD community to 
establish a national IBD epidemiology program to further our 
understanding of these diseases. The Committee understands that 
CDC has entered into a partnership with the Crohn's and Colitis 
Foundation of America to initiate this important program. Now 
that this project has been established through an investment by 
the patient community, the Committee looks forward to reviewing 
a report from the CDC Director (as requested in the fiscal year 
2003 Senate Labor-HHS committee report) regarding the support 
that CDC has provided for this important initiative.
    Kidney Disease.--The Committee recognizes that while kidney 
disease is the ninth leading cause of death in the United 
States and 350,000 Americans have End Stage Renal Disease, 
requiring dialysis or a transplant to survive, at a cost to the 
Medicare program of $12,000,000,000 annually, there is mounting 
evidence that kidney disease will be an even greater public 
health problem in the future. Recent epidemiologic research 
indicates that more than 20 million Americans have signs of 
kidney disease and that an additional 20 million individuals in 
this country are at increased risk of kidney disease. Moreover, 
most of these individuals are unaware of this danger to their 
health. The Committee believes there is a need for public 
health programs to identify and educate those who are 
threatened by kidney disease and thereby reduce morbidity and 
improve outcomes. Therefore, the Committee urges the Centers 
for Disease Control and Prevention to develop a national kidney 
disease action plan and a public health strategy to combat 
kidney disease in this country.
    Micronutrients.--Deficiencies of micronutrients such as 
iron, iodine, and vitamin A, affect nearly one-third of the 
world's population, and result in reduced mental and physical 
development of children, poor pregnancy outcomes, diminished 
work capacity of adults, and increased morbidity and premature 
mortality among populations. Effective and inexpensive 
interventions such as dietary diversification, food 
fortification and supplementation have eliminated most 
micronutrient deficiencies in developed countries.
    The Committee has provided sufficient funding for CDC to 
continue its efforts to eliminate micronutrient malnutrition. 
The focus of these efforts is to support a number of national 
and international efforts to assess mirconutrient status of 
populations and to monitor and strengthen implementation of 
interventions as well as to assess the impact of the 
interventions over time. CDC has extensive expertise in 
epidemiology, monitoring and assessment, and laboratory 
science. These efforts reflect the unique contribution that CDC 
can make to eliminate micronutrient deficiencies.
    Nutrition, Physical Activity and Obesity.--Obesity is 
epidemic 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 commends the substantial, comprehensive 
efforts that CDC is directing to stem the obesity epidemic 
across all life stages. CDC is coordinating national, State and 
school-based programs to research and implement interventions 
to increase physical activity levels and good nutrition at all 
ages, to provide important health information, and to monitor 
health and healthy behaviors in the population. CDC currently 
funds some States to promote physical activity and good 
nutrition to prevent and control obesity. As part of its 
physical activity, nutrition and obesity prevention initiative, 
the Committee has included a significant increase for 
Nutrition, Physical Activity, and Obesity at CDC.
    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 Division 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.
    Prevention Centers.--The Committee encourages the continued 
support of center activities aimed at improving knowledge about 
the usefulness and effectiveness of health promotion programs 
for persons with disabilities. The Committee also continues to 
support within the prevention center program a Tobacco 
Prevention Research Network to increase the knowledge base on 
the most effective strategies for preventing and reducing youth 
tobacco use, as well as on the social, physiological, and 
cultural reasons for tobacco use among children.
    Prostatitis.--The Committee urges the CDC to continue and 
expand its investigation of the etiology of prostatitis. New 
methods to explore the infectious etiology of chronic diseases 
should be applied to chronic prostatitis. The CDC should 
undertake educational efforts to overcome the stigma assumed by 
prostatitis patients and the conspiracy of silence it produces 
that limits the public discussion and research.
    Pulmonary Hypertension.--The Committee continues to be 
interested in pulmonary hypertension, a rare, progressive and 
fatal disease that predominantly affects women, regardless of 
age or race. Pulmonary hypertension 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 looks forward to reviewing a report (as requested in 
the fiscal year 2003 omnibus appropriations bill) from the CDC 
outlining the progress that has been made in establishing a 
pulmonary hypertension awareness campaign focused on the 
general public and health care providers. Moreover, the 
Committee encourages CDC to support a cooperative agreement 
with the pulmonary hypertension community designed to foster 
greater awareness of the disease.
    School Health.--The Committee notes that obesity rates were 
cut in half among girls in grades 6-8 who participated in a 
school-based intervention program. The Committee applauds CDC 
for establishing effective coordinated school health programs 
in 20 States and two local education agencies. As part of its 
physical activity, nutrition and obesity prevention initiative, 
the Committee has included sufficient funds for CDC to expand 
its coordinated school health program to address risk behaviors 
such as tobacco use, unhealthy diets, and physical inactivity.
    Steps to a Healthier U.S.--The Committee applauds the 
Department's 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 continued funding for this new 
initiative and significantly increased existing programs with 
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.
    The Committee recognizes the important role that private 
nonprofit organizations such as YMCAs and Jewish Community 
Centers play in providing millions of American youth 
comprehensive health and wellness programs designed to address 
risk behaviors such as physical inactivity, unhealthy diets, 
and tobacco use. With only 25 percent of public schools 
offering daily physical education programs, it is these 
community-based organizations that are being called upon to 
implement health promotion and health education strategies and 
interventions to increase physical activity levels and foster 
good nutrition. In addition, these community organizations are 
a critical link in providing physical activity programs for 
youth from charter schools, alternative schools or who are home 
schooled. The Committee encourages CDC to include private 
nonprofit organizations as eligible applicants under STEPS. 
Funding should be used for the development and implementation 
of comprehensive health and wellness programs aimed at 
preventing obesity, diabetes and asthma among American youth. 
To ensure fiscal responsibility and local support, the 
Committee encourages these nonprofit programs to be funded at a 
minimum of 50 percent from private sources. Successful 
applicants should have a history of directly providing youth-
development programs in both school-based and community-based 
setting, a long-standing dedication to promoting lifelong 
health, and a commitment to serving all ages, incomes and 
abilities.
    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 
encourages 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 and 
has included $300,000 for this activity in the infant mortality 
program. The Committee expects CDC to be prepared to report on 
progress on this initiative during the fiscal year 2005 
hearings.
    The recently completed Aberdeen Area Infant Mortality 
Study, funded by the Department of Health and Human Services, 
identified protective and risk factors associated with SIDS. 
Conclusions included observations that programs to reduce 
alcohol consumption among women of childbearing age could 
potentially reduce the high rate of SIDS. Maternal and 
environmental tobacco exposures remain critical health issues 
not only in reducing the risk for SIDS, but also for the health 
of the baby and family overall. Further, women, who give birth 
to their first child while under the age of 20 years, are at a 
higher risk for pre-term birth and low birth weight babies, and 
that both factors increase the risk for SIDS. In 2000, for 
infants of African American mothers, the SIDS death rate is 2.4 
times that for non-Hispanic white mothers. Nationwide, SIDS 
rates for infants of American Indian mothers were 2.6 times 
those of non-Hispanic white mothers.
    Tobacco Use.--Tobacco use is the single most preventable 
cause of death and disease in our society. It causes more than 
400,000 deaths in the United States each year, and costs the 
Nation $50,000,000,000 in medical expenses alone. Children are 
especially hard hit by tobacco. Ninety percent of adult smokers 
begin their habit as children. The Committee believes that a 
significantly increased effort to curtail youth tobacco use is 
needed. Therefore, the Committee has included sufficient funds 
to maintain no less than last year's level of funding for 
tobacco control. 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.
    Urinary Incontinence.--The Committee is concerned that 25 
million Americans suffer from Urinary Incontinence [UI]. 
According to the Agency for Healthcare Research and Quality 
[AHRQ], 8 out of 10 patients can be treated or cured and yet 
fewer than half ever discuss the condition with their health 
care professional. Moreover, 1 in 4 women ages 30 to 59 have 
experienced an episode of UI and $16,400,000,000 is spent every 
year on incontinence related care. The Committee also views UI 
as a barrier to health because many patients experience social 
isolation, depression and reduced physical activity. These 
consequences dramatically decrease a healthy lifestyle. The 
Committee urges the CDC to formulate and implement an action 
plan for health care professional education in order to ensure 
those who suffer from UI will seek and receive treatment 
leading to healthier lives.

Environmental Health

    The Committee recommends $184,329,000 for environmental 
health activities. The fiscal year 2003 comparable level was 
$182,829,000, and the administration requested $150,227,000 for 
fiscal year 2004.
    Within the total provided, the following funding levels are 
for specific funding activities: $37,518,000 is for the 
environmental health laboratory; $66,928,000 is for 
environmental health activities; $37,886,000 is for the asthma 
program; and $41,997,000 is for the childhood lead poisoning 
prevention program.
    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 that the CDC has taken 
steps to address the increasing prevalence of childhood cases 
of asthma, and has included $3,498,000 above the 
administration's request to expand the CDC's asthma-related 
activities, including tracking childhood asthma cases, 
conducting investigations, and building partnerships for asthma 
control within schools and community organizations.
    The problem of asthma in Hawaii remains a serious health 
threat and challenge, especially among the medically 
underserved. In particular, the problem of volcanic emissions 
in Hawaii contributes to this and other respiratory problems. 
Community Health Centers continue to be important venues to 
address this serious problem, and the CDC is encouraged to 
contract with these facilities throughout Hawaii.
    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 Committee recognizes CDC for its commendable work in 
analyzing toxic exposures throughout the United States. The 
Committee further recognizes that CDC's environmental 
laboratory is unprecedented in the world for measuring toxic 
exposures to humans and further commends CDC for publishing the 
National Report on Human Exposure to Environmental Chemicals, 
which provides information about the U.S. population's exposure 
to 27 toxic substances, including heavy metals and certain 
pesticides.
    The Committee supports the CDC biomonitoring program and 
study of environmental toxins and their relationship to chronic 
diseases, such as asthma, many birth defects, and cancer to 
increase our understanding of the cause of many chronic 
diseases and conditions and to facilitate the development of 
effective prevention strategies.
    Fallon Cancer Cluster.--The Committee strongly urges the 
CDC to continue to investigate the cancer cluster in Fallon, 
Nevada. In addition, the Committee expects the CDC to 
facilitate, through the provision of scientific data collected 
in Fallon and other assistance as may be required, the 
independent scientific study of the Fallon cancer cluster.
    Health Tracking Network.--The Committee has included 
$28,000,000 to support the continued 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. Such a surveillance system may help scientists 
to develop hypotheses for further research regarding potential 
relationships between environmental hazards, exposures and 
health effects. 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 believes 
that the CDC's Centers of Excellence may be able to provide 
valuable assistance to the States in designing their health 
tracking initiatives, and strongly urges the CDC to continue to 
ensure that the States work with the Centers to design programs 
and approaches that are grounded in a rigorous scientific 
approach. In furtherance of this objective, the CDC should 
ensure that the Centers provide guidance to the States on the 
reporting of data and results in a manner consistent with the 
objectives of the Information Quality Act. The Committee also 
reaffirms the importance of ensuring that the health tracking 
effort is made compatible and integrated with other CDC and 
government tracking systems that focus on other environmental 
factors that may be related to health effects, such as 
infectious agents, behavioral risks, ultraviolet radiation, 
tobacco smoke, food-borne illness, naturally occurring 
substances, natural disasters and temperature extremes. The 
Committee eagerly awaits the outcome of the strategic planning 
process now underway. This activity was previously funded 
within the Public Health Improvement account.
    Primary Immunodeficiencies Diseases.--In each of the last 2 
years, Congress has directed CDC to support the national 
physician education and public awareness campaign developed by 
the Jeffrey Modell Foundation. To date, the campaign has been a 
major success featuring physician symposia throughout the 
country, an advertising campaign under the auspices of the Ad 
Council, development of new materials and mailings to 
physicians and other providers, and more. The Committee 
believes that this effort has been a model of public-private 
cooperation, and should include an international component. The 
Committee has included $2,200,000 to continue this campaign, 
which has great importance to public health.

Epidemic Services and Response

    The Committee recommends $127,494,000 for epidemic services 
and response. The fiscal year 2003 comparable level was 
$77,494,000 and the administration request was $76,158,000 for 
fiscal year 2004.
    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 scientific basis of this program is applied 
epidemiology, in concert with other components of sound public 
health practice. Findings from these disciplines enable States, 
health organizations, foreign ministries of health, and others 
in the health field to make sound decisions and create 
effective policy. Information derived from epidemiologic data 
and scientific reasoning provides public health programs with 
an objective rationale to set priorities, apply interventions 
and policies, and evaluate public health programs. Within the 
epidemic services and response program, CDC carries out a 
variety of applied research and development activities. Areas 
of research include: social determinants of health; aberration 
detection; burden of disease; injury, and death; prevention 
effectiveness; and health care quality. 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.
    Global Disease Detection System.--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 $50,000,000 for CDC to develop the 
Global Disease Detection System to full capacity to assure a 
rapid and appropriate response to global infectious disease 
threats.
    Landmine Survivors.--The Committee commends CDC for its 
partnership with the Landmine Survivor Network that has 
developed peer support networks for landmine survivors in six 
mine-affected countries around the world. In 2002, outreach 
workers made over 14,000 peer visits to survivors, launch more 
than 280 small businesses for survivors and worked with more 
than 1,800 landmine survivors and their families to improve 
access to psycho-social, physical and rehabilitative care. 
Health and educational materials for survivors have been and 
translated into nine languages. But much remains to be done. 
Less than 10 percent of survivors have access to medical care 
and rehabilitation services, and 85 percent of mine victims are 
civilian, often women and children. The Committee has included 
funding for CDC to enhance these peer support networks to 
expand the number of survivors that are reached in network and 
non-network countries; strengthen the capacity of medical and 
rehabilitative care facilities to address the needs of 
amputees; enhance economic opportunities for survivors; and 
further CDC programs and research for victims of landmines, 
civil strife and warfare.

Health Statistics

    The Committee recommends a program level of $127,634,000 
for the National Center on Health Statistics. All of these 
funds are made available in transfers available under section 
241 of the Public Health Service Act. The fiscal year 2003 
comparable level was $125,899,000 and the administration 
requested $124,621,000.
    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.

HIV, STD, and TB Prevention

    The Committee recommends $1,239,388,000 for HIV, STD, and 
TB Prevention. The fiscal year 2003 comparable level was 
$1,186,388,000 and the administration requested $1,281,176,000 
for fiscal year 2004. Of the amount provided, $932,189,000 is 
for HIV/AIDS programs, of which $232,569,000 is for global HIV/
AIDS programs; $169,572,000 is for the STD program; and 
$137,627,000 is for the Tuberculosis program.
    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 
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.
    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 has included bill language providing 
$90,000,000 for the International Mother and Child HIV 
Prevention Initiative. The Committee recognizes the importance 
of this critical program, and has provided $50,000,000 above 
the fiscal year 2003 level. The Committee encourages CDC to 
ensure that funds provided to this program, the CDC GAP 
initiative, and the Global Fund are used in a coordinated and 
complementary fashion.
    The Committee is strongly supportive of the 
administration's efforts to address the global HIV/AIDS 
epidemic. The Committee is aware that one of the stated goals 
of the HIV/AIDS efforts is to bring 2 million people into 
antiretroviral [ARV] treatment within 5 years. The Committee 
understands that only 13 percent of the fiscal year 2003 Global 
AIDS Program budget was directed toward care and treatment, 
including operations research on ART. The Committee believes 
that substantially more resources will be necessary to 
accomplish the treatment goals. The International Mother to 
Child Transmission Initiative is a good start, but does not 
necessarily ensure that the parents of the children saved will 
be healthy enough to care for them. The Committee urges the CDC 
to evaluate the current allocation of resources in light of the 
ARV treatment goals, and to carefully consider new ways to 
purchase and provide ARV treatment in resource poor countries. 
This could include partnering with organizations that are 
already providing ARV treatment.
    The Committee notes that Russia and other countries of the 
Former Soviet Union are experiencing the highest growth of HIV 
infections in the world today. The Committee also notes that 
these countries hold tremendous scientific capacity. The 
Committee encourages the CDC to seek opportunities to increase 
collaborative research between the United States and countries 
of the former Soviet Union in the area of HIV/AIDS research, 
utilizing organizations that facilitate and support scientific 
collaboration as appropriate, to maximize the impact of 
scientific discovery.
    The Committee recognizes that one of the ways to prevent 
the transmission of HIV/AIDS in Africa is to ensure a blood 
supply free of HIV. The Committee encourages CDC to find ways 
to increase the safety of blood and blood products in Africa by 
partnering with organizations and foundations that have a 
proven track record in successfully helping African nations 
monitor their blood supply.
    Sexually Transmitted Diseases.--The Committee is concerned 
that sexually transmitted diseases continue to rage at epidemic 
levels in the United States, costing our Nation billions of 
dollars each year. The United States has the highest rates of 
sexually transmitted diseases in the industrialized world.
    The Committee is aware that chlamydia is the most 
frequently reported disease in the United States. Untreated 
chlamydia is the number one cause of infertility in the Nation. 
For every dollar spent to prevent chlamydia $12 is saved. The 
Committee is aware that where it has been established, the 
CDC's Infertility Prevention Program has reduced chlamydia 
rates by 66 percent and decreased treatment costs by over 80 
percent. However, it is concerned that this prevention program 
still offers very limited coverage to women residing in more 
than half of the States, and provides only minimal screening 
services for men. The Committee is also aware that progress in 
control of syphilis has been substantial as a result of State 
efforts under the National Plan to Eliminate Syphilis. The 
Committee recognizes the urgency of controlling syphilis 
because of the impact of this STD on the spread of HIV 
infection and on infant health. The Committee is concerned that 
syphilis is one of the most glaring examples of racial 
disparities in health. The Committee, therefore, urges CDC to 
address these inequities by expanding the infertility screening 
program and providing support for State efforts to control 
syphilis. In addition, the Committee encourages CDC to expand 
the infertility prevention project to provide screening and 
testing technologies for STDs and HIV, as well as other related 
women's health services that are provided by recipients of 
these funds.
    Tuberculosis.--The Committee commends CDC for its continued 
efforts to control tuberculosis [TB] in the United States, as 
demonstrated by nearly a decade of declining TB trends 
reported. However, the Committee remains concerned that the 
overall decline conceals large gaps in two specific 
populations. African Americans and individuals born in a 
foreign country account for two-thirds of TB cases in the 
United States. With respect to the foreign born cases of TB, 
until global control efforts are more effective and new 
treatments and vaccines are developed, the global crisis on TB 
will continue to directly impact the United States; therefore, 
the Committee urges CDC to continue working with domestic 
partners to maintain strong prevention and control programs and 
to work with international partners assuring the success of 
international control programs, and to encourage and support, 
when possible, the development of new TB treatments and the 
development of an effective TB vaccine. With respect to TB in 
African Americans, the Committee notes CDC's activity to 
address TB in the Southeastern U.S. and encourages CDC to 
implement additional innovative programs to address this 
disparity in TB.
    In addition, the Committee encourages CDC to continue 
implementation of recommendations from the recent Institute of 
Medicine Report entitled, ``Ending Neglect: The Elimination of 
Tuberculosis in the United States'' to advance efforts to 
maintain control of TB in the United States by identifying and 
curing active TB; to speed the decline of TB through target 
testing and treatment of latent infection; and to advance 
global research and control efforts. As the report recommends, 
the Committee encourages CDC to partner with private 
foundations in order to further research in the areas of 
development of vaccines, therapeutics, diagnostic tests, and 
new drugs and to test the applicability of new tools, to 
achieve the recommendations.

Immunization

    The Committee recommends $655,686,000 for the program 
authorized under section 317 of the Public Health Service Act. 
The fiscal year comparable level was $650,586,000 and the 
administration requested $620,506,000 for fiscal year 2004. The 
Committee recommendation includes $14,000,000 in transfers 
available under section 241 of the Public Health Service Act.
    The Omnibus Reconciliation Act [OBRA] of 1993 established a 
new vaccine purchase and distribution system that provides, 
free of charge, all pediatric vaccines recommended for routine 
use by the Advisory Committee on Immunization Practices to all 
Medicaid-eligible children, uninsured children, underinsured, 
and native Americans through program-registered providers.
    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 exclusively 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.
    The Committee understands that investing in immunization is 
essential to protecting our public health. Vaccines save lives, 
medical, employer and personal costs. The Committee recognizes 
that every person born or living in this country needs to 
receive the vaccines recommended for his or her age group and 
condition. With 4 million children born in the United States 
each year who require 20 immunizations by age 2, with more age 
groups requiring influenza vaccine, with recent outbreaks of 
whooping cough, with the threat of pandemic flu, and with new 
vaccines entering the market, the cost will likely continue to 
rise.
    The Committee expects CDC to better anticipate the public's 
demand for vaccines, as in the case of pneumoccocal conjugate 
vaccine [PVC-7], and make its request to OMB better conform to 
that demand. The Committee wants to avoid repeating last year's 
situation when 19 States were unable to purchase PCV for their 
public clinics.
    The Committee recognizes that immunization registries, like 
all database systems, continue to require funding. The 
Committee's goal is to have registries up and running in all 
States. CDC must remain vigilant in offering the best technical 
assistance to States. Immunization providers lose interest if 
they have learned a new system that fails, and registries are 
only as good as the number of accurate records they hold. The 
Committee understands that immunization registries are able to 
perform many of the functions required of State immunization 
programs, including immunization surveillance, vaccine 
inventory, VFC compliance, school surveys for compliance with 
immunization requirements, reminder notices to patients, 
immunization records for parents, etc.
    Global Immunization Activities.--The Committee includes 
$152,921,000 for global immunization activities which include 
$106,400,000 for polio vaccine, surveillance, and program 
operations for the highly successful, yet unfinished polio 
eradication efforts; and $46,521,000 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. This total is $20,645,000 above the 
administration's request and $5,100,000 above the fiscal year 
2003 level.
    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, the number of 
people afflicted with polio increased in 2002 and polio is 
still endemic in seven 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.

Infectious Disease Control

    The Committee recommends $372,760,000 for infectious 
disease control. The fiscal year 2003 comparable level was 
$359,225,000 and the administration requested $331,640,000 for 
fiscal year 2004.
    Within the total provided, the following funding levels are 
for the specific program activities: hepatitis C, $22,781,000; 
lyme disease, $7,313,000; West Nile virus, $36,760,000; anti-
microbial resistance, $24,768,000; hanta virus/special 
pathogens, $6,957,000; HIV/AIDS, $43,437,000; malaria, 
$14,379,000; patient safety, $3,963,000; pandemic flu, 
$3,666,000; prion diseases, $4,477,000; and all other emerging 
infectious diseases, $162,263,000.
    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.
    Emerging infectious diseases, like West Nile virus and 
Severe Acute Respiratory Syndrome [SARS], continue to pose a 
serious threat to the public's health. Outbreaks of these 
diseases cause great suffering and death and impose an enormous 
financial burden on societies around the world. The Committee 
recognizes the necessity of a strong domestic public health 
infrastructure and robust partnerships between CDC, the World 
Health Organization, and other global stakeholders to counter 
the threat posed by emerging infections. Recent experiences 
with SARS and the West Nile virus illustrate the vital 
necessity of strengthening CDC's capacity to identify and 
combat emerging infectious diseases. The Committee has provided 
an additional $25,000,000 for CDC to continue to improve its 
ability to detect and control emerging infectious disease 
threats in the United States and around the world.
    Chronic Fatigue Syndrome.--The Committee is pleased that 
CDC has branched into new and important areas of CFS research 
and medical education in the 4-year period in which $12,900,000 
is being restored to the CFS program at CDC. The Committee 
expects CDC to extend the payback period by 2 years, through 
fiscal year 2005. The Committee further encourages CDC to 
provide sufficient funding, including funds allocated through 
the payback program, to accelerate its CFS research plan to 
identify the causes, risk factors, diagnostic markers, natural 
history and economic impact of CFS; to create a CFS patient 
registry; and to educate health care providers about the 
detection, diagnosis and management of CFS.
    Global Malaria Initiative.--The Committee continues to 
recognize the tremendous impact of malaria in the developing 
world, and notes malaria's increasing resistance to 
antimalarial drugs designed to counter its pervasive effects. 
New drugs must be developed, and the Committee urges the CDC to 
continue its efforts to lead in new compound discovery. The 
Committee has provided additional funding for CDC's malaria-
related activities, including sufficient funding to continue 
the CDC's Global Malaria Initiative at the same level as in 
fiscal year 2003. The Committee notes that the University of 
Mississippi has been working collaboratively with the CDC to 
address research in the area of malaria, along with TB and HIV/
AIDS. The Committee encourages CDC to give full consideration 
of these projects to continue its efforts to lead to new 
compound discovery.
    Hepatitis C.--The Committee encourages funding for the 
National Hepatitis C Prevention Strategy. This includes several 
cooperative agreements with the coalition of partners, who 
developed and produced health education, communication, and 
training materials about the prevention, diagnosis and medical 
management of hepatitis A, B, and C. While most States have 
designated a State Hepatitis C Coordinator, the Committee is 
concerned that coordinators have not been requested by six 
States. CDC is urged to work with these States to ensure the 
availability of hepatitis C coordinators. The Committee also 
notes that less than 50 percent of state health departments 
provide hepatitis C counseling and only 23 percent provide HCV 
testing. Additionally, the Committee is concerned that States 
lack the resources to provide more aggressive HCV outreach and 
medical referrals, and urges CDC to require all grantee States 
to identify sources for appropriate medical referral of HCV 
positive persons.
    The Committee is aware that the 3 year funding cycle for 
several hepatitis C prevention demonstration projects expires 
at the end of fiscal year 2003, and urges that priority be 
given to an analysis of these demonstrations and implementation 
of comprehensive programs in several States that utilize best 
practices learned from the recently completed hepatitis C 
prevention and control demonstrations.
    Additionally, the Committee is concerned that the Advisory 
Committee on Blood Safety and Availability has yet to complete 
recommendations for implementing HCV ``lookback'' initiatives 
regarding screening and counseling for people who may have been 
infected with Hepatitis C through blood transfusions before 
1992. The Committee calls on CDC to assist States in 
notification of persons who have tested positive for HCV and 
remain unaware of their HCV status, including those identified 
through the HCV lookback and those cases reported to the States 
where the patient was not informed of the results.
    Pandemic Influenza.--Pandemic influenza is a particularly 
virulent strain of influenza that arises spontaneously and 
periodically. Examples include the outbreak of Spanish flu in 
1918, that killed 500,000 people, and outbreaks in 1957 (Asian 
flu) and 1968 (Hong Kong flu). The Committee has included funds 
for pandemic influenza activities both here and in the Public 
Health and Social Services Emergency Fund within the Office of 
the Secretary. These funds will allow CDC to strengthen global 
and domestic surveillance capabilities in order to increase the 
likelihood of early detection of an influenza pandemic and the 
effective tracking of its spread.
    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.

Injury Prevention and Control

    The Committee recommends $152,409,000 for injury prevention 
and control. The fiscal year 2003 comparable level was 
$148,414,000 and the administration requested $144,796,000.
    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.
    Sufficient funds have been included to continue support for 
all existing Injury Control Research Centers.
    National Violent Death Reporting System.--In fiscal year 
2003, Congress appropriated funds to continue implementation of 
a system of more timely, complete, objective and accurate 
information about violent deaths and injuries to inform and 
evaluate policy and program efforts. Working with private and 
public partners, the CDC has entered cooperative agreements 
with public health agencies in six States, Maryland, 
Massachusetts, New Jersey, Oregon, South Carolina, and 
Virginia, and is extending the system to as many as eight 
additional States. The Committee is pleased with the progress 
that has been made and has included $4,500,000 to continue to 
extend implementation of this model plan for the establishment 
of a national violent death reporting system [NVDRS]. NVDRS 
will enable each State to understand and more effectively 
address local and State violence problems.
    The Committee is aware of the contributions made by the 
Harvard School of Public Health, the Medical College of 
Wisconsin, the University of Pennsylvania, and the University 
of Maryland, among others, in developing and implementing model 
population-based violent injury reporting systems, and the 
Committee applauds their work in developing systems that link 
information from law enforcement agencies, medical examiners 
and coroners, health providers, crime laboratories and other 
agencies. The Committee urges the CDC to continue to work with 
private health and education agencies as well as State agencies 
in the development and implementation of an injury reporting 
system.
    Traumatic Brain Injury.--The Committee has provided an 
increase of $1,500,000 above the fiscal year 2003 level in the 
TBI Prevention Program to continue and expand TBI surveillance 
and registry, a One-Call Information Center, and awareness 
programs with an emphasis on minority populations. This 
increase will assist in filling significant gaps in information 
available at State and Federal levels regarding the incidence 
and prevalence of TBI, the resources available to victims of 
TBI, and the nature of specific factors involving TBI in young 
children and in institutionalized individuals.

Occupational Safety and Health

    The Committee recommends $282,385,000 for occupational 
safety and health programs. The fiscal year 2003 comparable 
level was $273,385,000 and the administration requested 
$246,329,000 for fiscal year 2004. The Committee recommendation 
includes $41,900,000 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.
    The Committee recommendation is sufficient to allow funding 
for CDC's National Occupational Research Agenda [NORA] at the 
same level as in fiscal year 2003. 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.
    Construction Safety and Health.--Injury rates in the 
construction sector have continued to decline over the last 5 
years, and the Committee is encouraged by the overall progress 
of NIOSH's construction safety and health research initiative, 
particularly the Institute's success in partnering with labor 
and industry. The Committee is also pleased by NIOSH's new 
focus on active intervention to prevent occupational injury and 
illness in the construction industry, and the National 
Occupational Research Agenda [NORA] for establishing research 
priorities. The Committee supports the continuation of the 
construction initiative and the NIOSH/Labor/industry 
partnership. The Committee has included funding to continue the 
construction program to focus on improvement in injury and 
illness rates, and to also develop new programs targeting the 
still unacceptable high level of fatalities in the construction 
sector.
    Education and Research Centers.--The Committee commends the 
work of the 15 university-based Education and Research Centers 
[ERC's] and the smaller single discipline Training Project 
Grants [TPG's]. These regional centers are integral to the 
Nation's efforts to improve the health and safety of working 
men and women, and important to the future efforts of NIOSH to 
implement the National Occupational Research Agenda [NORA]. The 
Committee has included $19,700,000 for this activity, which is 
$1,000,000 above last year and $2,300,000 above the 
administration's request.
    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.
    National Personal Protective Technologies Laboratory.--The 
Committee recommendation includes $16,000,000 for the NIOSH 
National Personal Protective Technologies Laboratory. The 
additional funds should be used, in part, to expedite research 
and development in, and certification of, protective equipment 
for use against the hazards of terrorist agents. This includes 
identification of surrogate terrorist agents to facilitate 
protective equipment research in this area. Research, 
development, and certification of protective equipment for use 
against Chemical, Biological, Radiological, Nuclear [CBRN] and 
toxic chemical hazards ensures that domestic manufacturers' 
products will be available when needed.

Preventive Health and Health Services Block Grant

    The Committee recommends $134,966,000 for the preventive 
health and health services block grant. The fiscal year 2003 
comparable level was $134,089,000 and the administration 
requested $134,966,000 for fiscal year 2004.
    The Preventive Health and Health Services Block Grant 
provides States with funds for services to reduce preventable 
morbidity and mortality to improve the quality of life. The 
Block Grant is the primary source of funding to States for 
health education and risk reduction activities; cholesterol, 
hypertension, and cancer screening; and programs to prevent sex 
offenses. The strategy of the Block Grant is to provide States 
with flexibility to tailor prevention and health promotion 
programs to their health priority needs. Block Grant funding 
enables States to provide money for developing new programs; 
fund essential services that would otherwise go unfunded; and 
address urgent, rapidly developing health hazards such as 
disease outbreaks or environmental disasters.

Public Health Improvement

    The Committee recommends $145,389,000 for public health 
improvement. The fiscal year 2003 comparable level was 
$153,034,000 and the administration requested $113,677,000 for 
fiscal year 2004. The Committee recommendation includes 
$28,600,000 in transfers available under section 241 of the 
Public Health Service Act.
    Our national public health system is the first line of 
defense against preventable disease, disability and 
bioterrorism. Virtually every health problem in our 
communities--infectious disease outbreaks, chemical hazards, 
chronic diseases, and injuries--is first recognized by local 
public health professionals, who must work in concert with 
State and national officials to control these threats, prevent 
spread, and save lives. Despite steady increases and shifts in 
the U.S. population there has been a decline in the number of 
public health workers per capita in the past decade. Schools of 
Public Health and Preventive Medicine report that the majority 
of graduates do not seek employment in public health agencies.
    Prevention Research.--The Committee recommends $16,000,000 
for the extramural prevention research program. This reverses 
the virtual elimination of the program proposed in the 
President's request. The prevention research program is in the 
second year of funding 25 research projects, in which teams of 
investigators from universities, private research firms, State 
and local health departments, and community based organizations 
work together to conduct research to prevent disease and save 
lives. The Committee supports this program strongly.
    Public Health Research.--Our Nation's substantial economic 
investment in biomedical research has identified causes of and 
methods to prevent illness, allowing medical practitioners to 
diagnose and treat an astonishing array of medical conditions. 
To have a public health impact commensurate with this level of 
investment, however, the information generated in biomedical 
laboratories must be translated into effective public health 
programs. Public health research conducted by CDC is solution-
oriented, designed to bridge the gap between medical research 
discoveries and behaviors people adopt. Specifically, public 
health research helps to define 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. This kind of 
practical, applied research seeks to overcome barriers that 
prevent people from adopting healthy behaviors proven effective 
by biomedical research. As public health research is essential 
to improving health status of the Nation, the Committee has 
provided $30,000,000 for CDC to expand its efforts in this 
area. The Committee expects some of these funds to be used to 
support research on ways to prevent disease and disability in 
rural areas and to better utilize nurses and allied health 
professionals in prevention and health promotion efforts.
    As more and more Americans use alternative and 
complementary therapies to maintain and improve their health, 
there is a growing need for better consumer information about 
these therapies. The Committee expects CDC to expand their 
effort in this area. Practice-based assessments and the 
identification and study of promising and heavily used 
complementary and alternative therapies and practices should be 
undertaken and results published. The Committee expects CDC to 
collaborate with the National Center for Complementary and 
Alternative Medicine to assure that its efforts complements 
efforts by this Center.

Buildings and Facilities

    The Committee recommendation includes $250,000,000 for the 
planning, design, and construction of new facilities, repair 
and renovation of existing CDC facilities, and data security 
and storage. The fiscal year 2003 comparable level was 
$266,258,000 and the administration requested $114,000,000 for 
fiscal year 2004.
    The Committee recommendation includes sufficient funds for 
the continuation of CDC's building program for its Atlanta and 
Fort Collins facilities. The Committee has long supported the 
rapid implementation of CDC's Buildings and Facilities Master 
Plan and is pleased with the progress made to date for the 
agency's Atlanta, Georgia facilities. The Committee notes that 
continuing to implement the Master Plan as quickly as possible 
is essential for the public health security of our Nation.
    The Committee encourages CDC to evaluate the need for a 
physical laboratory building at the NIOSH National Personal 
Protective Technologies Laboratory.
    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 constructing the 
Atlanta and Fort Collins facilities.

Office of the Director

    The Committee recommends $59,707,000 for the Office of the 
Director. The fiscal year 2003 comparable level was $49,426,000 
and the administration requested $59,707,000 for fiscal year 
2004.
    The Office of the Director [OD] manages and directs 
programs of the CDC. OD provides leadership, advises on policy 
matters, and develops and evaluates progress of goals and 
objectives related to disease prevention and control. OD 
provides direction and coordination to the epidemiologic 
activities of CDC and coordinates CDC's response to health 
emergencies. In addition, OD coordinates and manages programs 
on global health activities, minority health, and women's 
health relating to disease prevention and control.
    The Committee is aware of the importance of the Prevention 
Research program at the Public Health Program Office. This 
program awards peer-reviewed grants to academic health centers 
in partnership with community-based organizations to 
demonstrate and to measure the performance of promising 
prevention demonstrations. This program is an example of CDC's 
commitment to extramural research in support of evidence-based 
prevention programs. The Committee believes that disease 
prevention and health promotion is central to better health and 
longer lives for every American and that investments today in 
prevention research, including research on behavioral change, 
can significantly contain health care costs tomorrow. 
Accordingly, the Committee urges the Director to place 
prevention research at a higher priority and, in addition, 
encourages the CDC to collaborate with the NIH Office of the 
Director to coordinate each agency's prevention research 
programs.
    Air Transport.--When a public health threat emerges, CDC is 
called upon to respond in an appropriate and timely manner to 
investigate and contain the threat. To engage in the highest 
level of outbreak response, CDC requires an aircraft capable of 
being anywhere in the world in one stop or 6,500 miles in 12 
hours, refitted to provide appropriate infection control 
capabilities and maintained on standby near CDC headquarters. A 
dedicated aircraft with a capability to retrieve specimens 
rapidly, deploy key CDC personnel, or evacuate CDC personnel in 
the field to appropriate health care facilities is a tool which 
will optimize CDC's ability to provide timely outbreak 
response. The aircraft would enable CDC to obtain specimens 
early in the outbreak of a disease, which is critical. 
International clearances, paperwork required to ship specimens, 
and availability of a commercial carrier all contribute to 
delays and sometimes failed receipt of specimens. The Committee 
is very concerned by the difficulty CDC experienced in 
transporting SARS specimens via commercial aircraft from Asia 
to CDC's Atlanta-based headquarters for testing. Deploying key 
CDC personnel early in the discovery of an outbreak is another 
essential factor in identifying and containing the spread of a 
disease. CDC currently lacks an effective means of safely and 
efficiently transporting personnel with highly communicable 
infections to locations that can provide appropriate care. 
Experience has demonstrated that CDC cannot rely on commercial 
companies or other Federal agencies to transport infectious 
specimens or to move highly contagious patients. The Committee 
believes CDC requires its own aircraft to move specimens and 
emergency personnel worldwide on a moment's notice.

                     National Institutes of Health

    This Nation's investment in biomedical research has 
propelled a remarkable transformation in our understanding of 
the life sciences, out of which has flowed a bounty of new ways 
to prevent, cure and treat disease. Since the structure of DNA 
was first discovered in 1953, for example, scientists have 
identified thousands of genes linked to rare disorders as well 
as common diseases that were never thought to be genetic 
conditions. In all, more than 4,000 diseases are now thought to 
have genetic causes. This new knowledge is helping to broaden 
our understanding of how biological processes work at the 
molecular level, elucidating the cause of disease not just the 
symptoms, and opening the path to prevention strategies, 
earlier intervention in the disease process, and new, more 
effective treatments. But challenges remain. Chronic diseases 
like cancer, heart disease, stroke and diabetes continue to 
waste precious human resources and drain billions of dollars 
from the Nation's economy. Infectious agents like SARS, Monkey 
Pox, hepatitis C, and West Nile virus kindle new threats to 
health; diseases like tuberculosis and malaria are re-emerging 
in more virulent, drug-resistant forms; and threats of 
bioterrorism impose added demands on science for rapid 
detection and treatment. But even larger challenges loom on the 
horizon as the population of Americans over age 65 more than 
doubles--to 75 million--over the next 3 decades, resulting in 
exponential increases in the number of individuals suffering 
from Alzheimer's, arthritis, Parkinson's, and osteoporosis.
    This Committee has long recognized the worth of the 
National Institutes of Health, not only as the world's most 
important biomedical research establishment, but as the taproot 
that nourishes growth and progress in medical science. Along 
with that recognition comes the understanding that the engine 
of progress must be maintained. Although the private sector has 
an important role to play, the Federal Government is the only 
source able to provide sustained, long-term support. NIH-
supported research helps supply the cadre of highly skilled 
investigators, stimulates investments in new technology 
development, and is an important precursor to innovation. When 
this Committee embarked on an historic, bipartisan effort to 
double the Federal investment in NIH, it did so not as a means 
to an end but as part of a continuing endeavor to strengthen 
and revitalize the research enterprise in this Nation. The 
funds provided in this bill represent an important step in that 
continuum.
    The Committee recommends $27,990,804,000 for the NIH. This 
amount is $1,000,000,000 above the fiscal year 2003 
appropriation and $326,813,000 over the budget request.

                       NATIONAL CANCER INSTITUTE

Appropriations, 2003....................................  $4,592,348,000
Budget estimate, 2004...................................   4,770,519,000
Committee recommendation................................   4,770,519,000

    The Committee recommends an appropriation of $4,770,519,000 
for the National Cancer Institute [NCI]. This is equal to the 
budget request. The fiscal year 2003 appropriation was 
$4,592,348,000. 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.
    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 all populations are to 
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.
    Blood Cancers.--The Committee urges the NCI to continue to 
implement the research priorities for leukemia, lymphoma, and 
multiple myeloma included in the May 2001 Progress Review Group 
Report.
    Bone Metastasis.--The Committee encourages NCI to continue 
its emphasis on studying the bone microenvironment and bone 
metastasis related to prostate cancer, breast cancer and 
multiple myeloma and to support research to delineate the 
mechanisms of reciprocal interactions between tumor cells and 
bone. To provide an infrastructure for this research, NCI is 
encouraged to establish a repository of human bone metastases 
for the scientific community and support research to generate 
three-dimensional in vitro and/or in vivo models that yield 
bone metastases.
    Brain Tumor.--In November 2000, the NCI and NINDS convened 
a panel of experts to review the field of brain tumor research 
and make recommendations to enhance it. The Committee is 
pleased that the Institutes followed that meeting by 
establishing the Neuro-Oncology Branch, an inter-institutional 
initiative aimed at bringing a multidisciplinary approach to 
brain tumor research. The Committee now urges the NCI and NINDS 
to establish a coordinated and multi-institutional tissue bank 
that would gather not only tissue but also blood and 
cerebrospinal fluid from patients with all varieties of brain 
tumors. The system should also be linked to a comprehensive 
database of relevant clinical, demographic, pathologic, 
biologic, and therapeutic information on all patients whose 
tissue is banked. The Committee further strongly urges the NCI 
to increase funding and the number of 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 and Minorities.--The Committee remains concerned 
that cancer rates for Native Hawaiians and other Native 
American Pacific Islanders are disproportionately high. The 
Committee encourages the NCI to expand its research in this 
area.
    Cancer Genomics.--The Committee commends NCI for its 
commitment to understanding the role of genomics and genetics 
in the progression of cancer. Considerable effort must now be 
directed toward applying those findings to tumor classification 
and therapeutic choice, with a focus on breast, colorectal and 
lung cancer, as well as leukemia and lymphoma. An important 
component of this effort will be to build a public database of 
whole genome expression profiles from various tumor types, 
which includes clinical outcome information. The Committee 
encourages NCI to ensure that this data is available to health 
professionals to assist physicians and patients in choosing the 
best treatment options.
    Cancer Survivorship.--With the advances that have resulted 
from the ongoing commitment and investment in biomedical 
research, and the resultant advances in cancer treatment, 
cancer for many has become a chronic illness. Currently, there 
are over 9 million cancer survivors in the Nation, and this 
number is expected to grow dramatically. More must be done to 
improve the understanding of the growing cancer survivorship 
population, including determinations of physiological and 
psychological late effects, prevalence of secondary cancers, as 
well as further development of effective survivorship 
interventions. The Committee supports an aggressive expansion 
of the NCI Office of Cancer Survivorship activities and urges 
the NCI to continue its work to expand the Office of cancer 
Survivorship within NCI, as well as advance and increases 
opportunities in cancer survivorship. The Committee was pleased 
to see NCI include cancer survivorship in the cancer bypass 
budget and urges NCI to provide increased funding for cancer 
survivorship research.
    Chronic Lymphocytic Leukemia.--The Committee strongly 
encourages the NCI to increase the level of research aimed at 
determining the underlying cause and optimum therapies for CLL, 
the most common form of adult leukemia in the United States. 
The Committee is encouraged by the NCI's willingness to 
consider a supplementary application for research funding for 
the CLL Research Consortium. The Committee further urges the 
NCI to expand funding for the Consortium to speed up the 
progress in finding significant scientific breakthroughs.
    Chronic Myeloproliferative Disorders.--Polycythemia vera, 
idiopathic myelofibrosis and essential thrombocytosis are 
malignant diseases of the bone marrow that are underserved with 
respect to research funding, considering the number of people 
they strike. These disorders are chronic and can transform into 
acute leukemia. They offer great research promise with respect 
to insights into the behavior of blood cells, since the cells 
that they affect appear normal but behave abnormally. The major 
obstacle to research into the causes and the treatment of these 
disorders has been the lack of Federal funds designated for 
this purpose. The Committee strongly believes that the NCI 
should expand research into these disorders, and be prepared to 
report to the Committee during the fiscal 2005 budget hearing 
about existing efforts, as well as planned future efforts, to 
better understand these disorders.
    Complementary and Alternative Cancer Therapies.--The 
Committee expects the 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.
    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 the 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.
    Diet and Nutrition.--The evidence is mounting that diet and 
nutrition play a key role in causing cancer and preventing it. 
For example, studies show that a diet with little fiber may be 
a contributing factor in colon cancer, while lycopene found in 
tomatoes may be useful in preventing prostate cancer. Likewise, 
diet can play a major role in treating a variety of cancers. 
The Committee encourages the National Cancer Institute to 
dedicate more funding to research and education programs 
focused on diet and nutrition.
    Gynecologic Cancers.--The Committee is encouraged by the 
success of the Gynecological Cancer SPORE program but believes 
an increased investment is needed as the survival rate for 
ovarian cancer remains disappointingly low--14,300 women are 
expected to die this year while 25,400 will be diagnosed during 
that same time. The Committee believes the CanCOR program 
should be expanded to help identify barriers to receiving 
optimal care among women with newly diagnosed gynecological 
cancer. The NCI should also develop prophylactic and 
therapeutic HPV vaccines to prevent cervical cancer and 
strengthen research in the biology of endometrial cancer in 
order to improve prevention and treatment, thus sparing women 
the need to undergo hysterectomy and other cancer therapy. The 
Committee also believes that the NCI should be partnering with 
the NICHD Reproductive Sciences Program to investigate 
gynecological cancer.
    Health Communications.--The Committee is pleased at the 
growth of this program of research, since health communications 
is such a vital contributor to the public health and health 
care generally. Understanding and improving communication 
between health providers and patients, improving communication 
with low literacy populations, and understanding what aids and 
hinders public health messages is critically important for 
building a healthier Nation. The Committee particularly 
encourages NCI to provide additional information about the 
HINTS survey that will commence this year. This will be the 
first national health communications survey, involving some 
8,000 adults.
    Imaging Systems Technologies.--The Committee is encouraged 
by progress made by the NCI following its August 1999 
conference on biomedical imaging, and it 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.
    Kidney Cancer.--The Committee is concerned about the 
growing incidence of kidney cancer. According to the American 
Cancer Society, 30,800 Americans were expected to be diagnosed 
with kidney cancer and 12,100 were expected to die of this 
disease in 2001. Unfortunately, kidney cancer is often not 
diagnosed until it has spread to other parts of the body, 
decreasing chances of long-term survival from the disease. The 
Committee is concerned that treatment options are very limited, 
particularly for late-stage kidney cancer patients. Therefore, 
the Committee strongly urges the NCI to place a greater 
emphasis on and dedicate expanded resources to research on 
kidney cancer. The Committee requests the NCI to convene an 
expert conference by December 2003 to develop a short- and 
long-term research agenda and action plan for improving the 
diagnosis and treatment of kidney cancer. The Committee 
recommends that the conference include patient advocates.
    Liver Cancer.--The Committee is concerned that primary 
liver cancer continues to be one of the few forms of cancer for 
which incidence is growing. This has serious implications for 
public policy, cancer being a significant factor in 
transplantation. While progress is being made, much more needs 
to be done. NCI is planning a joint meeting with NIDDK for 
April 2004. It is critical that this meeting result in a strong 
plan for future research in primary liver cancer that will 
reverse the current increases.
    Lymphoma Research.--The Committee recommends that NCI 
increase its efforts to examine the issue of environmental and 
viral links to lymphoma. Although many studies have suggested 
an increased risk of lymphoma associated with environmental 
factors such as chemicals, pesticides and herbicides, other 
investigations have reported inconsistent results. However, 
many of these studies are weakened by limited sample sizes, 
flaws in study design, and imprecision in the measurement of 
environmental carcinogen exposures. The Committee recommends 
that NCI work to develop a well-constructed prospective study, 
using a multidisciplinary, approach to examine environmental 
links to lymphoma.
    In a recent report (October 2002) the Institute of Medicine 
concluded that there is moderate to strong biological evidence 
supporting a role of Simian Virus 40 in human cancer. Recent 
reports suggest that more than 40 percent of lymphomas tested 
were positive for this virus. Additional research studies have 
also found an association between other viruses, such as human 
herpes virus 8 and hepatitis C, and lymphoma. As a result of 
these studies, it is possible that more than half of all 
lymphomas may be attributed to viruses. The Committee therefore 
recommends that NCI also increase its efforts to examine the 
viral etiology of lymphoma.
    More than 61,000 Americans will be diagnosed with Hodgkin's 
lymphoma and non-Hodgkin's lymphoma [NHL] in 2003. The 
Committee notes that there have been significant advances in 
the treatment of Hodgkin's lymphoma over the last 30 years and 
some improvements in the treatment of NHL. However, NHL 
treatments are not adequate, and treatment improvements are 
absolutely critical for this group of cancer patients. Although 
industry has recently developed several new NHL therapies, the 
involvement of the National Cancer Institute in lymphoma 
research is still critical. The Committee urges that NCI 
increase its investment in clinical research on lymphoma and 
strengthen its collaboration with industry to improve the 
efficiency and timeliness of the lymphoma drug development 
process.
    The Committee also recommends that, in addition to 
initiatives to improve the lymphoma drug development process, 
NCI increase its investment in several other areas of research, 
including research on nonablative transplants, immunomodulatory 
regimens, central nervous system lymphoma, the late and long-
term effects of current lymphoma treatments, and lymphoma 
etiology and prevention. The Committee also urges NCI to 
cooperate with private organizations in the development of a 
comprehensive lymphoma tissue bank.
    Multiple Myeloma.--The Committee acknowledges that the 
National Cancer Institute [NCI] has developed the Academic 
Public Private Partnership Program to facilitate public-private 
partnerships in research on orphan cancers, including but not 
limited to blood-related cancers. The Committee is pleased by 
this action, but in light of the serious burden associated with 
the blood cancers and the limited treatment possibilities for 
many blood cancers, it strongly urges additional efforts to 
accelerate the development of blood cancer therapies. The 
Committee encourages NCI to develop funding mechanisms for 
translational blood-related cancer research that will 
facilitate multi-disciplinary and multi-institutional research 
collaborations instead of research focused at only one 
institution. Multi-institutional cooperation is critical if new 
therapies are to be efficiently developed. The Committee also 
urges the NCI to increase its overall investment in blood 
cancer research, including but not limited to its investment in 
these multi-institutional research grants. To ensure that 
progress on blood cancer research initiatives continue, the 
Committee requests that NCI submit a report on the status of 
its blood cancer research program by April 2004.
    Myelodysplasia and Myeloproliferative Disorders.--The 
Committee is pleased with NCI's efforts to address the lack of 
basic knowledge about myelodysplasia and myeloproliferative 
disorders, two very different types of chronic diseases of bone 
marrow cells that can develop into acute leukemia. The 
Committee urges NCI to carry out the recommendations of its 
recent conference of experts on these diseases and advance new 
research initiatives into developing effective treatments.
    Nanosystems Biology.--The Committee encourages NCI to 
support a collaborative effort to bring nanotechnology, systems 
biology and molecular imaging together 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 to fail 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.--Neurofibromatosis [NF] research has 
significant potential for cancer patients since NF genes have 
been implicated in the signaling processes that determine cell 
growth and cell differentiation. It will contribute to the 
development of new technologies and enhance understanding of 
the fundamental processes of both cancer and NF. The Committee 
encourages NCI to intensify and expand its NF research 
portfolio in such areas as molecular biology, development of 
animal models, natural history studies, malignant 
transformation in tumors, therapeutic intervention, and 
clinical trials. It recommends that NCI use all available 
mechanisms, including requests for applications, program 
announcements, and the national cooperative drug discovery 
group program to achieve this end. The Committee expects NCI to 
coordinate its efforts with other Institutes where appropriate 
and to be prepared to report on its progress at the fiscal year 
2005 appropriations hearings. The Committee thanks NCI for 
conducting phase II clinical trials of NF1 patients with 
plexiform neurofibromas. Finally the Committee encourages NCI 
to increase its NF research portfolio in such areas as further 
development of animal models, natural history studies, 
therapeutic experimentation, and clinical trials.
    Organ Cancers.--The Committee acknowledges that the 
National Cancer Institute [NCI] has developed the Academic 
Public Private Partnership Program to facilitate public-private 
partnerships in research on orphan cancers, including but not 
limited to blood-related cancers. The Committee is pleased by 
this action, but in light of the serious burden associated with 
the blood cancers and the limited treatment possibilities for 
many blood cancers, it strongly urges additional efforts to 
accelerate the development of blood cancer therapies.
    The Committee encourages NCI to develop funding mechanisms 
for translational blood-related cancer research that will 
facilitate multi-disciplinary and multi-institutional research 
collaborations instead of research focused at only one 
institution. Multi-institutional cooperation is critical if new 
therapies are to be efficiently developed. The Committee also 
urges the NCI to increase its overall investment in blood 
cancer research, including but not limited to its investment in 
these multi-institutional research grants. To ensure that 
progress on blood cancer research initiatives continue, the 
Committee requests that NCI submit a report on the status of 
its blood cancer research program by April of 2004.
    Pancreatic Cancer.--Pancreatic cancer is the country's 
fifth leading cause of cancer death, and 99 percent of people 
diagnosed with this disease die within 6 months. The Committee 
is concerned that research funding for pancreatic cancer has 
not increased commensurate with the severity of this disease or 
the overall increase afforded the NCI within the past 5 years. 
The Committee strongly urges the NCI to complete the immediate 
and short-term strategies identified in the ``Strategic Plan 
for Addressing the Recommendations of the Pancreatic Cancer 
Progress Review Group,'' which was issued by the NCI in 
September 2002. In addition, the Committee asks the NCI to 
complete a professional judgment budget to carry out those 
strategies, and to provide it to the Committee by April 1, 
2004.
    Prostate Cancer.--The Committee is aware of the 
considerable investment that has been made in prostate cancer, 
the leading cause of cancer death among men, and encourages NCI 
to continue to support research to improve the accuracy of 
screening and early detection of prostate cancer. Emphasis 
should also be placed on the development of new, more effective 
therapies for cancer that was not detected early enough and is 
no longer confined to the prostate capsule.
    The Institute has worked with the urologic scientific 
community to identify research needs in other urologic 
oncology, including bladder, kidney and testis cancers. The 
Committee expects the Institute to increase the research 
resources directed to these other urologic cancers, which 
affect thousands of men and women annually.
    The success in treating prostate, and other cancers, means 
that there are many individuals in society who are cancer 
survivors. There are a series of distinct physical and 
emotional issues facing these individuals, and the Committee 
encourages NCI to develop programs that address these problems.
    The report titled ``Prostate Cancer Research Plan Fiscal 
Year 2003--Fiscal Year 2008'' that NCI provided to Congress in 
August 2002 did not include a professional budget judgment. The 
Committee requests the NCI to provide such a budget for fiscal 
year 2004 through fiscal year 2008 by April 2004.

               NATIONAL HEART, LUNG, AND BLOOD INSTITUTE

Appropriations, 2003....................................  $2,793,733,000
Budget estimate, 2004...................................   2,867,995,000
Committee recommendation................................   2,897,595,000

    The Committee recommendation includes $2,897,595,000 for 
the National Heart, Lung, and Blood Institute [NHLBI]. The 
fiscal year 2003 appropriation was $2,793,733,000 and the 
budget requested $2,867,995,000. 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, the NHLBI is encouraged to enhance 
program activity at research institutions training these 
individuals. 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.
    Alpha-1 Antitrypsin Deficiency.--The Committee is aware 
that Alpha-1 Antitrypsin Deficiency is a genetic disorder that 
can result in fatal lung and/or liver disease. The disease is 
often misdiagnosed as asthma or Chronic Obstructive Pulmonary 
Disease [COPD]. Alpha-1 is a major cause of lung 
transplantation in adults and a leading cause of liver 
transplantation in children. The Committee encourages NIH to 
enhance in research portfolio through all available mechanisms, 
including conducting a State of the Science Conference aimed at 
evaluating current science and identifying future research 
priorities for a 5-year research agenda in Alpha-1. NIH is 
encouraged to consult closely with the research community, 
clinicians, and patient advocates regarding Alpha-1 research 
and the achievement of this goal. NIH is also encouraged to 
expand efforts to raise public awareness and to provide 
information about Alpha-1 to the public and health 
professionals.
    Basic Behavioral Research.--The NHLBI is commended for its 
support of basic research with animal models to better 
understand the effects of various diets, exercise, and stress 
on the heart and circulatory system, as well as work on gene-
environment interactions. The NHLBI is encouraged to continue 
to work cooperatively with other institutes and the Office of 
Behavioral and Social Sciences Research on efforts to add to 
fundamental knowledge in these areas.
    Blood-Related Cancer Research.--In 2003, approximately 
110,000 Americans will be diagnosed with multiple myeloma, 
lymphoma, or leukemia, which are considered blood-related 
cancers. There are good treatment choices for some who are 
diagnosed with blood cancers, but for others the treatment 
options are limited. Treatment advances will only be 
accomplished through the more efficient translation of basic 
research findings into new therapies. In May 2002, Congress 
approved and the President signed into law the Hematological 
Cancer Research Investment and Education Act, which directs the 
National Institutes of Health [NIH] to expand, intensify, and 
coordinate the research program for blood-related cancers as 
part of the Joe Moakley Research Excellence Program.
    Cardiovascular Diseases.--The Committee continues to regard 
research into the causes, cure, prevention and treatment of 
heart disease, stroke and other cardiovascular diseases as one 
of the Nation's top priorities. Cardiovascular diseases remain 
the leading cause of death in the United States and a major 
cause of permanent disability. The Committee continues to 
strongly believe that an intensive research program on heart 
disease, stroke and other cardiovascular diseases should be a 
top priority of the NHLBI. The Committee urges the Institute to 
expand its resources dedicated to cardiovascular disease 
research through all available mechanisms, as appropriate.
    Cooley's Anemia.--The Committee remains strongly supportive 
of the Institute's creation of and support for the Thalassemia 
Clinical Research Network, which is composed of North America's 
leading experts on thalassemia, the medical term for Cooley's 
anemia. The Committee believes that research into this disease 
has implications far beyond this patient population and that 
all reasonable steps should be taken to assure that the Network 
reaches its maximum potential. In addition, the Committee 
encourages NHLBI to join with CDC and FDA to enhance blood 
safety.
    Diagnostic Screening Test for Salt Sensitivity.--High blood 
pressure is the most critical stroke risk factor and a leading 
cause of heart attack and heart failure. The cause of 90 to 95 
percent of the cases of high blood pressure is not known, but 
high blood pressure is easily detected and usually 
controllable. Excess dietary salt is an important risk factor 
for high blood pressure. While public health authorities 
caution all Americans to limit salt intake, the ability to 
identify people who are most likely to benefit from salt 
restriction would provide strong incentives for susceptible 
individuals to heed the message. The Committee urges the NHLBI 
to increase funding for the development of a noninvasive or 
minimally invasive, rapid, practical diagnostic test for salt 
sensitivity, i.e., the propensity for an individual to 
experience an increase in blood pressure in response to a salt-
rich diet.
    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 thanks NHLBI for their 
attention to this important disorder.
    Hematology Networks.--The Committee is very supportive of 
NHLBI's Clinical Research Networks, especially with the 
progress of the Transfusion Medicine/Hemostasis Network. To 
address the shortage of hematology specialists, the Committee 
looks forward to learning about NHLBI's plans to formalize a 
training component for clinicians and researchers within the 
networks.
    Hemophilia.--The Committee commends NHLBI for its 
leadership in advancing research on bleeding disorders and the 
complications of these disorders, including inhibitor 
development and improved treatments such as gene therapy. The 
Committee encourages NHLBI to continue to partner with the 
National Hemophilia Foundation in further expanding 
opportunities for hematologic research through clinical 
research networks and, where appropriate, with other NIH 
Institutes. The Committee also requests a report by April 2004 
on the status of research on type 1 and 2 von Willebrand 
disease and how NHLBI plans to expand research in this 
important area.
    Juvenile Diabetes.--Vascular complications, including 
cardiovascular, peripheral vascular, and cerebrovascular, are a 
major cause of mortality and morbidity in persons with 
diabetes, particularly in those with juvenile diabetes. The 
NHLBI is urged to focus on initiatives specifically relating to 
individuals with juvenile diabetes who experience accelerated 
and severe complications as a result of hyperglycemia, such as 
atherosclerosis, vascular inflammation, and microvascular 
disease.
    Marfan Syndrome.--The Committee commends the NHLBI for its 
past and ongoing support of research on aortic aneurysms, which 
are pathologically related to Marfan syndrome. Marfan syndrome 
is a life-threatening progressive disorder affecting the heart, 
lungs, skeleton and eyes. The Committee urges the NHLBI to 
enhance both basic and clinical research efforts specifically 
in the area of Marfan syndrome through all available mechanisms 
such as recommended from a 2002 NHLBI working group meeting.
    Minority Health.--The Committee notes lung diseases 
disproportionately affect 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 encourages NHLBI to fund research in myelodysplasia 
and myeloproliferative disorders, specifically into the 
vascular, thrombotic, and hemorrhagic abnormalities associated 
with myeloproliferative disorders as well as the specific 
abnormalities in cell gene expression that are responsible for 
these diseases.
    National Asthma Education and Prevention Program [NAEPP].--
The Committee commends NAEPP for its leadership in helping to 
educate physicians, asthma patients, their families, and the 
general public regarding asthma and its management. The 
Committee urges NAEPP to enhance the role that its Advisory 
Committee plays in helping to coordinate asthma education 
throughout the United States.
    The Children's Health Act of 2000 legislation 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.--Neurofibromatosis is a neurological 
disorder that causes a variety of problems including learning 
disabilities, skeletal abnormalities, disfigurement, deafness, 
blindness, loss of limbs, and brain, spinal, heart, and 
vascular abnormalities, and tumors on nerves anywhere on or in 
the body. Research on the effects of NF on formation, growth, 
and functioning of the heart and vascular system are of 
relevance to the NHLBI. In addition, it has been brought to the 
Committee's attention that NF research has documented the 
involvement of neurofibromatosis in heart valve formation which 
may lead to new opportunities and understanding of the genetic 
and environmental causes of heart and vascular disease. The 
Committee therefore strongly encourages NHLBI to work with 
other Institutes and NF advocacy groups such as The National 
Neurofibromatosis Foundation, Inc. to identify areas where 
research goals may be complementary, expand its NF research 
portfolio and to build appropriate partnerships.
    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.
    Pediatric Heart Research.--Pediatric heart disease, which 
includes heart defects existing at birth, disorders of heart 
function and heart rhythm and other heart conditions acquired 
in childhood, remain an important public health problem. Heart 
defects are the most common birth defect and cause more infant 
deaths than any other birth defect. The Committee urges the 
NHLBI to support a program on Specialized Centers of Clinically 
Oriented Research in Pediatric Heart Development and Disease, 
designed to stimulate and foster multidisciplinary clinical and 
basic research to enhance prevention, diagnosis and treatment 
of acquired pediatric heart disease and heart defects that 
exist at birth.
    The Committee is also aware of the need for Pediatric 
Mechanical Circulatory Support Research and Development. 
Circulatory assist devices, such as left ventricular assist 
devices, increase survival rates and quality of life for adult 
patients. But, such devices are not available for infants and 
children. The Committee urges the NHLBI to support planned 
research that would develop and evaluate pediatric circulatory 
assist devices that could provide short, intermediate or long-
term lifesaving support for infants and children waiting for 
heart transplants or development of new surgical or other 
therapies.
    Peripheral Arterial Disease [PAD].--The Committee 
encourages the NHLBI to develop research initiatives in the 
area of PAD, including studies to improve prevention, diagnosis 
and treatment. The Committee urges the NHLBI to create 
informational and educational programs directed to health 
professionals, patients and the public to raise awareness and 
understanding of PAD as a risk factor for heart disease and 
stroke and the importance of preventing, diagnosing and 
treating PAD.
    Pulmonary Hypertension [PH].--The Committee commends 
NHLBI's efforts to promote PH related research. The Committee 
urges the Institute to increase funding for basic research, 
gene therapy and clinical trials of promising pharmaceuticals, 
and to take appropriate measures to ensure the submission of 
high quality proposals in this area.
    Recovery of Heart Function with Circulatory Assist.--The 
Committee is aware that the only treatment for sufferers of 
end-stage heart failure is a heart transplant. Since there is a 
severe shortage of hearts available for transplant, mechanical 
circulatory assist devices are typically used to stabilize 
these patients until a suitable donor heart becomes available. 
Anecdotal evidence shows that the ``rest'' provided by 
circulatory assist devices, in some cases, enables the adult 
heart to recover sufficiently to resume pumping on its own. The 
Committee urges the NHLBI to initiate research to determine 
whether sustained heart recovery is achievable through 
circulatory assist devices, characterization of patients who 
would likely benefit and study of other therapies that may 
improve outcomes.
    Scleroderma.--The Committee encourages the Institute to 
undertake research initiatives to be undertaken by the NHLBI 
for the study of cause and treatment options for scleroderma, a 
chronic and progressive disease that predominantly strikes 
women. Scleroderma is disfiguring and 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 
devastating complications of scleroderma that include pulmonary 
fibrosis, pulmonary hypertension, myocardial fibrosis, cardiac 
arrhythmias, pericarditis, and Raynaud's Phenomenon.
    Sleep Apnea (obstructive) in Adults.--Symptomatic sleep 
apnea is common in middle-age adults, and far more frequent in 
the elderly. Untreated sleep apnea results in mortality, 
cardiovascular disease, and quality of life deficits. The 
Committee recommends that the National Heart, Lung, and Blood 
Institute, in collaboration with the National Institute on 
Aging, support research to define useful treatments--including 
surgical treatments--for the large segment of the general 
population that suffers from insufficiently treated obstructive 
sleep apnea.
    Sleep Medicine.--The Committee commends NHLBI and the 
National Center for Sleep Disorders Research on the completion 
of the 2003 National Sleep Disorders Research Plan, which 
provides an enormous breadth of research topics ranging from 
better understanding sleep mechanisms and functions, to 
improved treatments for sleep disorders, to the effect of sleep 
on health outcomes. The Committee therefore expects NHLBI to 
move forward on these research initiatives and looks forward to 
a progress report on the implementation of the research plan at 
next year's budget hearings.
    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.
    Vascular Disease and Alzheimer's.--There is a growing body 
of evidence that cerebrovascular disease may be a key mechanism 
in triggering the manifestation of Alzheimer's disease. The 
Committee therefore is pleased to note that NHLBI, in 
collaboration with NIA, is supporting cardiovascular health 
studies that are examining the natural history of the 
development of Alzheimer's, and identifying individuals at high 
risk of developing the disease. Ancillary studies also are 
underway to determine the contribution of vascular factors to 
Alzheimer's. The Committee encourages NHLBI to continue to 
pursue this line of research and to work collaboratively with 
NIA.

         NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH

Appropriations, 2003....................................    $371,636,000
Budget estimate, 2004...................................     382,396,000
Committee recommendation................................     386,396,000

    The Committee recommendation includes $386,396,000 for the 
National Institute of Dental and Craniofacial Research [NIDCR]. 
The fiscal year 2003 appropriation was $371,636,000 and the 
budget requested $382,396,000. 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 the American people. 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.--The Committee learned in 
public witness testimony about the advances occurring in the 
field of salivary diagnostics. 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 our 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 the NIDCR's 
interest in scleroderma, a chronic and progressive disease that 
predominantly strikes women. Scleroderma is often associated 
with a number of potential dental and craniofacial 
complications. The major and most 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. The Committee encourages the NIDCR to increase its 
research portfolio on scleroderma and to develop safe and 
effective treatments and to identify the cause or causes of the 
devastating complications of this disease.

    NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES

Appropriations, 2003....................................  $1,722,730,000
Budget estimate, 2004...................................   1,820,007,000
Committee recommendation................................   1,833,007,000

    The Committee recommends an appropriation of $1,833,007,000 
for the National Institute of Diabetes and Digestive and Kidney 
Diseases [NIDDK]. The fiscal year 2003 appropriation was 
$1,722,730,000 and the administration's request is 
$1,820,007,000. 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.
    Behavioral Research.--Diabetics who have co-occurring 
depressive symptoms have less success managing their illnesses. 
The Committee also notes that NIDDK's recent clinical trial, 
the Diabetes Prevention Program, demonstrated that diet and 
exercise could be more successful than medication alone in 
preventing the development of diabetes in groups who faced a 
high risk of diabetes. The NIDDK is strongly encouraged to 
build upon its investment in behavioral research, particularly 
in areas that would add to the science base on the maintenance 
of positive behavior change.
    Bladder Disease.--Bladder diseases and disorders are 
diverse, prevalent, economically costly and increasing with the 
aging of the American population. Collectively, bladder cancer, 
urinary incontinence, interstitial cystitis, and urinary tract 
infections affect over 40 million people, with severe negative 
impact on work and life quality. These serious needs must be 
met by a strong commitment to fund research concerning bladder 
disease. The Committee was pleased by the publication of the 
Bladder Research Review Group Document titled ``Overcoming 
Bladder Disorders: A Strategic Plan for Research,'' and it 
strongly urges the NIDDK to carry out the report's 
recommendations.
    Cooley's Anemia.--The Committee continues to support the 
outstanding research being supported by NIDDK on such issues as 
iron chelation, non-invasive iron measurement, fetal 
hemoglobin, and other topics of importance to Cooley's anemia 
patients. The development of a less burdensome method of iron 
chelation, which currently involves a daily infusion of up to 
12 hours, is desperately needed. In addition, NIDDK is urged to 
continue its collaboration with NIBIB on imaging issues related 
to iron measurement.
    Cystic Fibrosis [CF].--Advances in the treatment of CF have 
resulted in significant improvements in life expectancy for 
individuals with CF. This progress can be attributed to strong 
public and private sector investment in CF research, including 
clinical trials evaluating a wide range of possible new 
treatments. The panel strongly urges the NIDDK to continue its 
support for CF researchers engaged in basic and clinical 
research.
    Diabetes in Native Hawaiians.--As the NIDDK develops 
expanded plans for diabetes research, the Committee recommends 
investigating the incidence 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.--Diseases of the digestive system 
continue to affect more than one-half of all Americans at some 
time in their lives. Serious disorders such as colorectal 
cancer, inflammatory bowel disease, irritable bowel syndrome, 
hemochromatosis, celiac disease, and hepatitis take a 
tremendous toll in terms of human suffering, mortality, and 
economic burden. 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.
    End-Stage Renal Disease.--Diabetes is the leading cause of 
kidney failure and end-stage renal disease. The Committee urges 
the NIDDK to expand research into early prevention and 
therapeutic intervention of kidney disease to prevent end-stage 
renal failure. It has been brought to the Committee's attention 
that rural Native Hawaiians with end stage renal disease have a 
particularly high rate of repeated infections. The Committee 
strongly urges the NIDDK to increase research targeted to end 
stage renal disease in the rural Native Hawaiian population.
    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, NIDDK is collaborating on a joint 
research program with the NephCure Foundation to include basic 
and genetic studies. Further, the Committee continues to 
encourage NIDDK to consider initiating a scientific conference 
on glomerular injury research, and to explore support for 
gathering prevalence data on glomerular injury.
    Hepatitis C in Children.--Recent studies indicate that 1 in 
every 200 children over the age of 12 is infected with the 
hepatitis C virus. The Committee urges the NIDDK, with 
appropriate support from the NICHD, to study the natural 
history of hepatitis C in infected children to help determine 
the optimal timing and medical regimen for treatment.
    Hepatitis C Consensus Development Conference.--The 
Committee is aware of the Hepatitis C Consensus Development 
Conference that occurred in June 2002 and made 17 specific and 
high-priority research recommendations that need to be pursued 
to develop better treatments and a cure for hepatitis. The 
Committee also notes that the Consensus Conference recommended 
the creation of a Hepatitis Clinical Research Network and urges 
its organization at the earliest possible time. The Committee 
requests a report by April 2004, with regards to the plans and 
progress to address these specific research recommendations.
    Hematology.--The Committee encourages NIDDK to sponsor a 
conference of experts to develop a blueprint for further study 
into the microvascular and thrombotic complications of 
metabolic disease, such as limb ischemia, vision loss, and 
renal failure.
    Inflammatory Bowel Disease.--The Committee has been 
encouraged in recent years by discoveries related to Crohn's 
disease and ulcerative colitis, collectively known as 
inflammatory bowel disease [IBD], and looks forward to 
reviewing the forthcoming report from the Institute on IBD 
research as requested in the fiscal year 2003 Senate Labor-HHS 
committee report. The Committee commends NIDDK for its strong 
leadership in this area and encourages the Institute to 
increase funding for research focused on; (1) the cellular, 
molecular and genetic structure of IBD, (2) identification of 
the genes that determine susceptibility or resistance to IBD in 
various patient subgroups, and (3) translation of basic 
research findings into patient clinical trails as outlined in 
the research agenda developed by the scientific community 
entitled, ``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.
    Irritable Bowel Syndrome.--The Committee remains concerned 
about the increasing frequency of irritable bowel syndrome 
[IBS], a chronic complex of disorders that malign the digestive 
system. These common dysfunctions strike people from all walks 
of life and result in significant human suffering and 
disability. The Committee encourages NIDDK to provide adequate 
funding for irritable bowel syndrome/functional bowel disorders 
research and to give priority consideration to funding grants 
that will continue to increase the IBS portfolio. The Committee 
is also pleased that NIDDK is considering the development of a 
strategic plan for IBS research.
    Interstitial Cystitis [IC].--The Committee commends the 
NIDDK for its recent investment in IC-specific basic science 
research and continuation of the IC Clinical Trials Group. 
However, the Committee is concerned about the current direction 
of the epidemiology studies on pelvic pain of bladder origin 
and IC currently being funded by the NIDDK. In fiscal year 
2000, the Committee urged the NIDDK to undertake a 
comprehensive epidemiology study of IC that would include 
scientifically valid statistics of the incidence of the 
disease, the demographics, occurrence in minority populations, 
and the health care costs. The Committee is concerned that the 
current studies will not adequately address these goals. 
Therefore, the Committee urges the NIDDK to rectify any 
shortcomings in the epidemiology effort, including funding 
additional studies if necessary.
    The Committee urges the NIDDK to pursue additional studies 
on bladder epithelium, bladder afferent nerve cells, and 
urinary markers of IC patients. In addition, the Committee 
urges the NIDDK to work with the Interstitial Cystitis 
Association to undertake a national IC awareness campaign aimed 
at reducing the delay in diagnosing IC, which currently takes 
an average of 5 to 7 years.
    Juvenile Diabetes.--The Committee commends the NIDDK for 
its development of the platform technologies of genomics and 
proteomics to expand clinical research capability. The 
Committee urges the Institute to continue the effort to remove 
the most common barriers between laboratory discoveries and 
clinical trials; this effort should include making available on 
a competitive basis the resources for pre-clinical development 
of drugs and therapies. The Committee applauds the NIDDK for 
the launch of TrialNet, which establishes an infrastructure to 
coordinate and support clinical trials dealing with the 
preservation of pancreatic beta cell function to prevent 
juvenile diabetes in high-risk individuals.
    Metabolic Bone Disease.--The Committee urges NIDDK to 
expand genetic research focusing on bone mass and functional 
genomics to further disease prevention and treatment of 
metabolic bone diseases. The Committee encourages NIDDK to 
support further research into drugs and mechanisms that can 
build better bone and comparison drug trials to determine best 
treatments.
    Mucopolysaccharidosis [MPS].--The Committee recognizes the 
efforts made by the NIDDK to achieve a greater understanding 
and pursue development of effective therapies for MPS 
disorders. The Committee encourages continued investment in MPS 
related research and is further encouraged to enhance 
collaborative efforts with the NINDS, NICHD, and appropriate 
institutes and centers involved in this crucial research, 
including bone and joint involvement in MPS disorders and 
pathophysiology of brain damage as they related to MPS 
disorders.
    Pediatric Kidney Disease.--Although significant strides 
have been made in understanding kidney disease in adults, much 
less is known about its complications in children, including 
obstacles to full growth potential and neurocognitive 
development. For this reason, the Committee is encouraged that 
the NIDDK has solicited proposals for a prospective cohort 
study of chronic kidney insufficiency in children and looks 
forward to the implementation of this study. Given the long-
term implications when children reach adulthood, the Committee 
continues to urge the NIDDK to undertake research into the 
history and treatment of cardiovascular problems in children 
suffering from chronic kidney disease, giving careful 
consideration to (1) the role of hypertension, lipid 
abnormalities, obesity, cardiovascular calcification, and 
cardiac arrhythmia; and (2) neurocognitive and developmental 
deficits including learning disabilities, with related issues 
of chronic neurological, intellectual and emotional impairment; 
poor linear growth; and abnormal bone formation. Funding for 
ancillary studies to determine the pathophysiology of these 
problems in children, including the ongoing clinical trial for 
focal segmental glomerulosclerosis, should be supported in 
order to develop new approaches to their treatment and 
prevention.
    Pediatric Liver Disease.--The Committee is pleased that the 
NIDDK has taken steps to increase research on biliary atresia, 
the most common cause of liver transplantation in children. The 
Committee notes that metabolic causes of liver disease and non-
alcoholic steatohepatitis [NASH] are also significant causes of 
liver disease in children. Therefore, it urges additional 
research focused on these diseases and other forms of pediatric 
liver disease.
    Pediatric Liver Disease--National Database and Registry.--
The Committee is aware of a privately funded initiative which 
that follows the natural history of infants and children who 
receive liver transplants until they are 18 years of age. With 
increased financial support, this national database and 
registry could permit more adequate hypothesis testing and 
outcomes research to determine both the health and financial 
impact of liver transplants on the child and the child's 
family. The Committee encourages NIDDK to favorably consider a 
pediatric liver disease national database and registry.
    PKD (Polycystic Kidney Disease).--The Committee anticipates 
important scientific advances in this exciting field of 
research resulting from the NIDDK sponsored International PKD 
Strategic Planning Meeting in late fiscal year 2002. 
Furthermore, the Committee is pleased the ``Halt PKD 
Interventional Trials Network'' is beginning and will identify 
therapeutic strategies to retard the progression of PKD, the 
result of which will forestall kidney failure for PKD patients, 
free up more than 3,000 spots on the kidney transplant waiting 
list, save $2,000,000,000 annually in PKD-caused Medicare costs 
for End-Stage Renal Disease, and alleviate pain, suffering, and 
premature death for 600,000 American PKD patients. Likewise, 
the Committee is gratified such novel discoveries as the recent 
``abnormal fluid-flow sensation'' phenomenon, involving cilia 
located PKD proteins, bodes well for developing drug therapies 
to decrease abnormal cell growth in the PKD disease process. 
Therefore, because of such extraordinary scientific momentum, 
the Committee urges NIDDK to expeditiously implement the new 
PKD Strategic Plan and thus intensify its efforts to find a 
treatment and cure for PKD by establishing two additional PKD 
Centers and by issuing RFA's to develop Surrogate Markers of 
Disease Progression and for Testing Innovative Treatment 
Strategies using knowledge based studies of pathophysiology and 
cellular pathobiology.
    Prostatitis.--The Committee recognizes the efforts of the 
CPCRN (Chronic Prostatitis Collaborative Research Network) 
funded by the NIDDK. The Committee encourages inclusion of more 
diverse medical specialties to supplement and build upon the 
background of basic information developed. The genetic and 
molecular epidemiology, the management of pelvic pain, the 
infectious origins and the symptoms identical to prostate 
cancer need intense scrutiny.
    The Committee encourages additional funding for educational 
efforts aimed at reaching primary care physicians, the patients 
and general public in an effort to prevent all prostatitis from 
becoming chronic and removing the stigma many patients feel 
after being diagnosed with a disease of unknown origin.
    Scleroderma.--The Committee encourages the NIDDK to support 
scleroderma relevant research. Scleroderma is a chronic and 
progressive disease that predominantly strikes women. Many 
patients have Gastrointestinal involvement include 
gastroesophageal reflux disease, dysphagia, Barrette's 
esophagus, gastroparesis, malabsorption, and fibrosis of the 
small and large intestines.
    Urinary Incontinence.--The Committee is pleased that the 
NIDDK has developed the Urinary Incontinence Treatment Network 
and urges increased funding for this important clinical 
network. Recent studies have yielded gains in understanding 
these conditions but 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 encourages the Institute to provide more resources to 
investigator-initiated applications to ensure a self-sustaining 
core of ongoing research and encourages a dedicated study 
section in this area.
    Urology Research.--NIDDK houses the urologic basic science 
program. Despite significant increases in funding for the 
Institute, the Committee remains concerned that the research 
portfolio in urology is not keeping pace with the impact of 
these diseases on women, men, and children.
    The report of the Bladder Research Progress Review Group 
outlines a strategic plan for research in this neglected area. 
Bladder diseases, such at interstitial cystitis, urinary tract 
infections, and urinary incontinence, disproportionately affect 
women, and the Committee urges NIDDK to develop a comprehensive 
program to address these and other urological needs of women.
    This report identifies the considerable urologic 
complications of diabetes. Until the epidemic of diabetes is 
conquered, the incidence of these complications will only 
increase. Significant resources have been directed to diabetes 
research, but this area is underfunded. The Committee urges 
that a cooperative program of research be developed by the 
Division of Diabetes and the Urology program to address this 
unmet need.
    Related to this problem is the issue of obesity and 
incontinence. This particularly affects minority women and 
should be given priority in the Institute's plans for the 
coming fiscal year. Incontinence is also a major cause of 
nursing home admissions, yet little work is being done to 
address the underlying causes. The Committee recommends that 
the Institute initiate an effective program to examine the 
causes and remedies for incontinence.
    AIDS continues to be a significant health problem in this 
country and worldwide. It is well established that the disease 
is readily transmitted through sexual contact, yet no work has 
been done to examine the specific role of semen in this 
transmission. The Committee believes that a better 
understanding of these fundamental issues could contribute 
significantly to research for a vaccine and more effective 
treatments.
    Benign diseases of the prostate affect men of all ages. 
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.
    Urologic problems in children are often the result of 
congenital anomalies at birth. The Committee urges the 
Institute to organize a pediatric urology review group to 
identify the priority research needs in this area and to 
formulate a research plan that addresses them.
    Stone disease afflicts millions of Americans each year, 
particularly in certain regions of the country. While effective 
treatments are available, there is little understanding of ways 
to prevent the formation of kidney stones. The Committee urges 
NIDDK to work with the scientific community to formulate a 
research plan to address prevention needs in this area.
    The Committee has heard testimony on the decrease in the 
number of physician investigators. This is a particular problem 
in urology, and the Institute Director is encouraged to develop 
training programs especially suited to the needs of urologic 
residents and fellows who might be interested in research 
careers if given the right kind of support.

        NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE

Appropriations, 2003....................................  $1,456,476,000
Budget estimate, 2004...................................   1,468,926,000
Committee recommendation................................   1,510,926,000

    The Committee recommends an appropriation of $1,510,926,000 
for the National Institute of Neurological Disorders and Stroke 
[NINDS]. The fiscal year 2003 appropriation was $1,456,476,000 
and the budget request is $1,468,926,000. 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.--Research supported by NINDS continues 
to play an integral role in widening the scientific base of 
knowledge about Alzheimer's disease. NINDS is working closely 
with NIA in the area of immunotherapy for Alzheimer's disease, 
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 continue to work closely 
with NIA and other institutes. 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.
    Amyotrophic Lateral Sclerosis [ALS].--ALS, or ``Lou 
Gehrig's disease,'' is one of a family of neurodegenerative 
diseases that plague millions of Americans. The Committee is 
pleased by the Institute's recent efforts to intensify its 
research into ALS, and it commends NINDS on its multiple 
initiatives involving high-throughput screening and assay 
development to identify compounds with activity in 
neurodegenerative orders, including ALS. The Committee 
understands that The ALS Association has been involved as a co-
sponsor in some of these activities, and urges the Institute to 
continue such productive partnerships in its efforts to 
understand and develop treatments for ALS, which can lead to 
possible prevention and treatment interventions for other 
degenerative disorders.
    The Committee is also pleased by the January 2003 
scientific workshop on ALS that the NINDS held with the 
Department of Veterans Affairs [VA]. The Committee encourages 
the Institute's further collaboration with the VA in developing 
an initiative to address the scientific questions and gaps in 
the knowledge of ALS and motor neuron biology discussed at the 
workshop. The Committee also encourages the NINDS to coordinate 
and collaborate on ALS research with other appropriate NIH 
Institutes, particularly the NIEHS, and to continue its 
partnership with other organizations, as appropriate, to 
advance ALS research.
    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.
    Basic Behavioral and Treatment Research.--The Committee 
applauds the NINDS for its broad support of both basic and 
clinical behavioral research and training in such areas as the 
neural bases of cognition and behavior, including sensation/
perception, attention, learning and memory, language, and other 
higher cognitive processes. The Committee notes the importance 
of integrating the research across multiple levels, including 
molecular, genetic and behavioral. The Committee encourages the 
NINDS to continue its support of imaging technologies to study 
the neural bases of cognitive processes in real time, including 
studies of language, face recognition, and decision-making 
ability. The Committee appreciates that understanding the 
deleterious effects of neurological disorders on cognition and 
behavior will allow for the design of more effective treatment 
and rehabilitation strategies including behavioral 
interventions. The Committee encourages the NINDS to continue 
supporting research on the cognitive and behavioral deficits 
associated with epilepsy, autism, stroke, Parkinson's disease, 
traumatic brain injury, migraine, and neurofibromatosis.
    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 
requests the Institute to inform the Committee of the steps 
taken to increase research on Batten disease.
    Brain Tumors.--The Committee continues to be concerned that 
not enough attention is being given by NINDS 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.
    Cognitive Neuroscience.--By encouraging research on higher 
brain functions that underlie complex behaviors such as 
learning, memory, attention, and cognition, the NINDS will 
continue to unlock secrets not only on basic brain structure 
and function, but also on neural activity associated with 
specific cognitive processes. The Committee is interested in 
seeing progress in this research.
    Down Syndrome.--Down syndrome is caused by extra genetic 
material on the 21st chromosome. It is the leading genetic 
cause of mental retardation in humans. The Committee urges the 
NINDS to increase funding for research of Down syndrome, 
particularly as it relates to cognitive enhancement. The 
Committee urges NINDS to coordinate these efforts with other 
Institutes working on related activities, including NICHD, NIA, 
NHGRI, and NIMH.
    Dushenne Muscular Dystrophy.--The Committee commends NINDS 
for initiating the muscular dystrophy cooperative research 
centers. The Committee expects NINDS to work cooperatively with 
NIAMS and NICHD to expand the scope and level of research 
undertaken by the centers program.
    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 encourages 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 research area. In addition, the Committee 
requests NINDS be prepared to report on it at the fiscal year 
2005 budget hearings.
    The Committee commends NINDS for the recent release of the 
joint dystonia research program announcement with other 
institutes. 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 encourages NINDS to expand its 
research efforts into the prevention, treatment, and eventual 
cure of epilepsy. In particular, the Committee urges the 
Institute to focus on the critical research issues relating to 
the 30 percent of patients with intractable epilepsy, the life-
long impact of seizures on young children, and the growing 
incidence of epilepsy in the elderly. The Committee encourages 
the Institute to continue its anti-epileptic drug development 
program, including research on therapies for the large number 
of people not responding to current treatments.
    Juvenile Diabetes.--The Committee commends the NINDS for 
its efforts to prevent and treat hypoglycemia and neuropathy, 
both of which are serious complications of diabetes and 
demonstrate accelerated development in individuals with 
juvenile diabetes. The Committee encourages the NINDS to expand 
its research in neuropathy and to consider establishing centers 
specifically for the detection and prevention of this dangerous 
complication of diabetes.
    Learning Disabilities.--The Committee commends NINDS for 
the work conducted to explore the neurological aspects of 
learning disabilities. We look forward to learning the results 
of this work and encourage the Institute to continue to 
coordinate with other Institutes working on related activities.
    Mucoploysaccharidosis [MPS].--The Committee is encouraged 
by NINDS sponsorship of a scientific conference focusing on 
central nervous system issues and the barriers to and 
development of effective therapies for MPS disorders. The 
Committee urges the NINDS to solicit investigator proposals 
resulting from the findings of the conference. The Committee 
further encourages the NINDS, in collaboration with the NIDDK 
and the NICHD, 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.
    Neurofibromatosis.--Advances in NF research have linked NF 
to cancer, brain tumors, learning disabilities and heart 
disease. Because NF regulates both the RAS and cAMP pathways 
relating to cell growth and cognition, NF plays a pivotal role 
both in disorders of the brain and in cancer. The enormous 
promise of NF research is now reaching fruition in the testing 
of potential therapies. Therefore, the Committee encourages 
NINDS to expand its NF clinical and basic research portfolios 
through clinical trials, RFAs, and other funding mechanisms to 
accelerate and exploit the tremendous progress in NF research. 
The Committee commends NINDS for its leadership role in NF 
research and in coordinating efforts with other Institutes 
engaged in NF research and encourages the NINDS to work in 
partnership with the NF research community, including patient 
advocacy groups, in identifying and pursuing scientific 
opportunities that will ultimately allow for the development of 
effective treatments for NF.
    Pick's Disease.--The Committee urges the NINDS in 
conjunction with NIA to increase research efforts on Pick's 
Disease and other frontotemporal dementias. The Committee 
further urges the Institutes to consult with researchers, 
clinicians, and patient advocates and report to the Committee 
on progress being made in this field of research.
    Spinal Muscular Atrophy.--Spinal Muscular Atrophy [SMA] is 
the most common genetic killer of infants and toddlers and is 
the most prevalent genetic motor neuron disease. While there is 
currently no cure for the disease, the research outlook is 
promising. Researchers have already identified the genes 
involved in SMA as well as compounds that may lead to potential 
treatments. The Committee understands that the severity of the 
disease, its relatively high incidence, and the possibility of 
imminent treatments have led NINDS to select SMA as a model for 
a new approach to funding translational research. The Committee 
strongly endorses that plan. The Committee urges NIH/NINDS to 
equip the program and the personnel charged with executing the 
plan with appropriate authoritative and financial resources to 
maximize the chances of success.
    In addition, the Committee strongly urges the Institute to 
increase funding for basic and translation SMA research by 
aggressively soliciting grant applications. The Committee 
encourages the Institute to employ existing mechanisms such as 
websites, publications, workshops, and conferences to promote 
awareness of funding opportunities. In addition, the Committee 
encourages the Institute to further develop opportunities for 
upcoming clinical trials and to help make available all ongoing 
patient care options. Lastly, the Institute is encouraged to 
work with other Institutes and Federal agencies 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 2004 with a progress report on 
all aspects of SMA translational research.
    Stroke.--The Committee commends the NINDS for convening a 
Stroke Progress Review Group. The Group's report identifies 
critical gaps in stroke knowledge and outlines 5 research 
priorities and 7 resource priorities. The Committee urges the 
Institute to implement the priorities of the Progress Review 
Group.
    Tremor.--The Committee has been made aware of the very 
common condition of essential tremor affecting millions of 
Americans and causing significant physical and social 
disability. Its case and underlying pathological basis is 
unknown. Very little basic or clinical research on this 
disorder is currently being undertaken. It appears that new 
research such as technical imaging and chemical analysis may 
offer promise in shedding light on this mysterious and common 
disorder. The Committee was pleased to learn that NINDS 
supports a tissue bank for essential tremor and the Committee 
looks forward to learning of the Institute's assessment of 
research opportunity and of progress through expansion of other 
relevant research efforts.

         NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Appropriations, 2003....................................  $3,706,139,000
Budget estimate, 2004...................................   4,335,255,000
Committee recommendation................................   4,335,255,000

    The Committee recommends an appropriation of $4,335,255,000 
for the National Institute of Allergy and Infectious Diseases 
[NIAID]. This is same as the budget request. The fiscal year 
2003 appropriation was $3,706,139,000. Included in these funds 
is $150,000,000 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.
    Adverse Reactions to Smallpox Vaccine.--The Committee is 
pleased that the NIAID has focused considerable attention on 
research efforts aimed at reducing adverse reactions to the 
smallpox vaccine. The Committee understands that the risk of 
adverse reactions is particularly high in individuals who have 
or have experienced atopic dermatitis. Given the high incidence 
of atopic dermatitis among the growing number of Americans with 
asthma and allergies, the potential for adverse reactions to 
the smallpox vaccine is a major concern. The Committee is 
pleased that the NIAID has undertaken a major initiative in 
this area, the Atopic Dermatitis and Vaccinia Immunization 
Network. The Committee believes that NIAID should take 
additional steps to encourage investigator-initiated research 
to complement this effort.
    AIDS in the Soviet Union.--The Committee notes that Russia 
and other countries of the former Soviet Union are experiencing 
the highest growth of HIV infections in the world today. The 
Committee also notes that these countries hold tremendous 
scientific capacity. The Committee encourages the Institute to 
seek opportunities to increase collaborative research between 
the United States and countries of the former Soviet Union the 
area of HIV/AIDS research, utilizing organizations that 
facilitate and support scientific collaboration as appropriate, 
to maximize the impact of scientific discovery.
    Asthma Research and SARS.--The Committee encourages the 
NIAID to continue its outstanding efforts in the area of asthma 
research. Clearly, research in this area is closely related to 
that undertaken by the NIAID with respect to Severe Acute 
Respiratory Syndrome [SARS]. The therapies currently used to 
treat SARS are commonly used to treat complications of asthma. 
The Committee urges the NIAID to engage the asthma research 
community in efforts related to SARS so that knowledge gained 
from studies of immune reaction to viruses in the lung among 
asthma patients can be applied.
    Asthma Research and Management.--The Committee is very 
pleased with NIAID's leadership regarding asthma research and 
management. The Committee recognizes the role the Institute has 
played in the Inner City Asthma Study and the importance of 
this effort concerning morbidity and mortality among 
underserved populations, particularly children. 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 
may play in the development of asthma.
    Autoimmune Disease Prevention and Treatment.--The Committee 
commends the NIAID for implementing a new model for clinical 
research. The Autoimmunity Centers of Excellence support an 
integrated basic and clinical research program focused on 
approaches for the treatment or prevention of immune-mediated 
diseases like Type 1 diabetes, rheumatoid arthritis, and 
multiple sclerosis. The involvement of clinical specialists in 
planning, performance, and evaluation of trials and studies 
should lead to a more coordinated approach to the development 
of new immune-based therapies for all autoimmune diseases as 
well as accelerate the translation of basic advances to the 
clinic.
    Hemophilia.--The Committee is supportive of NIAID's efforts 
with the National Hemophilia Foundation to ensure access for 
persons with hemophilia to clinical trials for improving 
treatment of HIV and complications of hemophilia, including 
hepatitis C [HCV]. The Committee urges the Institute to 
continue its efforts related to research on liver disease 
progression and response to HCV treatment among HIV/HCV co-
infected persons with hemophilia.
    Hepatitis.--The Committee urges NIAID to work with public 
health organizations to promote liver wellness, education, and 
prevention of hepatitis.
    Hepatitis C Vaccine.--The Committee notes the slow progress 
towards the development of a vaccine to prevent infection from 
the Hepatitis C virus and urges the Institute to redouble its 
efforts in this regard. The Committee requests a report by 
April, 2004 reporting on progress made to date to develop a 
hepatitis C vaccine and a discussion of future plans, including 
and the most promising avenues of research that are needed to 
meet the goal of developing a hepatitis C vaccine.
    Kidney and Islet Transplantation.--The Committee commends 
the NIAID for its leadership role in the evaluation of 
strategies to achieve tolerance in the context of kidney and 
islet transplantation. These two areas of investigation hold 
significant promise for moving research into the clinical 
setting.
    Primary Immunodeficiencies Diseases.--The Committee notes 
that more than 70 primary immune deficiency diseases have been 
identified to date. These diseases, which impair the body's 
immune system, strike most severely at children, many of whom 
do not survive beyond their teens or early twenties. The 
Committee commends NIAID for the establishment of its Primary 
Immunodeficiency Disease Research Consortium. As part of this 
new initiative, the Committee encourages the Institute to 
provide adequate support for primary immune deficiency 
research, clinical registries, and a repository for biomedical 
specimens. Finally, the Committee encourages NIAID to work 
closely with the primary immune deficiency patient community on 
this promising new program.
    The Committee remains concerned that research into 
biodefense concerning smallpox vaccination focus on the 
identification of immunodeficient patients. Undiagnosed 
patients are at risk of suffering serious adverse reactions to 
such live vaccinations. One means for NIAID to address this 
issue of under-diagnosis is through active participation in the 
Jeffrey Modell Foundation's national physician education and 
public awareness campaign for primary immunodeficiencies.
    Radiological Exposure.--The Committee urges the Institute 
to increase research to identify and develop effective 
countermeasures to acute nuclear and radiological exposure. 
This is in keeping with the Institute's lead role in 
identifying and developing countermeasures to chemical, 
biological and nuclear and radiological threats. The Committee 
is aware of research being carried out at the Armed Forces 
Radiobiology Research Institute [AFRRI], including its leading 
radioprotectant candidate, 5-androstenediol, and encourages the 
Institute to work with AFRRI in this critical effort.
    Tuberculosis.--Tuberculosis continues to account for more 
deaths worldwide than any other infectious disease and for over 
a quarter of all preventable adult deaths. The Committee 
commends NIAID for its aggressive program of tuberculosis 
research, and encourages greater emphasis on tuberculosis 
vaccine development, as noted by the NIAID developed Blueprint 
for Tuberculosis Vaccine Development.

             NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES

Appropriations, 2003....................................  $1,847,000,000
Budget estimate, 2004...................................   1,923,133,000
Committee recommendation................................   1,917,033,000

    The Committee recommendation includes $1,917,033,000 for 
the National Institute of General Medical Sciences [NIGMS]. The 
fiscal year 2003 appropriation was $1,847,000,000 and the 
administration's request is $1,923,133,000. 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.
    Behavioral Research.--The Committee believes that NIGMS has 
a scientific mandate to support basic behavioral research 
because of the clear relevance of fundamental behavioral 
factors to a variety of diseases and health conditions. The 
Committee encourages the 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.
    Minority Science Training Programs.--The Committee 
continues to be pleased with the quality of NIGMS's training 
programs, particularly those that have a special focus on 
increasing the number of minority scientists such as the 
Minority Access to Research Careers [MARC] and Minority 
Biomedical Research Support [MBRS] programs. The Committee 
expects NIGMS to continue to support these important 
initiatives, and is particularly pleased that NIGMS has 
supported biomedical career opportunity programs for high 
school and undergraduate college students in conjunction with 
historically black health professions schools. The Committee 
urges continued, long-term support of this program.
    Pharmacogenetics Research Network.--The Committee commends 
NIGMS for its vision in creating the Pharmacogenetics Research 
Network to address the genetic bases for differences in 
patients' reactions to medications. Development of a deeper 
understanding of how genetics influences whether treatments 
work, don't work, or cause moderate or severe side effects is 
critical. This is an emerging field that will lead to a 
personalized approach to medicine. The Committee urges NIGMS to 
continue to develop and expand this field further with a strong 
emphasis on studying drug metabolism variation and treatment 
response in those disease states that affect large numbers of 
Americans, such as diabetes, mental illness and others.
    Pre-Disease Pathways.--The Committee encourages the NIGMS 
to collaborate with other Institutes, including NCI and 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, 2003....................................  $1,205,927,000
Budget estimate, 2004...................................   1,245,371,000
Committee recommendation................................   1,251,185,000

    The Committee recommends an appropriation of $1,251,185,000 
for the National Institute of Child Health and Human 
Development [NICHD]. The fiscal year 2003 appropriation was 
$1,205,927,000 and the administration's request is 
$1,245,371,000. 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 which is 
responsible for conducting and supporting research on maternal 
and child health, the population sciences, and medical 
rehabilitation. Research encompassed by these areas targets 
infant mortality; genetic diseases, including birth defects; 
mental retardation; 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 supports the NICHD's 
efforts to determine the biological, behavioral, and social 
factors that affect child development, particularly the 
important role of family structure and fathers in child 
development. The Committee is particularly concerned about 
rising rates of childhood obesity and supports continued 
initiatives to promote healthy behaviors in children and 
adolescents and prevent health risk behaviors.
    Bleeding Disorders.--The Committee expects the Institute to 
work collaboratively with the National Hemophilia Foundation to 
address issues related to neonatal intracranial hemorrhage and 
pediatric complications of bleeding disorders, including 
medical, psychosocial, and quality-of-life issues.
    Cognition and Learning.--The Committee applauds NICHD's new 
program in Mathematics and Science Cognition and Learning, 
aimed at supporting scientifically based approaches to 
improving the understanding of normal development and obstacles 
to learning in these domains. Discovering the causes of 
difficulties and disorders of learning in these areas will be 
of considerable importance for developing strategies to improve 
diagnosis and treatment of specific learning disabilities and 
for designing more effective instructional interventions in 
mathematics and science.
    Down Syndrome.--Down syndrome is the most common genetic 
cause of mental retardation. The Committee strongly encourages 
NICHD to place a high priority on researching the causes and 
treatment of Down syndrome and to increase funding for research 
in the areas of cognitive enhancement and the early onset of 
dementia. The Committee further urges NICHD to increase funding 
for the production of the Ts65Dn mouse, which is used 
extensively in the research of Down syndrome and Alzheimer's 
disease. Current funding for the production of this mouse 
strain is inadequate to produce the quantity of mice needed for 
current research.
    Demographic Research.--The Committee commends NICHD for its 
outstanding support of demographic research. This research has 
consistently provided critical scientific knowledge supporting 
efforts to strengthen and empower American families through 
sound public policy. Recent findings related to the effects of 
maternal employment and paternal involvement on the development 
of children are particularly noteworthy. The Committee 
encourages NICHD to continue to invest necessary resources in 
maintaining the databases that make these studies possible, 
while strengthening research on the causes of trends in family 
stability. Continued and adequate support for training and 
infrastructure funding is necessary to sustain demographic 
research on these topics and on other critical issues, 
including the causes of immigration and population movement, 
the impact of immigration on the American people, adolescent 
health, and disparities in health among different groups within 
our population.
    Drug Safety for Children.--The Committee recognizes the 
importance of ensuring that drugs are safe and effective for 
use by children. The Committee urges the Institute to implement 
the provisions of the Best Pharmaceuticals for Children Act of 
2003 (Public Law 107-109) which supports the pediatric testing 
of off-patent drugs, as well as on-patent drugs not being 
studied through existing mechanisms. In implementing this 
provision, the National Institute of Child Health and Human 
Development should act as coordinator for all other Institutes 
within NIH for which pediatric pharmacological drug research 
may have therapeutic relevance and will consult with the Food 
and Drug Administration. The Committee requests NIH to provide 
an update during its annual appropriations testimony. This 
update shall include 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.
    Duchenne Muscular Dystrophy.--The Committee commends the 
Institute for initiating the muscular dystrophy cooperative 
research centers. The Committee expects NICHD to work 
cooperative with NIAMS and NINDS to expand the scope and level 
of research undertaken by the centers program.
    Fragile X Research Coordination Conferences.--To facilitate 
effective coordination of research on Fragile X and related 
disorders, the Committee strongly urges NICHD to regularly 
convene and conduct a state-of-the-science conference on 
Fragile X research and further urges the NICHD to continue to 
hold Fragile X Research Coordination Conferences at least once 
every 3 years or more frequently if warranted by scientific 
advancement. Investigators conducting research on Fragile X and 
related fields who are funded by the NIH, as well as other 
researchers as appropriate, should be invited to attend and 
participate in these conferences. The Committee expects the 
first Fragile X Coordination Conference shall be held in 2004.
    Fragile X Research Coordination Reports.--Within 6 months 
after each Fragile X Research Coordination Conference is held, 
the Director of the NICHD shall issue a report on the state-of-
the-science of research on Fragile X and include summaries of 
Fragile X and related research being supported by NIH 
Institutes and Centers, as well as plans for future Fragile X 
research.
    Hepatitis C in Children.--The Committee is aware that 
recent studies have indicated that 1 in every 300-400 children 
over the age of 12 is infected with the hepatitis C virus. The 
Committee urges NIDDK, with appropriate support from NICHD, to 
study the natural history of hepatitis C in infected children 
to help determine the optimal timing and medical regimen for 
treatment.
    Infertility and Contraceptive Research.--The Committee 
continues to place high priority on research to combat 
infertility and speed the development of improved 
contraceptives. The NICHD is urged to continue aggressive 
activities in this area, including grants for individual 
researchers and for infertility and contraceptive research 
centers.
    Juvenile Diabetes.--NICHD is encouraged to work closely 
with NIDDK on the continued development of Trial Net, which was 
recommended by the 1999 Congressionally-mandated Diabetes 
Research Working Group to coordinate and support clinical 
trials in diabetes with the ultimate goal of preventing 
juvenile diabetes in high risk individuals.
    Learning Disabilities.--The Committee is pleased that NICHD 
continues to place high priority on learning disabilities 
research. The efforts to address the special needs of children 
affected by a learning disability and improve literacy are 
showing promising results. The Committee encourages NICHD to 
continue to focus on reading disability and mathematics 
development research. Additionally, the Committee urges NICHD 
to lead an effort to collaborate on research efforts with other 
Institutes working on related activities. The Committee 
encourages cooperation in areas where work can be shared across 
Institutes on behalf of individuals with learning disabilities.
    Living Donor Liver Transplants.--The Committee is aware 
that more than 1,774 people died over the past year waiting for 
a liver transplant due to a lack of a donor liver. As of March 
6, 2003 there were almost 16,934 on the list waiting for a 
liver transplant. In view of the continuing shortage of livers 
available for transplantation, the Committee is pleased with 
the award in the past year of funding for a study of adult-to-
adult living donor liver transplants which will compare 
outcomes of living donor transplants to cadaver transplants. 
The Committee urges additional research that would facilitate 
the success of a living donor liver transplant and the number 
of livers available for transplantation.
    Maternal-Fetal Medicine Network [MFMU].--The Committee 
recognizes the outstanding contributions of the Maternal-Fetal 
Medicine Network [MFMU] in addressing clinical questions 
related to the care and treatment of high risk and complicated 
pregnancies. By studying large numbers of patients, the Network 
has demonstrated that it offers the most effective and cost-
efficient way to study high-risk conditions. However, the 
Committee is concerned that additional funds are needed in 
order for the Network to continue to make progress in these 
issues of concern to the health of women and their babies. 
Therefore, the Committee urges the NICHD to expand its support 
of the Network and to provide increased funds to continue to 
address these important research questions, with an emphasis on 
issues pertaining to pre-term births and low birth weight 
deliveries.
    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 environmental 
influences, including physical, chemical, biological and social 
influences, on child health and development. The Committee 
urges the Director of the NICHD to continue to closely 
coordinate with the CDC, EPA, other Institutes and agencies and 
non-Federal partners conducting research on children's 
environmental health and development, such that this study is 
ready for the field by no later than 2005. To that end, in 
fiscal year 2004, the Committee expects the Director of NICHD 
to increase support for study planning, administration, and 
initial pilots that will provide the information necessary to 
develop and implement the full national study.
    National Center for Medical Rehabilitation Research.--The 
National Center for Medical Rehabilitation Research supports 
research grants, training, centers and clinical trials in 
medical rehabilitation to improve the function of persons with 
physical disability and is the focal point within NIH for this 
field of science. Recent initiatives have involved efforts to 
expand the use of assistive technology by persons with 
disabilities and clinical research to determine improved 
outcomes of care for persons with Traumatic Brain Injury, 
stroke, hip fracture and limb loss. The Committee encourages 
the Institute and NCMRR to continue its focus on assistive 
technology, clinical trials and other research on improved 
outcomes. The Committee would also encourage the Institute and 
NCMRR to review needs and plan to expand medical rehabilitation 
research to improve outcomes for trauma victims.
    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 unlocking the mysteries of how the NF gene is related 
to learning disabilities which significantly advances the 
prospects of finding a treatment for learning disabilities not 
only in children with NF but in the general population as well. 
The Committee urges the Institute to consider the progress 
being made in NF research, expand the NF research portfolio and 
to identify possible areas for collaboration.
    Osteogenesis Imperfecta.--The Committee understands that 
research is urgently needed into quantification of bone mass 
and its biomechanical properties in children, and the 
relationship of diet and exercise and comorbid conditions to 
bone health. A greater understanding of the genetic and other 
determinants of peak bone mass will help children with 
Osteogenesis Imperfecta [OI], osteopetrosis, etc. The Committee 
encourages NICHD to expand OI research in genetic therapies, 
animal models, drug treatment and rehabilitation.
    Pediatric Kidney Disease.--Kidney disease remains a 
persistent and little-understood problem among infants, 
children, and adolescents. The NICHD is strongly urged to 
undertake research to identify factors responsible for poor 
linear growth, abnormal bone formation and cognitive deficits 
in children; epidemiological studies designed to quantify the 
magnitude of the problem and identify which kidney diseases 
present the highest risk; and initiatives aimed at maximizing 
the academic potential of children with kidney disease.
    Pediatric Liver Disease.--The Committee notes the 
Institute's limited involvement in issues relating to pediatric 
liver disease and urges the Institute to initiate research in 
this area and collaborate with NIDDK on these efforts. For 
example, the Committee notes the lack of involvement of NICHD 
to support the collaborative network of centers established to 
gather data and study specific hypothesis of the cause and 
treatment of Biliary Atresia. The Committee would also 
encourage NICHD to cooperate with NIDDK on research questions 
relating to optimal timing and medical treatment regimens for 
children infected with the hepatitis C and the need to support 
a database and registry to track the outcome of children who 
receive liver transplants.
    Pre-term Labor and Delivery.--Pre-term labor and delivery 
is the number one problem in obstetrics today and a serious 
problem in pediatrics. It is the leading cause of neonatal 
mortality, and many babies born prematurely have serious 
physical and mental disabilities, such as cerebral palsy, 
mental retardation, chronic lung disease, and vision and 
hearing loss, that last a lifetime. Prematurity is also a 
growing problem. The Committee strongly urges NICHD to allocate 
more funds to reveal the underlying causes of pre-term delivery 
and most importantly to identify prevention strategies.
    Primary Immunodeficiencies Diseases.--The Committee 
continues to be impressed with the commitment the NICHD has 
shown to addressing PI, through its close partnership with the 
Jeffrey Modell Foundation's efforts to raise the awareness of 
PI and to identify undiagnosed patients. With the availability 
of cutting-edge microarray technologies, the Committee strongly 
encourages the NICHD to identify specific molecular biomarkers, 
improve diagnostic methodologies, and develop newborn screening 
procedures for PI. Rapid, cost-effective, and accurate 
molecular screening procedures and strategies for PI that are 
incorporated into a universal newborn screening program will 
significantly enhance the early identification, treatment, and 
management of PI patients. This will help reduce the morbidity 
and mortality of affected children, improving their health and 
well-being. The Committee strongly encourages NICHD to bring 
together the stakeholders in newborn screening to assess 
comprehensively the scientific, legal, social and ethical 
issues associated with such screening.
    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, Barrette'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 critically needed in order to 
develop safe and effective treatments and to identify the cause 
or causes of the devastating complications of scleroderma.
    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. NICHD is encouraged to enhance research to 
address issues related to the outcome of the conference and 
urged to significantly expand its research efforts in the 
prevention and treatment of Spina Bifida and associated 
secondary conditions.
    Sudden Infant Death Syndrome.--The Committee is pleased 
with NICHD's continued efforts to extend the reach of its 
extremely successful ``Back to Sleep'' campaign to underserved 
populations and daycare providers. The Committee also commends 
NICHD's attempts to further its progress in SIDS research by 
initiating a third SIDS 5-year research plan. This third 5-year 
plan will continue the efforts of the past two 5-year plans, 
which have been responsible for many of the research 
breakthroughs in the effort to reduce SIDS cases in the United 
States. The Committee requests that this 5-year plan be re-
examined to determine the appropriateness and scientific 
validity of including research on stillbirth and miscarriage as 
components of the plan.
    Traumatic Brain Injury [TBI].--The Committee commends the 
NICHD and the National Center for Medical Rehabilitation 
Research for their efforts in establishing a TBI clinical 
trials network to investigate the efficacy of rehabilitation 
services for TBI victims. The Committee continues to support 
research by the Center to investigate methods of improving 
decision-making functions and related cognitive skills of TBI 
victims.
    Urogynecology Program.--Urinary incontinence and other 
pelvic floor disorders serve as barriers to healthy living. The 
Committee commends the NICHD for developing the Pelvic Floor 
Disorder Network [PFDNO] and expects additional resources will 
enable the network to excel in 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 
of 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 and 
translational research in order to create better foundations 
for clinical care. The Committee encourages the Institute to 
provide more research to investigator-initiated applications to 
ensure a self-sustaining core of ongoing research and 
encourages a dedicated study section in this area.
    Vulvodynia.--Preliminary new research indicates that 
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. Therefore, the Committee expects the Institute to 
provide a significant increase in funding for vulvodynia.

                         NATIONAL EYE INSTITUTE

Appropriations, 2003....................................    $633,148,000
Budget estimate, 2004...................................     648,299,000
Committee recommendation................................     657,199,000

    The Committee recommends an appropriation of $657,199,000 
for the National Eye Institute [NEI]. The budget request was 
$648,299,000 and the fiscal year 2003 appropriation was 
$633,148,000. 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.--Diabetic retinopathy is a 
potentially blinding complication of diabetes characterized by 
the uncontrolled growth of fragile new blood vessels in the 
retina that may leak fluid and blood threatening vision. It is 
the leading cause of new cases of blindness in working age 
adults in this country. Macular edema secondary to diabetic 
retinopathy is also a major cause of visual loss in patients 
with diabetes. The Committee is pleased with NEI's initiative 
to develop a clinical research network that will accelerate the 
evaluation of promising new approaches to treated eye and 
vision-related complications of diabetes.
    Degenerative Eye Diseases.--Scientists have linked a gene 
on the X chromosome that is normally associated with a form of 
retinitis pigmentosa that causes a blinding loss of 
photoreceptor cells with a unique type of cone photoreceptor 
cell degeneration of the macula. The macula is the part of the 
retina responsible for sharp central vision. This type of study 
in affected families may help understand the mechanism of 
damage in other forms of macular degeneration and may help 
prevent or more effectively treat these diseases. The Committee 
urges NEI to continue this important line of research 
extramurally and through the revitalization of its intramural 
research on neurodegenerative and genetic forms of vision loss.
    Glaucoma.--The Committee is pleased to learn of the 
significant advances made in clinical research on glaucoma. The 
Ocular Hypertension Treatment Study demonstrated that eye drops 
used to treat elevated pressure inside the eye can be effective 
in delaying the onset of glaucoma in patients at higher risk 
for development of the disease. The Early Manifest Glaucoma 
Trial showed that immediate therapy to lower elevated 
intraocular pressure in patients with newly detected open angle 
glaucoma delayed and reduced the frequency of progression. Both 
studies underscore the need for early treatment of high 
intraocular pressure to slow or prevent glaucoma damage and 
subsequent vision loss until the means to prevent the disease 
itself can be discovered. In this regard, the Committee 
commends NEI for hosting a workshop on the pathophysiology of 
ganglion cell and optic nerve degeneration as a means of 
stimulating new approaches to the study of glaucoma and other 
neurodegenerative diseases of the eye.
    Health Disparities.--Scientists conducting a population-
based study in Mexican Americans in Arizona reported that the 
prevalence of open-angle glaucoma was intermediate between the 
high rates reported for African Americans and the lower rates 
reported for whites. However, only 38 percent were aware they 
had the disease. The Committee encourages NEI to expand its 
glaucoma awareness activities to increase awareness of the 
importance of glaucoma diagnosis and treatment in the Mexican 
American population so that timely treatment can be provided 
and vision can be preserved.
    Intramural Research Program.--The Committee commends NEI's 
efforts to revitalize its intramural research program to pursue 
new research opportunities related to neurodegenerative and 
genetic forms of vision loss and other complex human eye 
diseases. The Committee urges that the NIH allocate required 
space and positions as soon as possible, so that these new 
opportunities for research can be translated for the benefit of 
those afflicted with blinding eye diseases.
    Neurofibromatosis.--Neurofibromatosis [NF] is a 
neurological disorder that is linked to a variety of other 
serious medical conditions. It has no known cure or prevention. 
NF can manifest itself in one of two forms known as NF1 and 
NF2. Among its possible effects are tumors of the optic nerves 
which may cause bulging of the eye or visual difficulties. The 
Committee encourages the Institute to expand its research 
portfolio in collaboration with the NF community to address 
issues that may be of mutual interest and benefit.
    Ocular Albinism.--Ocular albinism is a set of diseases and 
conditions characterized by deficient cellular production of 
the pigment melanin that results in a cosmetic loss of ocular 
and skin pigmentation. Importantly, ocular albinism limits the 
development of vision in infants and children by altering the 
connections between the brain and the eye. The Committee 
recognizes NEI's efforts to encourage research in this 
important area through the issuance of requests for 
applications and funding of several grants during fiscal year 
2002 and additional new grants in fiscal year 2003. The 
Committee encourages the Institute to continue its efforts to 
ensure continued progress toward understanding the causes of 
this disease.

          NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES

Appropriations, 2003....................................    $614,239,000
Budget estimate, 2004...................................     630,774,000
Committee recommendation................................     637,074,000

    The Committee recommends an appropriation of $637,074,000 
for the National Institute of Environmental Health Sciences 
[NIEHS]. The budget request was $630,774,000 and the fiscal 
year 2003 appropriation was $614,239,000. 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.
    Alternative Methods.--In order for the Interagency 
Coordinating Committee for the Validation of Alternative 
Methods [ICCVAM] to carry out its responsibilities under the 
ICCVAM Authorization Act, the Committee urges the NIEHS to 
increase the resources for ICCVAM's activities in order to 
ensure that new and alternative test methods used or 
recommended to Federal regulatory agencies, and those used 
within the National Toxicology Program's [NTP's] toxicity 
testing program, are validated prior to their use.
    Breast Cancer.--The Committee commends the NIEHS for its 
recent efforts to bolster research on the relationship between 
the environment and breast cancer. The Committee urges the 
Institute to establish a group of breast cancer and 
environmental research advisers to make recommendations to the 
Director with regard to research in this area, and to include 
in the group representatives from the breast cancer community 
who have had breast cancer. The Committee also encourages the 
NIEHS to consider establishing centers to conduct multi-
disciplinary and multi-institution research on environmental 
factors that may be related to breast cancer and to develop a 
national strategy to address this issue.
    Children's Health.--The Committee is pleased that the 
NIEHS, in collaboration with the EPA, is supporting eight 
children's health centers focused on the role that 
environmental factors play in asthma and other respiratory 
disorders. The Committee urges the NIEHS, in continued 
collaboration with EPA, to support additional Centers of 
Excellence with a focus on disease endpoints in children.
    Environmental Health Sciences Centers.--The Committee 
continues to strongly support the Environmental Health Sciences 
Centers program, and it believes that a fully funded Centers 
program is critical to carrying out the expanding mission of 
the NIEHS. The Committee expects these Centers to be funded at 
peer-reviewed levels.
    Volcanic Emissions.--The Committee continues to be very 
concerned about the public health aspects of volcanic emissions 
in Hawaii. Such emissions present significant acute and long-
term health problems, and the Committee urges the development 
of a multidisciplinary approach to this problem.

                      NATIONAL INSTITUTE ON AGING

Appropriations, 2003....................................    $993,598,000
Budget estimate, 2004...................................     994,411,000
Committee recommendation................................   1,031,411,000

    The Committee recommendation includes $1,031,411,000 for 
the National Institute on Aging [NIA]. The budget request was 
$994,411,000 and the fiscal year 2003 appropriation was 
$993,598,000. 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.--An estimated 4.5 million Americans--
almost all of whom are Medicare beneficiaries--suffer from 
Alzheimer's disease. Their complex health and long-term care 
needs are driving Medicare and Medicaid costs to unsustainable 
levels--even though 70 percent of care is provided by families. 
Within 10 years, annual Medicare costs for beneficiaries with 
Alzheimer's will increase by 55 percent--to nearly 
$55,000,000,000; Medicaid costs will go up 80 percent to nearly 
$33,000,000,000. That will happen just as baby boomers begin to 
enter the age of risk. By the middle of the century, as many as 
16 million Americans will have Alzheimer's--neither Federal, 
State, nor family budgets can sustain the costs. The Committee 
several years ago first drew attention to the challenges 
presented by Alzheimer's. As a result, science is now at the 
point where effective treatment and prevention of Alzheimer's 
are within reach. But there is a very narrow window of time. 
Scientists are now focusing on catching the disease process 
early, in the 10 to 20 years before clinical symptoms become 
apparent. Scientists believe that an investment of 
$1,000,000,000 as soon as possible will produce the answers 
necessary to conquer Alzheimer's. The Committee expects the NIA 
to expand its investment in Alzheimer's disease research, 
including clinical trials for the rapid translation of 
laboratory findings to effective treatments and prevention, as 
well as new initiatives in imaging and genetics aimed at 
finding risk factors and surrogate markers.
    Bone Diseases.--The Committee recognizes that little is 
known about the pathophysiology of osteoporosis and Paget's 
disease and the role of environmental and lifestyle factors 
associated with these diseases, particularly in men and women 
of diverse races and ethnicities. Tools to assess risk have 
inadequate sensitivity and specificity and have not been widely 
tested, resulting in limited clinical effectiveness. The 
Committee urges NIA to expand research in all these areas. The 
Committee also encourages NIA to coordinate research with NIAMS 
into treatment for aging-related osteogenesis imperfecta 
complications.
    Claude D. Pepper Older American Independence Centers.--The 
Committee continues to strongly support these successful 
centers, which focus on developing innovative and cost-
effective ways to enhance the independence of older Americans. 
The centers also play the critical role of developing top-level 
experts in geriatrics. The Committee again urges NIA to make 
all possible efforts to expand these centers to include a 
school of nursing.
    Cognitive Behavioral Research.--The Committee commends the 
NIA for its research program to explore the research 
recommendations in the National Academy of Sciences report 
``The Aging Mind.'' The Committee encourages the NIA to 
continue its own work, as well as cooperative efforts with 
other Institutes, to add to fundamental and applied knowledge 
of how the memory works and may be enhanced, and how age or 
behavior may affect memory.
    Demographic and Economic Research.--The Committee once 
again commends the NIA for its demography and economic 
research, with special recognition of the research undertaken 
at NIA's 11 demographic research centers. The Committee also 
strongly recommends that NIA provide increased funding for 
these Centers to sustain their productivity and efficiency. The 
Committee is impressed by the findings from NIA's Health and 
Retirement Study [HRS] which provide important policy 
information necessary to evaluate the costs of alternative 
options. The Committee supports funding for a diverse body of 
analytic research on HRS findings so that as a Nation, we might 
better understand the timing of retirement, the transition from 
full-time work, and the social, as well as the economic 
consequences of retirement. Tracking research on the decline in 
disability continues to be a high priority for the Committee.
    Down Syndrome.--Research has shown that people with Down 
syndrome have an increased risk of developing Alzheimer's 
disease. Approximately 50 percent of individuals with Down 
syndrome over the age of 35 will develop the clinical signs and 
symptoms of Alzheimer's type dementia. All persons with Down 
syndrome will develop the neuropathology of Alzheimer's 
disease, even if they do not demonstrate dementia. Research 
into the process by which Alzheimer's disease evolves in 
persons with Down syndrome affords the opportunity to 
understand an important link between development and aging in 
all individuals. The Committee urges NIA to expand its research 
into the connection between Down syndrome and Alzheimer's 
disease.
    Health and Behavior.--The Committee commends the NIA for 
its continuing focus on behaviors that may enhance healthy 
aging, especially research on physical activity among sedentary 
or frail elderly. The Committee encourages the NIA to continue 
efforts, through the Roybal Centers for Applied Gerontology and 
other means, to move innovative behavioral interventions into 
health care and other settings where they may be applied.
    Hematology.--The Committee encourages NIA to develop new 
initiatives to study the basic biology of blood disorders that 
affect the elderly population, such as myelodysplastic 
syndromes and anemias, and the adverse quality-of-life 
consequences for the elderly who suffer from these disorders.

 NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES

Appropriations, 2003....................................    $486,143,000
Budget estimate, 2004...................................     502,778,000
Committee recommendation................................     505,000,000

    The Committee recommends an appropriation of $505,000,000 
for the National Institute of Arthritis and Musculoskeletal and 
Skin Diseases [NIAMS]. The budget requested $502,778,000 and 
the fiscal year 2003 appropriation was $486,143,000. 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 and lost productivity. 
The research activities of this Institute serve the concerns of 
many different special populations, including women, 
minorities, children, and the elderly.
    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/Becker Muscular Dystrophy.--The Committee notes 
that Duchenne Muscular Dystrophy [DMD] and its milder form 
Becker Muscular Dystrophy [BMD] are the most common, lethal 
genetic childhood disorders known to humankind. The Committee 
acknowledges that through NIH-sponsored research in 1987 the 
dystrophin gene which causes DMD/BMD was discovered and each 
day an average of two boys in the United States die from this 
disorder. Moreover, the Committee notes that 14 years later, 
there is still no effective treatment for this disease. The 
Committee further acknowledges that the Muscular Dystrophy 
Childhood Assistance, Research and Education Act [MD CARE ACT] 
of 2001 established Muscular Dystrophy as a research priority 
for the Department and NIH. The Committee requests that the 
Department provide a report to Congress by April 2004, on the 
implementation of the MD CARE ACT, outlining efforts to 
establish an interagency committee within NIH in order to 
expand opportunities for collaborative efforts, identify 
Centers of Excellence through NIH, and coordination with the 
Center for Disease Control [CDC]. The Committee is interested 
to learn of the implementation of the proposed ``Scientific 
Research Resource Cores'' within the Centers of Excellence, 
their potential to coordinate and facilitate muscular dystrophy 
research nation-wide, and how clinical trials are being 
facilitated through these new initiatives. The report to 
Congress should address all efforts by coordinating institutes, 
any initiatives or programs announced in muscle research, and 
efforts by the Center for Scientific Review [CSR] to create a 
temporary Skeletal Muscle Biology [SMB] Special Emphasis Panel. 
Additionally, the Committee is aware of the lack of information 
regarding the overall economic burden for the Nation of muscle 
diseases and injuries, as well as the lack of reliable data on 
how many individuals in the United States are affected by these 
diseases. The Committee, therefore, expects the NIAMS, in 
conjunction with other PHS components, including NINDS, NCHA, 
CDC, AHRQ, and HRSA, to sponsor a workshop to identify existing 
information sources on the costs and scope of muscle diseases 
and injuries, including Duchenne and other muscular 
dystrophies, and to recommend strategies for developing new 
information sources. The Institute is encouraged to work with 
muscle diseases researchers and voluntary health organizations 
to plan the workshop. The Committee urges the Director to 
provide additional resources to expand the research and 
establish at least four centers of excellence in this area and 
to work collaboratively with private research foundations to 
coordinate research findings. The Committee also expects NIAMS 
to work with NINDS to expand the scope and level of research 
undertaken by the Centers program. The Committee further 
expects NIAMS to fund translational research to further 
treatment for this devastating disease.
    Lupus.--Lupus is a widespread, debilitating autoimmune 
disease that affects up to 2 million Americans, most of whom 
are women in their late teens to early 40s. Lupus is the 
prototypical autoimmune disease that causes the immune system 
to become hyperactive and attack the body's own tissue. The 
disease can damage vital organs resulting in disability or 
death. Lupus and autoimmune diseases are the fourth leading 
cause of disability in women. Gaining an understanding of the 
factors associated with the high prevalence of lupus in women 
and minorities and the development of new and innovative 
treatments should be a high priority. There are five areas in 
which targeted research will yield important new insights: 
susceptibility, pathogenesis, inflammation and damage, clinical 
assessment and therapy. The Committee urges the Institute to 
provide the highest possible funding level for lupus research 
and explore all possible scientific opportunities for 
prevention, treatment and cure of this devastating disease.
    Neurofibromatosis.--Neurofibromatosis [NF] is a common 
genetic disorder of the nervous system. Its symptoms vary in 
kind and degree and may be severely disabling, mildly 
disfiguring, or can even go undetected. Some individuals with 
NF have many skin neurofibromas (tumors on the nerves) on the 
face and body and light brown (cafe-au-lait) spots on the skin. 
A variety of skeletal abnormalities may also be present such as 
bowing of the legs, curvature of the spine (scoliosis), or 
thinning of the shin bone. The Committee requests that NIAMS 
work in partnership with the NF community to identify and 
explore areas of mutual concern and to be prepared to discuss 
its progress at the fiscal year 2005 appropriations hearing.
    Pemphigus Registry.--The Committee urges NIAMS to establish 
a National Pemphigus Registry to identify the epidemiology, 
improve the understanding of the potential causes, and assess 
the value of old and new therapies for the chronic, life-
threatening autoimmune disease know as pemphigus.
    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. More research is critically needed in 
order to identify the genetic risk factors for scleroderma and 
to develop safe and effective treatments. The Committee urges 
NIAMS to collaborate with other Institutes, including NHLBI, 
NIDDK, and NIDCR, to generate additional research opportunities 
for scleroderma.
    Skin Disease.--The Committee was pleased to learn that the 
NIAMS conducted a workshop on the ``Burden of Skin Diseases.'' 
The Committee encourages NIAMS to examine the findings from the 
workshop and encourages the development of new tools to better 
measure the burden of skin diseases, and the training of 
researchers in this important area. The Committee further 
encourages NIAMS to move forward expeditiously to generate the 
required data in collaboration with Centers for Disease Control 
and Prevention [CDC], Agency for Health Care Policy and 
Research [AHCPR], Health Resources and Services Administration 
[HRSA], as well as all other agencies and organizations which 
participated in the conference.

    NATIONAL INSTITUTE ON DEAFNESS AND OTHER COMMUNICATION DISORDERS

Appropriations, 2003....................................    $370,382,000
Budget estimate, 2004...................................     380,377,000
Committee recommendation................................     384,577,000

    The Committee recommends an appropriation of $384,577,000 
for the National Institute on Deafness and Other Communication 
Disorders [NIDCD]. The budget requested $380,377,000 and the 
fiscal year 2003 appropriation was $370,382,000. 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.
    Aphasia.--It has come to the Committee's attention that the 
state of the science for aphasia, a common and devastating 
acquired speech and language disorder, has gone virtually 
unchanged for decades. Based upon previous direction, the NIH 
recently hosted a symposium to discuss some of the current 
issues surrounding aphasia. The Committee applauds these 
initial efforts. However, the Committee also recognizes that 
decades of insufficient research have resulted in numerous 
shortcomings in the areas of aphasia research, standards of 
care, rehabilitation and treatments. The Committee, therefore, 
urges a coordinated cross-functional effort involving the NIH, 
specifically NINCD, NIDCD, and NINDS, as well as other 
appropriate Federal healthcare agencies, specifically AHRQ, 
HRSA, and CMS, to address these concerns regarding aphasia.
    Clinical Evaluation of Hearing Loss.--The Committee 
realizes that the rapid advances in brain imaging should be 
used to dramatically improve our understanding of the central 
nervous system changes that attend hearing loss. These 
approaches will necessarily extend to atypical language 
development and the communication disorders experienced by 
geriatric populations.
    Dysphonia.--The Committee continues to be pleased with 
NIDCD's expanding intramural research program with respect to 
dysphonia. The Committee commends NIDCD on the release of a 
joint program announcement with NINDS, which will lead to a 
more active extramural research effort on dysphonia, and 
collaboration with other NIH Institutes on this important 
disorder.
    Early Detection and Intervention.--It is now clear that 
early treatment of hearing loss is essential for normal 
language acquisition. The Committee notes that there are many 
children who develop progressive hearing impairment in the 
first few years of life, which emphasizes the need for 
screening every baby born in the United States for hearing 
impairment before discharge from the hospital. Therefore, 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. We encourage 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 amongst 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 give 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. We also encourage investigation into the 
incidence of meningitis in children with specific cochlea 
implant protocols.
    Hereditary Hearing Loss.--The Committee applauds the 
remarkable progress towards understanding the molecular basis 
for hereditary hearing impairment. We encourage a sustained 
effort to screen for the single and multigenetic basis of 
hearing loss through contemporary techniques, including the 
development of diagnostic genechips for auditory dysfunction. 
We also encourage 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.
    Learning Disabilities.--The Committee is pleased that NIDCD 
continues to support research activities focused on speech 
processing and on the development of expressive and receptive 
language. The Committee encourages continued activity and looks 
forward to learning the results of this work as they hold 
significant promise for individuals with learning disabilities. 
The Committee encourages the Institute to continue to 
coordinate with other Institutes working on related activities.
    Neurofibromatosis.--Neurofibromatosis [NF] is the most 
common neurological disorder caused by a single gene. It may 
result in hearing loss, ringing in the ears, dizziness, balance 
problems, headaches, or seizures. Early removal of small 
auditory nerve tumors sometimes helps to preserve hearing. 
Diagnostic magnetic resonance imaging [MRI] techniques have 
improved early diagnosis of tumors. The Committee urges the 
Institute to expand its research portfolio in collaboration 
with the NF community to address issues that are relevant to 
deafness and other communication problems associated with NF2.
    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, 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. Studies should be undertaken to study the mechanism 
underlying the premature cell death that results in many forms 
of presbycusis so as to develop prevention and cure strategies.
    Tinnitus.--The Committee encourages the Institute to expand 
its research into mechanisms underlying peripheral and central 
tinnitus.

                 NATIONAL INSTITUTE OF NURSING RESEARCH

Appropriations, 2003....................................    $130,584,000
Budget estimate, 2004...................................     134,579,000
Committee recommendation................................     135,579,000

    The Committee recommends an appropriation of $135,579,000 
for the National Institute of Nursing Research [NINR]. The 
budget request was $134,579,000 and the fiscal year 2003 
appropriation was $130,584,000. 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 the 
NINR's research in adolescent risk behavior. Recognizing that 
many such behaviors are intertwined, the focus of NINR's 
initiative is on developing interventions that target several 
risk behaviors simultaneously. 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.
    Collaboration With NIMH.--The Committee commends the 
mentorship program established by the NINR in collaboration 
with the NIMH to prepare mental health nurse scientists. The 
Committee urges the NINR to continue to partner with NIMH and 
psychiatric nursing to build the capacity to address research 
questions in treating psychiatric populations that correlate to 
enhanced patient care; and to include improving nursing care 
for individuals with co-existing medical and mental illnesses 
in priority areas for funding research. Such interventions are 
crucial given the high prevalence of mental illness, the burden 
of mental disorders on patients and their families, and the 
critical role assumed by nurses in providing psychiatric 
services in diverse settings and systems of care.
    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 deserves.
    Genetics and Nursing Research.--NINR's efforts in genetics 
emphasize 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 
genetic expertise within the nursing knowledge base and 
healthcare practice.
    Health of Minority Men.--NINR is urged to continue its 
successful research in promoting the health of minority men who 
have a reduced life expectancy compared to women. Research on 
effective health promotion strategies such as smoking 
cessation, nutrition, physical activity, and increase 
management of stress are critical to improving and extending 
the life cycle of minority men.
    Minority Health 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 the rate of low 
birth weight for babies of 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 this country.
    Nursing Interventions for Psychiatric Populations.--The 
Committee commends the mentorship program established by NINR 
in collaboration with the National Institute of Mental Health 
[NIMH] to prepare mental health nurse scientists. The Committee 
urges NINR to continue to partner with NIMH and with 
psychiatric nursing to: (1) build the capacity to address 
research questions in treating psychiatric populations, and (2) 
stimulate research that develops and tests interventions for 
individuals with co-existing medical and mental illnesses. Such 
interventions are crucial given the high prevalence of mental 
illness, the burden of mental disorders on patients and their 
families, and the critical role assumed by nurses in providing 
psychiatric services in diverse settings and systems of care.
    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 are another initiative that helps 
produce an adequate number of nurse researchers and future 
faculty. 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 of Chronic Illness.--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, 2003....................................    $416,051,000
Budget estimate, 2004...................................     430,121,000
Committee recommendation................................     431,521,000

    The Committee recommends an appropriation of $431,521,000 
for the National Institute on Alcohol Abuse and Alcoholism 
[NIAAA]. The budget request was $430,121,000 and the fiscal 
year 2003 ppropriation was $416,051,000. 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.
    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.
    Alcoholic Liver Disease.--Alcoholic liver disease remains a 
major cause of morbidity and mortality in the United States. 
The Committee notes that recent research suggests that free 
radicals are a principal vehicle through which alcohol damages 
the liver, and that antioxidants look increasingly promising as 
a potential treatment. The Committee encourages the Institute 
to expand its research on alcoholic liver disease, particularly 
regarding the interaction between hepatitis C and alcohol in 
liver disease.
    Behavioral Genetics of Alcoholism.--Genes and the proteins 
they produce are key players in the biochemical and molecular 
processes that contribute to development of alcoholism. 
Identifying variations in them that predispose people to 
alcohol-use disorders will contribute essential information to 
design of prevention and treatment strategies. Because only 
half of the risk of alcoholism appears to be genetic, it is 
also critical to examine gene-environment interactions. The 
Committee recognizes the value of large longitudinal, 
multidisciplinary studies used to identify these risk factors 
and determine how they interact with each other to result in 
alcohol-use disorders. The Committee recommends that NIAAA 
continue its important twin and family genetic studies, broad 
epidemiological studies, and observational studies that might 
help elucidate the relationship between genetic and 
environmental factors particularly in cultural and ethnic 
minorities.
    Behavioral Treatments.--Behavioral, nonpharmacological 
therapies currently are the most widely used method of treating 
alcohol dependence and alcohol abuse. The Committee applauds 
NIAAA's efforts to advance the effectiveness of such therapies 
by examining approaches to improving clinicians' abilities to 
engage and retain adults and adolescents in treatment. The 
Committee recommends that NIAAA expand research to understand 
the mechanisms of action of successful behavioral therapies as 
well as behavioral therapies for patients with co-occurring 
substance abuse and psychiatric disorders. Further, the 
Committee recognizes the value of NIAAA's substantial 
medications development program and research to evaluate the 
use of new medications in combination with behavioral therapies 
to sustain recovery.
    Health Disparities.--Evidence suggests that alcohol affects 
genders and subpopulations differently, and that some groups 
suffer more adverse effects than others. The Committee 
encourages the Institute to work collaboratively with the NCMHD 
to study the role of gender, ethnicity, socioeconomic status, 
and other variables in determining the effects of alcohol use 
and abuse.
    Medications Development for Alcoholism Treatment.--The 
Committee urges the Institute to encourage studies on the 
influence of psychological and social factors on the success of 
treatment, and develop new medications for the treatment of 
alcoholism and alcohol-related disorders.
    Multidisciplinary Research on Fetal Alcohol Syndrome.--The 
Committee recognizes that fetal alcohol syndrome is among the 
most common preventable cause of mental impairment. The 
Committee supports the Institute's efforts to understand the 
biological mechanisms through which alcohol causes damage to 
the developing fetus. The Committee continues to urge the 
Institute to aggressively pursue research that will lead to 
effective strategies for the prevention and treatment of fetal 
alcohol syndrome.

                    NATIONAL INSTITUTE ON DRUG ABUSE

Appropriations, 2003....................................    $961,721,000
Budget estimate, 2004...................................     995,614,000
Committee recommendation................................     997,614,000

    The Committee recommends an appropriation of $997,614,000 
for the National Institute on Drug Abuse [NIDA], the same as 
budget request. The fiscal year 2003 appropriation was 
$961,721,000. 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 Decision Making and Drug Abuse.--The Committee 
recognizes that the scientific understanding gained by the 
support of behavioral and cognitive research will lead to 
improved treatment and prevention of drug abuse and addiction. 
The Committee encourages NIDA to support more research on 
adolescent decision making, including the cognitive, behavioral 
and social processes involved in initiating and continuing drug 
use.
    Asian Americans and Pacific Islanders.--The Committee notes 
that there is a lack of relevant research and culturally 
competent service programs to address the increased incidence 
of substance use and abuse among Asian American and Pacific 
Islander youth and adults. The Committee urges the Director of 
NIH and the Administrator of SAMHSA to increase their 
collaborative efforts to address the critical need for 
substance abuse research regarding these populations.
    Drug Abuse and HIV Interventions.--Women, youth, and 
minorities account for a growing proportion of new AIDS cases 
in the United States, and increasing numbers of cases are 
emerging in rural and smaller urban areas. Therefore, the 
Committee encourages NIDA to support research to develop and 
test developmentally and contextually appropriate drug abuse-
related HIV prevention interventions or intervention components 
to reach the broad youth population.
    Homeless Populations and Drug Abuse.--The Committee 
recognizes that homeless adults and youth have disproportionate 
rates of drug use disorders. The Committee encourages NIDA to 
accelerate more research on homeless populations, especially 
those that suffer from alcohol, drug abuse and/or mental 
disorders, and their ability to access services and treatment.
    Information Dissemination.--The Committee urges NIDA to use 
both the existing National Drug Abuse Treatment Clinical Trials 
Network infrastructure and the new prevention infrastructures 
that are currently being established as part of NIDA's new 
Prevention Research Initiative, to ensure that findings are put 
into practice in communities across the country. The Committee 
is pleased that NIDA and SAMHSA/CSAP are already having 
discussions to make this a reality.
    Methamphetamine Abuse.--The Committee continues to be 
concerned with the rate of methamphetamine abuse across the 
Nation. The problem is especially acute in Iowa and other 
Midwestern States. The Committee again urges NIDA to expand its 
research on improved methods of prevention and treatment of 
methamphetamine abuse.
    New Targets for Medications Development.--The Committee is 
pleased that NIDA research continues to lead to new discoveries 
about the brain. Recent advances have revealed new targets for 
medications development. The Committee urges NIDA to continue 
to support this important research to unravel the complexity of 
the brain and identify new systems, molecules, proteins, and 
genes that can be useful in developing new and better 
medications to treat drug abuse and addiction.
    Prevention Research.--The Committee is pleased that NIDA 
has launched a multi-component National Prevention Research 
Initiative that will involve partners at the State and local 
levels. The committee urges NIDA to expand this initiative to 
test the effectiveness of new and existing science-based 
prevention approaches in different communities, while also 
identifying the core components of effective drug abuse 
prevention, so that they can be easily adapted to meet local 
needs.
    Relapse.--The Committee encourages NIDA to continue its 
support of behavioral research that can further our 
understanding about the underlying cognitive, emotional, and 
behavioral factors that lead to drug abuse relapses.
    Stress.--The Committee encourages NIDA to continue to 
explore the effects of stress and its relationship on the 
initiation of drug use and the role that stress plays in 
triggering relapse to drug use. Such research may lead to 
development of more effective prevention and treatment, 
particularly for those who suffer from mental disorders as well 
as substance abuse.
    Tobacco Addiction.--The Committee recognizes the central 
role that NIDA research has played in paving the way for 
developing effective treatments for addiction to nicotine. The 
Committee is pleased with NIDA's participation with other NIH 
Institutes in activities to more rapidly translate tobacco 
addiction research into new treatments. The Committee urges 
NIDA to accelerate its efforts in these areas, particularly 
research that focuses on prevention of adolescents from 
starting to smoke.
    Translational Research.--The Committee applauds NIDA's 
efforts to support behavioral science research that provides 
insight into drug abuse and addiction, especially in the field 
of tobacco and nicotine addiction. Behavioral and cognitive 
studies are needed to examine the forerunners and consequences 
of nicotine use and the nature of the nicotine addiction 
process, including both genetic and environmental risk factors 
for nicotine abuse. The Committee encourages NIDA to continue 
its innovative approaches to move basic behavioral science into 
clinical application.
    Treatments for Adolescent Drug Abusers.--The Committee 
continues to see adolescent drug abuse as a major public health 
concern and recognizes the need for developing more treatments 
that are tailored to the unique needs of adolescent drug 
abusers.

                  NATIONAL INSTITUTE OF MENTAL HEALTH

Appropriations, 2003....................................  $1,341,014,000
Budget estimate, 2004...................................   1,382,114,000
Committee recommendation................................   1,391,114,000

    The Committee recommends an appropriation of $1,391,114,000 
for the National Institute of Mental Health [NIMH]. The budget 
request was $1,382,114,000 and the fiscal year 2003 
appropriation was $1,341,014,000. 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.
    NIMH is leading the Federal effort to identify the causes 
of, and most effective treatments for, mental illnesses. The 
Committee understands that this search is vital if we hope to 
be able to find the means to alleviate the pain and suffering 
of millions of Americans by reducing the impact of mental 
disorders on them and their families, on our healthcare system, 
and on our economy. Thanks, in part, to research funded and 
conducted over the last 50 years by NIMH there are effective 
treatments for many of these devastating illnesses.
    Through research, 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. The 
Institute strives, at the same time, to hasten the translation 
of this basic knowledge into clinical research that will lead 
to better treatments and ultimately be effective in our complex 
world with its diverse populations and evolving health care 
systems.
    Adherence and Behavior Change.--The NIMH supports studies 
of factors that influence decisions about adopting and adhering 
to treatment and prevention interventions, including individual 
personality or disease-related factors and type of treatment, 
as well as factors that may enhance or interfere with adherence 
to prevention, treatment, or rehabilitative regimens.
    Aging Research.--The Committee is pleased that NIMH has 
created a consortium specifically to oversee aging research at 
the NIMH, as well as to coordinate with other NIH components 
that also support research on diseases in the elderly. The 
Committee is aware that demographics will demand more attention 
to this area as the number of elderly in the population 
increases, and supports the increase in aging research at NIMH, 
and encourages the institute to continue these positive 
efforts.
    Alzheimer's Disease.--NIMH continues to play an important 
part in efforts to develop effective treatment strategies for 
Alzheimer's disease. The Institute is currently recruiting 
Alzheimer's patients to participate in a clinical trial 
designed to identify the best medication regimen for treating 
the behavioral problems that co-occur in Alzheimer's disease. 
The Committee is also pleased to note that through the efforts 
of its Aging Research Consortium and its collaboration with 
other NIH Institutes including NIA, NIMH is continuing to 
expand efforts to develop effective treatments for reducing the 
burdens of Alzheimer's disease. The Committee is also pleased 
that the NIMH has taken the lead in Alzheimer's disease 
biomarkers via its intramural research program.
    Autism.--The Committee notes that, that under the 
leadership of the NIMH, the NIH has quickly carried out the 
provisions of the Children's Health Act with respect to 
establishing autism centers of excellence and the Interagency 
Autism Coordinating Committee. The Committee is also encouraged 
by grants from the NIMH to investigate treatment options, 
including pharmaceutical research targeting the unique needs of 
the autism community in both children and adults. The Committee 
urges the NIMH to continue to fund behavioral and clinical 
research as well as other promising areas of research related 
to autism spectrum disorders.
    Behavioral Science.--The Committee encourages NIMH to 
continue to expand and strengthen its basic behavioral science 
portfolio to determine the basic psychological functions that 
become disturbed in mental disorders and realize the potential 
contribution of research in such areas as the bio-behavioral, 
cognitive, personality, emotional, and social processes that 
underlie behavioral functioning.
    Clinical and Translational Science.--The Committee is 
pleased that NIMH is working to expand the number of clinical 
scientists conducting research in mental disorders. The 
Committee understands that NIMH is currently working with the 
Academy of Psychological Clinical Science to explore new 
training models for clinical researchers. The Committee 
commends this groundbreaking effort.
    Depression and Bipolar Disorder.--The Committee is aware of 
the recently published findings regarding depression: its 
prevalence, its economic consequences, and its systemic nature. 
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. 
Although more people are currently receiving treatment, only 22 
percent of respondents with major depression during the past 
year reported receiving adequate treatment. This is especially 
troubling in light of the fact that there has been significant 
progress in the science of treating depression. 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 public education campaign entitled Real Men. Real 
Depression and encourages the institute to continue these 
education and information dissemination efforts.
    Down Syndrome.--Persons with Down syndrome have a greater 
risk of developing disorders such as autism, attention deficit 
disorder, obsessive-compulsive disorder, anxiety and 
depression. The Committee urges NIMH to conduct research on the 
mental health symptoms of persons with Down syndrome and to 
investigate effective treatments. The Committee also urges the 
Institute to include Down syndrome in its studies of related 
disorders and to coordinate its work with NICHD, NINDS and the 
National Center on Birth Defects and Developmental Disabilities 
at the Centers for Disease Control.
    Drug Metabolism.--The Committee is concerned that a high 
percentage of admissions to psychiatric hospitals are 
necessitated by moderate to severe adverse drug effects or 
prolonged while effective drug dosage is determined for 
patients. Genetic testing has been promoted as a way to improve 
drug safety and efficacy; improvements in microarray technology 
now allow genetic testing across drug response pathways 
providing a critical tool. The practicality of applying genetic 
information in clinical practice now depends on a determination 
as to whether genetic information, in fact, predicts best drug 
dose or adverse events. The Committee urges NIMH to create a 
major research focus on the relationship between drug 
metabolism variation and patients' response to psychiatric 
medications.
    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, 
including Alaska. 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. The 
Committee encourages NIMH to continue its outreach efforts such 
as those in Alaska and in its recent ``Dialogue Four Corners'' 
meeting in Albuquerque, New Mexico which focused on minority 
populations in the four States comprising that area: Arizona, 
Colorado, New Mexico and Utah. These efforts have involved 
bringing research knowledge to the public in local communities, 
but also in establishing the dialogue between local communities 
and NIH that is so important to public participation in the NIH 
priority-setting process. The Committee encourages NIMH to 
continue these efforts that have been focused on historically 
underserved populations.
    Genetic Schizophrenia.--The Committee urges the NIMH to 
continue research into the genetics of schizophrenia. The past 
year has seen the discovery of several genes associated with 
increased vulnerability to schizophrenia. For each of these 
genes, vulnerability is associated with a fairly common 
variation in gene sequence; none of these genes individually 
will provide a diagnostic test, but collectively they are 
providing the first picture of the genetic mechanisms for 
schizophrenia. Understanding how and where and when these genes 
are expressed in the brain now promises to provide an important 
new insight into the neurobiology of this illness.
    Global Effects of Mental Disorders.--The Committee 
encourages the NIMH to continue and expand its important work 
in the area of unipolar depressive disorders. A recent analysis 
used in the development of the World Health Organization's 
yearly report entitled ``The World Health Report, 2001, Mental 
Health: New Understanding, New Hope'' found that unipolar 
depressive disorders makes up the largest single cause of 
disability in the world. Over 36 percent of all years lost to 
disability in the western world are due to mental illnesses and 
alcohol and drug abuse. In the world, 20.2 percent of years 
lost to disability are due to mental illnesses. This is an 
extraordinarily significant burden on health and productivity 
in the United States and throughout the world.
    Late Life Mental Health Research.--The Committee continues 
to be concerned about funding for late life mental health 
research at NIMH but is encouraged by some of the positive 
steps the Institute has taken to address this issue. 
Furthermore, the Committee expects the NIMH to provide 
substantial resources to promote aging research or provide data 
on existing funds targeted toward geriatric mental health 
research. Therefore, this Committee strongly encourages NIMH to 
expand research in this area extramurally through all available 
mechanisms and to provide adequate resources to the NIMH Aging 
Research Consortium to advance the geriatric mental health 
research agenda.
    Learning Disabilities.--The Committee commends NIMH for the 
work conducted to explore the neurological and behavioral 
aspects of learning disabilities. The Committee looks forward 
to learning the results of this work and encourage the 
Institute to continue to coordinate with other Institutes 
working on related activities.
    Outreach.--The Committee continues to support NIMH's 
excellent outreach efforts such as the recent ``Dialogue Four 
Corners'' meeting in Albuquerque, New Mexico. These efforts 
have involved bringing research knowledge to the public in 
local communities, but also in establishing the dialogue 
between local communities and NIH that is so important to 
public participation in the NIH priority-setting process. The 
Committee encourages NIMH to continue these efforts that have 
been focused on historically underserved populations, with an 
emphasis on the co-occurrence of mental disorders with 
substance abuse and with other physical illnesses such as 
diabetes and heart disease--an area that the committee 
encourages NIMH to continue to explore.
    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, bioterrorism, 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 Portfolio.--The Committee is pleased with NIMH's 
progress in fashioning its research portfolio, which has 
balanced the urgent need to focus on severe mental disorders 
with the obligation to support the basic neuroscience and 
behavioral research that will ultimately uncover the mechanisms 
responsible for human behavior and for the development of the 
entire spectrum of mental disorders.
    Science in the Service of the Public.--The Committee 
supports the NIMH's determination to speed the translation of 
research results into practical societal benefits, including 
improved mental health services for those who need them, and 
commends NIMH for its focus on translating the findings from 
basic research into the clinical arena.
    Social Neuroscience.--The Committee is interested to learn 
that NIMH is supporting research in the emerging area of social 
neuroscience, focusing on the neurobiology of complex 
behaviors. This trandisciplinary research holds much promise 
for increasing understanding of the connections between the 
brain and behavior.
    Suicide.--The Committee is aware of the recent Institute of 
Medicine [IOM] study on suicide--``Reducing Suicide: A National 
Imperative''--which noted that nearly 30,000 people die by 
suicide each year in the United States alone. Many, many more 
attempt suicide. More than 90 percent of people who commit 
suicide suffer from some form of mental disorder, which 
emphasizes the severe emotional pain and suffering caused by 
some forms of mental illness. While the body of evidence 
pointing to specific risk factors has grown, and the number of 
NIMH grants focused on treating suicidal patients has 
increased, there are no intervention centers focused on 
advancing the scientific methods necessary to efficiently test 
approaches to the reduction of suicide risk. The Committee 
encourages NIMH's leadership in responding to the IOM report 
and urges it to address the need for building a sufficient 
research infrastructure to adequately reduce the burden of 
suicidality (suicide deaths, attempts and serious ideation).
    Translating Behavioral Research.--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.
    Traumatic Events.--The Committee supports NIMH's leadership 
in working quickly to address urgent public health problems. 
NIMH research has shown that, for some individuals, exposure to 
violent or traumatic events can result in very 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 of us 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, we now know that PTSD must 
involve a well-defined specific brain circuit. This information 
can be very important given our 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.

                NATIONAL HUMAN GENOME RESEARCH INSTITUTE

Appropriations, 2003....................................    $464,995,000
Budget estimate, 2004...................................     478,072,000
Committee recommendation................................     482,372,000

    The Committee recommendation includes $482,372,000 for the 
National Human Genome Research Institute [NHGRI]. The budget 
requested $478,072,000 and the fiscal year 2003 appropriation 
was $464,995,000. The comparable amounts for the budget 
estimate include funds to be transferred from the Office of 
AIDS Research.
    Mission.--In April 2003, the International Human Genome 
Project, led by the National Human Genome Research Institute 
[NHGRI] of the National Institutes of Health, accomplished all 
of its original goals of the project, ahead of schedule and 
under budget. 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, in the month of the 50th anniversary of Watson and 
Crick's seminal publication of the structure of DNA, opens the 
genomic era of medicine. April also witnessed the publication 
of a important new vision for the future of genomics research, 
developed by the NHGRI. This vision, the outcome of almost 2 
years of intense discussions with hundreds of scientists and 
members of the public, has three major areas of focus: Genomics 
to Biology, Genomics to Health, and Genomics to Society. It 
will serve to guide the NHGRI and NIH efforts in the area of 
genomic science in the years to come. The Committee commends 
the NHGRI for developing this vision for the future of genomics 
and will look to this document as a benchmark for assessment of 
future investment in the institute.
    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.
    ELSI.--The Committee remains concerned about the proper use 
of genetic information and encourages the NHGRI's ongoing 
efforts, though its ELSI program, to examine the privacy and 
fair use of genetic information. Other important issues related 
to human genetics research and its consequences should also be 
studied, including: the appropriate use of genetic tests; the 
influence of gene patenting and licensing on the field of 
genomics, the protection of human subjects who participate in 
genetic research; the development of policies to guide research 
into genetic variation; and complex social issues, such as how 
genetics informs concepts of race and ethnicity.
    ENCODE.--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. This 
significant undertaking will help scientists mine and fully 
utilize the human sequence, gain a deeper understanding of 
human biology, predict potential disease risk and stimulate new 
strategies for the prevention and treatment of disease. The 
Committee would like to receive a report on the progress of 
this effort prior to next year's hearings, with emphasis on the 
project's place within the Institute's plan for future 
activities.
    Gene-Environment Interactions.--The 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. The 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.
    HapMap.--The Committee commends NHGRI for creating the 
Haplotype Map project, which will assess the multiple genetic 
and environmental factors that influence many common diseases. 
This new initiative, organized as an international public/
private partnership, led and managed by NHGRI, will develop a 
catalog of the haplotype blocks to be known as the ``HapMap.'' 
This map will provide a new tool to identify genetic variations 
associated with disease risk and response to environmental 
factors and to drugs and vaccines. The NIH plans to require 
rapid release of data that the HapMap project generates. 
Ultimately, this powerful tool will allow scientist to 
understand many common diseases much more completely and will 
lead to improved treatments for many of these disorders.

      NATIONAL INSTITUTE OF BIOMEDICAL IMAGING AND BIOENGINEERING

Appropriations, 2003....................................    $278,279,000
Budget estimate, 2004...................................     282,109,000
Committee recommendation................................     289,300,000

    The Committee recommends an appropriation of $289,300,000 
for the National Institute of Biomedical Imaging and 
Bioengineering [NIBIB]. The budget requested $289,300,000 and 
the fiscal year 2003 appropriation was $278,279,000. 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.
    Positron Emission Tomography [PET].--The Committee 
continues to encourage the 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 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, 2003....................................  $1,138,821,000
Budget estimate, 2004...................................   1,053,926,000
Committee recommendation................................   1,186,483,000

    The Committee recommends an appropriation of $1,186,483,000 
for the National Center for Research Resources [NCRR]. The 
budget request was $1,053,926,000 and the fiscal year 2003 
appropriation was $1,138,821,000. 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 Facilities.--The Committee commends NCRR 
for its support of recent efforts to upgrade animal research 
facilities at minority health professions schools including the 
recent competitive supplement to Research Centers in Minority 
Institutions for developing and improving institutional animal 
resources. These upgrades are necessary to assist these 
institutions in complying with Federal regulations and attain 
accreditation by the appropriate scientific organizations. The 
Committee encourages NCRR to continue work in partnership with 
the National Center on Minority Health and Health Disparities 
to support this important initiative.
    Clinical Investigation.--The Committee urges NCRR to 
continue its efforts to improve the efficiency of clinical 
investigation by expanding the capabilities of clinical 
research resources. There are novel ideas and candidate 
molecules in the academic community that merit expeditious 
clinical testing. The Committee encourages the NCRR to provide 
the means to obtain rapid clinical proof of principle that a 
new molecule or approach is a viable candidate for expanded 
testing in the clinic.
    Cystic Fibrosis.--The Committee strongly encourages NCRR to 
evaluate clinical research partnerships with minority-serving 
institutions and to expand its support for clinical trials 
networks for orphan diseases, such as the cystic fibrosis 
clinical trials network. This clinical trials system holds 
promise as a model for other orphan diseases, and the Committee 
urges that NCRR provide support for the CF network to 
facilitate its expansion and also to consider strategies for 
the replication of this network for other orphan 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 2003 appropriation. The fiscal year 2004 
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 play a 
critical role in NIH efforts to translate basic science 
discoveries into vaccines, treatments, and cures for disease. 
GCRCs provide regional access to clinical research in 32 of 50 
States. Approximately 10,000 researchers use GCRCs each year 
for patient-oriented research focused on a wide variety of 
diseases. Over the last four decades, nearly every major 
medical discovery made in the United States has involved 
researchers working in the Nation's GCRCs. In recent years, the 
Committee has expressed extreme concern regarding the 
inadequate funding provided to the GCRCs. Since 1999, the 
budget for the NCRR has grown at more than twice the rate of 
increase for the GCRCs. To reverse this trend and enhance the 
capacity of these Centers to support research aimed at 
improving patient care, the Committee has provided $320,000,000 
for the GCRC program, an increase of $10,448,000 over the 
fiscal year 2003 appropriation and $7,272,000 over the budget 
request. The increased funds should be used 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.
    Graduate Training in Clinical Investigation Awards.--Over 
the past 2 years, the Committee has expressed concern that NIH 
has not moved forward with implementation of the Graduate 
Training in Clinical Investigation Awards. This program was 
authorized in the Clinical Research Enhancement Act to provide 
tuition and stipend support for students seeking advanced 
degrees in clinical research. The awards were intended to 
complement the NIH Clinical Research Curriculum Awards, a major 
NIH initiative aimed at establishing training programs to 
reverse the shortage of well-trained clinical investigators. 
The Committee is pleased that 57 Curriculum Awards have been 
provided to institutions across the country but believes the 
NIH is compromising the effectiveness of these training 
programs by failing to fund the complementary student stipend/
tuition awards. The General Accounting Office Report on NIH 
implementation of the clinical research legislation 
substantiates the Committee's concerns, noting the opinion of 
several training program directors that inadequate tuition and 
stipend support for students is ``a major constraint.'' The 
Committee believes that the graduate training awards authorized 
in the Clinical Research Enhancement Act should be implemented 
in fiscal year 2004 with a budget sufficient to support 200 
students.
    Health Disparities Research.--The Committee commends NCRR 
for its proposal to establish Comprehensive Centers for Health 
Disparities Research and looks forward to learning more about 
this important new initiative.
    IDeA Grants.--The Committee has provided $215,000,000 for 
the Institutional Development Award [IDeA] Program authorized 
by section 402(g) of the Public Health Service Act. This is a 
$6,365,000 increase over fiscal year 2003 and $5,000,000 over 
the fiscal year 2004 budget request. Within the total provided, 
$130,000,000 is for the Biomedical Research Infrastructure 
Network [BRIN] initiative and $85,000,000 is for the Centers of 
Biomedical Research Excellence [COBRE] initiative.
    Islet Resource Centers.--The Committee commends NCRR for 
establishing 10 sites for isolation, purification, and 
characterization of insulin-producing cells, and it encourages 
the Center to expand and extend these efforts by creating 
additional sites. The Committee also encourages NCRR to 
facilitate this important research by isolating insulin-
producing cells both for distribution to researchers as well as 
for transplantation, and by improving methods to store and 
transport insulin-producing cells.
    National Primate Research Centers.--The Committee values 
the critical role played by the eight National Primate Research 
Centers [NPRCs] and thanks the National Center for Research 
Resources [NCRR] for the two recent evaluations it sponsored to 
assess the needs of the NPRCs and NPRCs Users: An Evaluation of 
the Regional Primate Research Centers Program and a National 
Academy of Sciences Workshop on Rhesus Monkey Demands in 
Biomedical Research. Recognizing that the NPRCs have 
independently developed a 5 Year Advancement Initiative to 
effectively implement the recommendations set forth in these 
two evaluations and to address the upgrades and program 
expansions needed to meet the demanding research needs of the 
Nation, the Committee expects NCRR to fully commit to the 
initiative. This commitment ensures that the NPRCs will 
continue to fulfill the national need for primate resources and 
expertise, and contribute to the overall effectiveness of the 
Federal investment in biomedical research.
    Plant-Based Medicinal Products.--The Committee continues 
its interest in accelerating the development and 
commercialization of plant-based medicinal products, and it 
encourages the NCRR to actively collaborate with plant 
scientists in developing novel useful products.
    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.
    Research Centers at Minority Institutions.--The Committee 
continues to recognize the critical role played by minority 
institutions at both the graduate and undergraduate level in 
addressing the health research and training needs of minority 
populations. These programs help facilitate the preparation of 
a new generation of scientists at these institutions. The 
Research Centers in Minority Institutions [RCMI] Program 
continues to impact significantly on these problems. The 
Committee encourages NIH to strengthen participation from 
minority institutions and increase resources available in this 
area. The Committee also encourages NIH to work with minority 
institutions with a track record of producing minority scholars 
in science and technology.

   NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE [CCAM]

Appropriations, 2003....................................    $113,407,000
Budget estimate, 2004...................................     116,202,000
Committee recommendation................................     117,902,000

    The Committee has included $117,902,000 for the National 
Center for Complementary and Alternative Medicine. The budget 
request was $116,202,000 and the fiscal year 2002 appropriation 
was $116,202,000. 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, which 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 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 is aware of 
efforts to synthesize and calibrate the production of milk 
thistle for use in clinical trials to demonstrate its value to 
slow the progression of nonalcoholic steatohepatitis and to 
reduce the side effects of hepatitis C interferon treatments. 
The Committee looks forward to a report on the status of this 
research initiative.
    Chiropractic Research Center.--The Committee strongly urges 
NCCAM to increase support for the chiropractic research center.
    Office of Dietary Supplements.--The Committee is supportive 
of the efforts of NCCAM and the Office of Dietary Supplements 
[ODS] in the study of the beneficial effects of botanical 
dietary supplements as alternative medical therapies, and 
especially in the efforts to promote development and employment 
of reference standards and analytical methods. The Committee 
encourages the continued cooperation of NCCAM and ODS with the 
programs of FDA/CFSAN to ensure the safety of botanical dietary 
supplements.

       NATIONAL CENTER ON MINORITY HEALTH AND HEALTH DISPARITIES

Appropriations, 2003....................................    $185,714,000
Budget estimate, 2004...................................     192,724,000
Committee recommendation................................     192,824,000

    The Committee has included $192,824,000 for the National 
Center on Minority Health and Health Disparities. The budget 
request was $192,724,000 and the fiscal year 2003 appropriation 
was $185,714,000. 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.
    Glomerular Injury.--The Committee understands that 
glomerular injury, a group of diseases affecting the filtering 
mechanisms of the kidneys, is more prevalent among African 
Americans than the general population. The Committee urges 
NCMHD to explore collaboration with NIDDK to conduct support 
research activities related to glomerular injury.
    Hepatitis C.--The Committee remains deeply concerned about 
the disproportionate burden of hepatitis C among African 
Americans and Hispanics. The incidence is high and the response 
to treatment is low. The Committee strongly encourages NCMHHD 
to work with NIDDK and NIAID to expand research to improve 
treatment effectiveness and safety, and to partner with CDC and 
nonprofit groups to implement a prevention and education 
campaign targeted at high-risk populations.
    Minority Health and Health Disparities.--The Committee 
commends the National Center on Minority Health and Health 
Disparities for its leadership in addressing the longstanding 
problem of health status disparities in minority and medically 
underserved populations. For fiscal year 2004, the Committee 
continues to encourage NCMHD to implement its successful 
Research Endowment program as an ongoing initiative. Moreover, 
the Committee encourages NCMHD to implement the program in a 
manner that is consistent with the authorizing legislation.
    The Committee also commends NCMHD for its successful 
``Project EXPORT'' initiative and urges continued support for 
this important program. Finally, the Committee encourages the 
Director of NCMHD to coordinate with the NIH Director and the 
National Center for Research Resources in support of extramural 
facility construction and the development of other research 
infrastructure at minority health professions schools.
    Scleroderma.--The Committee urges the Center to support 
research that furthers the understanding of causes and 
consequences of scleroderma, a chronic, degenerative disease of 
collagen production, among African Americans, Hispanic and 
Native American men and women. The Center is encouraged to 
establish epidemiological studies to address the prevalence of 
scleroderma among these populations as statistics do 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, 2003....................................     $63,465,000
Budget estimate, 2004...................................      64,266,000
Committee recommendation................................      65,900,000

    The Committee recommends an appropriation of $65,900,000 
for the Fogarty International Center [FIC]. The budget request 
was $64,266,000 and the fiscal year 2003 appropriation was 
$65,900,000. 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 FIC expand 
its COPD research and training activities.
    Tuberculosis.--The Committee recognizes the growing 
importance of international research and surveillance programs 
with respect to infectious diseases such as tuberculosis [TB]. 
The Committee is pleased by the Center's research collaboration 
with international organizations and governments on multi-drug 
resistant TB and encourages the Center to continue these 
important studies. The Committee is aware that FIC offers TB 
supplemental training grants to recipients of AIDS 
International Training and Research Program [AITRP] or 
International Training and Research Program in Emerging 
Infectious Diseases [ERID]. The Committee encourages FIC to 
develop a specific free-standing TB training program.
    The Committee recognizes the growing importance of 
international research surveillance programs with respect to 
infectious diseases such as tuberculosis. The Committee is 
pleased by the Center's research collaboration with 
international organizations and governments on multi-drug 
resistant TB and encourages the Center to continue these 
important studies.

                      NATIONAL LIBRARY OF MEDICINE

Appropriations, 2003....................................    $308,335,000
Budget estimate, 2004...................................     316,040,000
Committee recommendation................................     320,035,000

    The Committee recommends an appropriation of $320,035,000 
for the National Library of Medicine [NLM]. The budget 
requested $316,040,000 and the fiscal year 2003 appropriation 
was $308,335,000. Included is $4,000,000 for improvement of 
information systems. The recommendation includes $8,200,000 in 
transfers available under section 241 of the Public Health 
Service Act. The comparable amounts for the budget estimate 
include funds to be transferred from the Office of AIDS 
Research.
    Mission.--The National Library of Medicine is the Federal 
institution that for more than 150 years has collected, 
organized, preserved, and disseminated the world's output of 
biomedical literature in all forms. As a result of this 
activity NLM is the world's largest library of the health 
sciences, its holdings numbering more than 5 million items. The 
NLM has pioneered innovative methods to disseminate 
bibliographic information. Basic to the mission of the NLM is a 
wide-ranging research program to improve how medical 
information is communicated. This responsibility is aided by a 
grants program and by specialized services in toxicology, 
environmental health, and biotechnology.
    Back-up Facility.--The increasing threat to Federal 
computer systems raises serious concerns about maintaining 
access to vital health information during an emergency. The 
Committee supports NLM's efforts to establish a remote back-up 
facility to ensure the continued availability of such critical 
national biomedical resources as MEDLINE and GenBank, as well 
as valuable information services to the public, including 
MEDLINEplus and ClinicalTrials.gov. The Committee also 
recognizes the need to provide ongoing resources to maintain 
such a facility once an initial investment is made to establish 
remote back-up capability.
    Bioethics Research.--The Committee urges the NLM to 
maintain strong support for the National Reference Center for 
Bioethics Literature [NRCBL] and the Bioethics Information 
Retrieval [BIR] Project. The BIR Project provides critically 
important enhancement to NLM's indexing of journal articles, 
thus facilitating searches on the Bioethics Subset of the NLM's 
MEDLINE database.
    Clinical Vocabulary Standards.--The Committee continues to 
note the contribution of NLM to the development of standardized 
clinical data vocabularies that play a key role in improving 
interoperability of medical information systems. The Committee 
supports NLM's efforts to expand the Unified Medical Language 
System [UMLS] to enable it to serve as a major vehicle for 
facilitating the exchange of clinical health information. 
Through common standards, patient care will be improved, errors 
will be reduced, and the communication of health information 
among disparate health care systems will be greatly enhanced.
    Digital Human.--Advances in medical research depend 
increasingly on using simulations to integrate the flood of 
biomedical research information in ways that can greatly 
enhance research aimed at understanding human health and curing 
disease, improve the practice of medicine, contribute to health 
and science education and training. The Committee acknowledges 
the pioneering work NIH has done in this area including at the: 
NIGMS, NINDS, NHLBI, NCRR, and NLM. Stronger NIH-wide 
management and coordination of this work could, however, 
achieve efficiencies and speed progress, and minimize 
duplication and costs in this critical and rapidly expanding 
research field and coordination with all NIH institutes and 
centers. The Committee encourages the NLM to develop consensus 
standards, ensure that simulation components developed by 
different groups work together efficiently, manage a review and 
error correction process, and provide a publicly available 
repository of models, simulations, and associated data. The 
Committee encourages NIH to develop a plan describing how 
coordination can best be achieved. The Committee further 
requests NIH to consider convening a conference of experts in 
biomedical simulations related fields to gather advice about 
where strengthened coordination of research and information is 
most needed and options for undertaking an NIH-wide effort to 
implement these recommendations.
    Expanding Library Facility.--The Committee was pleased to 
receive the reports it requested on expanding the facility for 
the National Library of Medicine, and to learn that the design 
work will be completed by August 2003. If NLM's cutting-edge 
biotechnology and other communications programs are to make 
their maximum contribution to advancing the Nation's biomedical 
research agenda, it is clear that the Library must have 
adequate facilities. In this regard, the Committee believes 
that construction should begin now on an expedited schedule. 
The need is mission-critical and a delay could significantly 
increase the cost.
    Home Medical Consultations.--The Committee expects the NLM 
to support an expansion of a demonstration called for in last 
year's report to test 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.
    Minority Health.--The Committee encourages NLM to expand 
its support of annual conferences sponsored by the minority 
health professions community designed to foster increased 
interest among minority students in the fields of biomedical 
science and bio-informatics.
    Outreach.--The Committee encourages NLM to continue its 
outreach activities aimed at educating health care 
professionals and the general public about the Library's 
products and services, in coordination with medical librarians 
and other health information specialists.
    PubMed Central.--The Committee commends NLM for its 
leadership in developing PubMed Central, an electronic online 
repository for life science articles. Because of the high level 
of expertise health information specialists have in the 
organization, collection, and dissemination of medical 
information, the Committee believes that health sciences 
librarians have a key role to play in the further development 
of PubMed Central. The Committee encourages NLM to work with 
the medical library community regarding issues related to 
copyright, fair use, peer-review and classification of 
information on PubMed Central.
    Senior Citizen Outreach.--The Committee again notes that 
senior citizens would benefit greatly from expanded access to 
NLM's databases, and it supports NLM's efforts to pursue this 
goal. The Committee encourages innovative means to reach older 
Americans, including Internet access at senior centers and 
congregate meal sites.

                         OFFICE OF THE DIRECTOR

Appropriations, 2003....................................    $266,232,000
Budget estimate, 2004...................................     317,983,000
Committee recommendation................................     323,483,000

    The Committee recommends an appropriation of $323,483,000 
for the Office of the Director [OD]. The budget request was 
$317,983,000 and amount appropriated in fiscal year 2003 was 
$266,232,000. 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.
    The Committee directs the Director of NIH to make a written 
request to the chairman of the Committee prior to any 
reprogramming of $1,000,000 or more, between programs, 
projects, activities, institutes, divisions, and centers. The 
Committee desires to have the requests for reprogramming 
actions which involve less than the above-mentioned amounts if 
such actions would have the effect of changing funding 
requirements in future years, if programs or projects 
specifically cited in the Committee's reports are affected, or 
if the action can be considered to be the initiation of a new 
program.
    Autism.--The Committee encourages NIH to expand the 
research portfolios at the existing Centers for Excellence in 
Autism as well as the existing collaborative programs for 
excellence in autism. Pursuant to the Children's Health Act of 
2000, the Committee strongly encourages NIH leadership, and 
particularly participant institutes including, NICHD, NIMH, in 
coordinating and financing a tissue bank program that will 
synchronize autism spectrum disorder brain banking, data 
management, and track research among all participants in the 
tissue collection program. The Committee further encourages NIH 
to work closely with its Interagency Autism Coordinating 
Committee in developing, implementing, and funding its matrix 
for autism spectrum disorder research. The Committee also 
encourages NIH to look at collaborative opportunities for joint 
projects and conferences with national autism organizations 
that will foster greater participation in research activities 
by investigators entering the field.
    The Committee further urges the NIH to provide more 
attention and resources to autism research. In particular, to 
support and expand the Startt centers and ensure that all large 
autism projects adhere to principles of sharing of data and 
genetic material. Data sharing is one of the most effective and 
economical ways to increase the rate of discovery. The 
opportunity now exists to create large, integrated data sets 
encompassing data from CPEA, STARTT, CADRE and NIEHS centers.
    Autoimmune Diseases.--The Committee strongly urges the 
Director to oversee the implementation of the December 2002 NIH 
Autoimmune Diseases Research Plan, which was requested in the 
Children's Health Act of 2000.
    Chronic Fatigue Syndrome.--The Committee is disappointed 
that since NIH released its long-awaited CFS program 
announcement in December 2001, it has yet to reverse 8 years of 
declining CFS research funding. The Committee urges the NIH to 
issue an RFA that would emphasize multidisciplinary studies to 
understand the cause and progression of CFS in adults and 
children as well as identify diagnostic markers and effective 
treatments.
    Chronic Myeloproliferative Disorders [MPDs].--Last year, 
the Committee requested a report from NIH regarding its plans 
to expand research into the Chronic MPDs, specifically 
identifying the disorders of Polycythemia Vera, Idiopathic 
Myelofibrosis, and Essential Thrombocytosis. The Committee 
notes that the NIH submitted its response to this request in 
April 2003. However, the Committee believes this report is 
remarkably unresponsive and blatantly fails to address the 
substance of the Committee's request. In fact, the report 
relies on work undertaken by the Leukemia, Lymphoma and Myeloma 
Progress Review Group [LLMPRG], yet the LLMPRG failed to even 
consider the Chronic MPDs in their review. The Committee also 
finds it alarming that the NIH would suggest that the funding 
of a clinical trial involving patients with Juvenile 
Myelomonocytic Leukemia [JML] has any relationship at all to 
the Committee's inquiry into Chronic MPDs, as JML is a 
pediatric leukemia and not a Chronic MPD. The Committee 
encourages NIH to expand research into the disorders of 
Polycythemia Vera, Idiopathic Myelofibrosis and Essential 
Thrombocytosis. The Committee requests that NIH submit a more 
detailed report on their plans to address this disorder.
    Clinical Research.--The promise of medical research is 
greater now than ever before. Strong and sustained investments 
of taxpayer dollars in basic biomedical research over the past 
five decades have generated a wealth of knowledge about the 
fundamental mechanisms of human health and disease. To reap the 
full harvest of these discoveries, the public now requires 
careful attention to and investment in the translation of these 
fundamental scientific advances into improved patient care, a 
task carried out in large part through clinical research 
conducted by the Nation's academic health centers. The 
Committee notes, however, that an increasing number of 
impediments to the translation of these remarkable research 
discoveries into practice, including rising costs, unfunded 
regulatory mandates, fragmented clinical research 
infrastructure, incompatible data bases, and a severe and 
growing shortage of qualified clinical investigators and 
willing participants. The Committee recommends that the NIH 
Director develop recommendations for addressing these 
impediments, with special consideration give to: providing 
clinical research infrastructure support grants to eligible 
institutions; support and/or restructuring of the institutional 
review board system; and work with the NIH, FDA, NSF, and DOD 
on regulations governing clinical research. The Committee 
expects a report by April 2004.
    Cooperation With the Veterans Health Administration.--The 
Committee applauds the increasing research collaboration 
between the NIH and the Veterans Health Administration, and it 
notes that the VA system of 173 hospitals and 771 clinics 
represents a significant resource to facilitate and accelerate 
research. The Committee urges increased cooperative efforts 
between NIDDK, NCI and the Veterans Health Administration to 
screen, diagnose, and manage the medical issues associated with 
hepatitis C and liver cancer.
    Distribution of Resources.--The Committee is concerned, in 
light of the doubling of the agency's budget over the past 5 
years and the rapid encroachment of new medical research 
challenges such as SARS and threats of bioweapons, that the 
agency has not moved more rapidly towards encouraging funding 
of large scale collaborative efforts to address these and other 
medical challenges. While the pace of new challenges has 
increased, review time for proposals submitted to the 
Institutes at NIH continues to average about 18 months. The 
Committee strongly encourages the Director to develop means of 
encouraging large scale multi-institution projects to address 
significant areas of medical research and to devise means of 
reducing the time frames between a submission of a proposal and 
the grant award.
    Education and Health.--The Committee is interested in the 
trans-NIH request for applications, initiated by the Office of 
Behavioral and Social Sciences Research [OBSSR], to better 
understand how education contributes to health. Better 
scientific understanding of the causal pathways between 
education and health could lead to new or improved prevention 
and therapeutic intervention strategies for important health 
problems. In some but not all studies of clinical treatments, 
those with lower levels of educational attainment demonstrated 
poorer outcomes. The Committee looks forward to hearing about 
new research directions in this important arena.
    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. A 
multidisciplinary approach to understanding this complex 
disorder can allow the more rapid translation of research to 
patient care. The Committee urges the Director to coordinate 
research efforts in epilepsy among these Institutes, and to 
implement the NINDS research benchmarks resulting from the 
March 2000 conference ``Curing Epilepsy: Focus on the Future.''
    Genomics.--The Committee has long been supportive of the 
extraordinary work done by NHGRI to sequence the human genome 
and to unlock the secrets held within the sequence. The 
Committee recognizes the important role that genomics and 
genetics plays in the progression of disease and believes that 
every institute has a key role to play in moving genomics to 
the clinical setting through the use of next generation 
technologies. The Committee urges the Director to continue to 
ensure that the institutes and centers are pursuing every 
available opportunity to advance this critical research.
    Human Embryonic Stem Cell Research.--The Committee believes 
strongly that embryonic stem cell research offers enormous 
promise for the more than 100 million Americans who suffer from 
chronic diseases. The Committee remains concerned that the 
current administration policy relating to embryonic stem cell 
research is too limiting and is significantly slowing the pace 
of this research. While the administration initially stated 
that approximately 70 embryonic stem cell lines would be 
available under the President's policy, only 11 are currently 
available. Moreover, the Committee has heard testimony that 
current embryonic stem cell lines are not sufficiently 
genetically diverse for therapeutic uses. Also, most all of the 
currently available stem cell lines are contaminated with mouse 
feeder cells, making it uncertain whether the FDA will permit 
them to be used in therapeutic applications. The Committee 
urges the administration to expand its embryonic stem cell 
research policy to allow additional stem cell lines to be 
available for research.
    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 NIH anticipates spending just 
$17,000,000 on human embryonic stem cell research, far short of 
the $100,000,000 budget originally announced by the HHS 
Secretary. The Committee was particularly troubled to learn 
that the National Cancer Institute is projecting no funding for 
human ES cell research in fiscal year 2003. Over the past 
several years, the Committee has heard from multiple witnesses, 
including former NIH and NCI directors, about the promise of 
human ES cell research to better understand and treat cancer. 
The Committee expects to hear from NCI during the fiscal year 
2005 hearings on their plan to vigorously implement a human ES 
agenda.
    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. 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, urges the Director to 
increase the core support NDRI receives from NCRR, and to 
continue to encourage the Institute Directors to identify and 
implement program-specific initiatives intended to expand 
support for NDRI.
    Inflammatory Bowel Disease.--The Committee continues to 
note with interest a scientific research agenda for Crohn's 
disease and ulcerative colitis (collectively known as 
inflammatory bowel disease) entitled ``Challenges in 
Inflammatory Bowel Disease [IBD].'' This report identifies 
strong linkages between the functions of the immune system and 
IBD. The Committee encourages the Institute to expand its 
research partnerships with the IBD community in fiscal year 
2004 and increase funding for research focused on (1) the 
immunology of IBD and (2) the interaction of genetics and 
environmental factors in the development of the disease. The 
Committee looks forward to reviewing a report from the 
Institute on the progress made in these areas as requested in 
the fiscal year 2003 Senate Labor-HHS Committee report.
    Irritable Bowel Syndrome [IBS].--The Committee is pleased 
with the increased focus on irritable bowel syndrome [IBS] at 
the NIH's Office of Women's Health. It is estimated that over 
60 million Americans, disproportionately women, suffer from 
IBS.
    Long-Term Maintenance of Behavior Change.--The Committee is 
pleased that 10 Offices and Institutes have contributed to 
OBSSR's trans-NIH research initiative on the challenges of 
maintaining positive behavior change, particularly regarding 
the strategies people use to maintain diet or exercise 
regimens.
    Lymphatic Diseases and Lymphedema.--The Committee commends 
the NIH for its recent initiatives to support research on 
lymphatic diseases and lymphedema, as described in its April 
2003 Report to Congress. However, these accomplishments, while 
notable, do not adequately address the current research 
imperatives that can lead to effective therapeutic options for 
the large, underserved patient population that is affected by 
these diseases. The Committee urges the NIH to give higher 
priority to this area of study. The Committee is also 
disappointed that the April 2003 report did not adequately 
outline short- and long-term plans to stimulate and support 
basic and translational research for lymphatic diseases, as 
requested in last year's Senate report language. Therefore, the 
Committee requests the Director to provide another report by 
April 1, 2004, that describes specific plans for lymphatic 
disease research initiatives. In this regard, the Committee 
urges the NIH to consider programs that will provide essential 
resources to sustain this field and will stimulate the future 
study of the lymphatic system, with particular emphasis on the 
abnormal development thereof. The Committee notes that the key 
factors limiting such study include the lack of: (a) suitable 
animal models; (b) functional imaging of the lymphatic system; 
(c) a national patient registry and tissue bank; and (d) 
academic career development in the area of lymphatic diseases. 
The Committee encourages a broad, trans-NIH involvement in all 
these efforts, given that a greater understanding of lymphatic 
function and disease will also contribute to a greater 
understanding of many interrelated diseases, such as cancer, 
AIDS, and autoimmune diseases, and of related processes, such 
as inflammation and infection.
    Microbicides for the Prevention of HIV.--HIV is a serious 
and growing women's health issue. As of the end of 2002, half 
of the world's HIV/AIDS-infected people were women. The typical 
woman who gets infected with HIV has only one partner--her 
husband. This trend devastates families and puts children at 
risk. Consensus has emerged across the public health, 
biomedical, and behavioral research communities that the range 
of preventive interventions for HIV transmission must be 
expanded, with particular focus on options women can control, 
such as microbicides. Microbicides are a class of products 
under development that would be applied topically to inactivate 
or block transmission of HIV and other infections. More than 60 
potential microbicides are in various stages of development at 
public and private research entities around the globe. Designed 
for maximum safety and effectiveness, these products are also 
being designed to be inexpensive, readily available, and widely 
acceptable. With increased funding and coordination, the first 
such product could be available to the public in 5 to 7 years. 
Microbicides would be critical both until a range of HIV-
preventive vaccines becomes available and as a necessary and 
complementary preventive technology thereafter. The National 
Institutes of Health, principally through the National 
Institute of Allergy and Infectious Diseases [NIAID], spends 
the majority of Federal dollars in this area. The Committee 
commends the NIH for increasing the funds available for 
microbicide research and development, and it supports 
additional increases in funding for this area through OAR, 
NIAID, NICHD, NIMH, NIDA, and ORWH. The Committee continues to 
be concerned that microbicide research at NIH is conducted with 
no single line of administrative accountability or specific 
funding coordination. To address this, the Committee urges the 
Director of NIAID to consider establishing a microbicides 
branch dedicated to research and development, with appropriate 
staff and funding. The Committee continues to request that 
NIH's Office of AIDS Research provide to the Committee, not 
later than 60 days after enactment of this legislation, a 
Federal plan for coordination and acceleration of microbicide 
research and development, as requested repeatedly by this 
Committee.
    Minority Health and Racial Disparities.--Research advances 
should be applied more expeditiously to ensure greater 
improvements in health outcomes across all communities of color 
and the general public. The Committee urges the NIH to improve, 
strengthen and expand its systems of information dissemination 
and outreach to health care providers, minority organizations, 
and the public.
    Minority Institution Research Centers.--The Committee 
continues to be pleased with the NIH Director's implementation 
of various programs focused on developing research 
infrastructure at minority health professions institutions, 
including Research Centers at Minority Institutions, Extramural 
Biomedical Research Facilities, and the National Center for 
Minority Health and Health Disparities. Because there are a 
number of new competitive mechanisms for NIH to work with these 
research institutions, the Committee recommends that the NIH 
Director work closely with the Director of the National Center 
on Minority Health and Health Disparities to establish a 
program of coordination among these various mechanisms to 
partner with minority health professions schools to address 
their infrastructure needs.
    Multidisciplinary Research Training.--The Committee 
commends the renewed emphasis NIH is placing on tailoring new 
training opportunities for scientists in the 21st century. The 
OBSSR is working to build a Ph.D.-Plus program that would allow 
behavioral scientists to earn a masters or certificate in 
another field of science, or to allow a biomedical scientist to 
earn a master's in one of the behavioral or social sciences. 
Such highly focused training programs can help fill gaps in 
scientific knowledge by building a workforce that can bridge 
the knowledge and strategies of multiple scientific 
disciplines. The Committee encourages the OBSSR to continue 
these efforts.
    NIH/DOE Medical Technology Partnership.--The Committee 
expects the NIH to continue to collaborate with the Department 
of Energy to evaluate the technologies developed within the 
nuclear weapons program and other DOE programs in terms of 
their potential to enhance health sciences, with the goal of 
achieving clinical applications and improved national health 
care.
    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 
continue its 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 Office of Dietary 
Supplements to contract with industry nonprofit associations or 
foundations who currently have and maintain databases of 
dietary supplement labels to develop, create, regularly 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 Rare Diseases.--The Office of Rare Diseases [ORD] 
plays an important role in bringing funding and attention to 
rare disease research, in cooperation with the institutes and 
centers. The Committee is concerned, however, that ORD has not 
directed sufficient attention to rare liver diseases such as 
autoimmune hepatitis, primary sclerosing cholangitis, and 
primary biliary cirrhosis. The Committee urges ORD to work 
closely with NIDDK to develop an appropriate response to 
address these significant diseases and to work toward a 
comprehensive research agenda.
    Orphan Diseases.--The Committee applauds the Office of Rare 
Diseases for its efforts to support the translation of basic 
research findings into improved treatments for orphan diseases. 
The Committee urges the Office to increase its support for 
demonstration or pilot projects aimed at the development of 
interventions for orphan diseases, including cystic fibrosis.
    Outreach to Hispanics.--The Committee is pleased with the 
leadership that NIH has shown, through its Projecto Ciencia 
initiative, to provide state-of-the-art health material to 
Hispanic consumers and information to Hispanic health 
professionals on NIH research opportunities. The NIH is 
encouraged to increase funding for this initiative with 
expanded emphasis on increasing outreach to Hispanic consumers, 
Hispanic participation in clinical trials, NIH training and 
research opportunities, especially as principal investigators. 
These efforts will support the NIH plan for eliminating racial 
and ethnic disparities.
    Parkinson's Disease.--The Committee is aware that the 
Parkinson's Disease Research Agenda developed by NIH in 2000 
included professional judgment funding projections that totaled 
an additional $1,000,000,000 over 5 years to achieve a cure. 
The Committee strongly urges the NIH to come as close as 
possible to fulfilling that Agenda while maintaining the 
standards of peer review.
    The Committee is greatly concerned, therefore, to learn 
that despite strong congressional support for the aims of the 
Research Agenda, the NIH's projected Parkinson's funding of 
$242,000,000 for fiscal year 2004 again falls substantially 
short of the $400,000,000 professional judgment budget estimate 
cited by the Research Agenda for that year.
    The Committee commends the Director, NIH, for stating his 
commitment to develop and implement a thorough plan for 
Parkinson's research, and for the initial steps taken. However, 
the NIH has failed to devote the resources necessary to 
implement it and has failed to date to fill a key leadership 
position, Director of NINDS.
    The Committee strongly urges the NIH to devote additional 
resources to Parkinson's research, as recommended by the 
Research Agenda, using all available mechanisms, including 
RFAs, further support of initiatives such as those begun at 
NINDS and NIEHS, and the Genome Institute's proteomics 
initiative, among others.
    The Committee expects the NIH to report to Congress by 
April 2004, on the steps it is taking to fulfill the 
Parkinson's Disease Research Agenda and to implement the 
Director's plan for Parkinson's research.
    Practice-Based Clinical Research Networks.--Clinical 
research is more important now than ever before to translate 
advances in basic science into better diagnosis, prevention, 
treatment, and cure of disease; and to provide high-quality 
evidence of diagnosis and treatment effectiveness to fully 
integrate into daily practice decisions. Placing clinical 
studies at the community practice level will ensure adequate 
representation of patients from all age, sex, and cultural 
groups in clinical studies, and will also increase the number 
of practicing clinicians who are trained to undertake clinical 
research. A model for such networks was established by the 
Agency for Healthcare Research and Quality [AHRQ]. The 
Committee urges the Director of the National Institutes of 
Health to adopt the AHRQ model networks to include specialty 
practitioners who care for the most common health problems of 
the American people.
    Scleroderma.--The Committee strongly supports the 
development of new research initiatives to support 
interdisciplinary research centers that will focus on 
scleroderma, a chronic, degenerative disease of collagen 
production, that strikes mainly women and affects multiple 
systems including digestive, kidney, heart, lung, and skin 
often leading to premature death.
    Skeletal Diseases.--Given that skeletal diseases can lead 
to or be linked to other diseases such as depression and 
cancer, the Committee calls for the expansion of trans-NIH 
studies investigating these linkages.
    Temporomandibular joint disorders [TMJ].--The May 2003 
report to Congress on Temporomandibular Joint Disorders 
explains that many Institutes, Centers, and Offices at NIH 
support research that, although not necessarily directed toward 
TMJ disorders, relates to this complex set of conditions. But 
while the research initiatives continue to grow, they lack 
sufficient integration, the report concludes. The Committee 
agrees with this finding. The multifaceted nature of TMJ 
disorders requires an approach that coordinates the work of the 
many interested parties at NIH. Unfortunately, the 
Temporomandibular Joint Diseases Interagency Working Group, the 
creation of which was first requested in fiscal year 1998 
report language from Congress, has not yet succeeded in uniting 
NIH researchers behind a common vision for addressing TMJ 
disorders. While many of the individual TMJ research 
initiatives launched or planned by the NIH over the past 
several years are commendable, there is no clear plan to insure 
that they are the most appropriate initiatives to pursue, that 
they do not duplicate research that is already being supported, 
or that they will actually be implemented in a timely manner. 
For example, the May 2003 report to Congress states that 
``[t]he NIDCR in conjunction with the ORWH has begun to work 
with patient advocacy groups and professional organizations to 
develop a workshop on stigmatization of the TMJ disorders.'' 
This is the exact same language used in the May 2002 report to 
Congress, and there is still no date for the workshop.
    Because of these concerns, the Committee strongly urges the 
Director to oversee the development of a TMJ research agenda 
that would guide further research planning at the NIH, as well 
as the entire scientific community. Such an effort can draw 
upon the TMJ research recommendations from recent conferences 
and should include input from, at a minimum, all of the 
Institutes, Centers, and Offices that support research that 
could be directed toward TMJ disorders, as well as the TMJ 
Association. The Committee expects this agenda to include 
specific short- and long-term goals and the designation of 
``primary leads'' to carry out those goals.
    Translational Research Initiative.--The Committee in the 
past has noted that while research supported by NIH has 
produced a wealth of knowledge about the fundamentals of human 
health and disease, the accumulation of scientific 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 finding 
treatments, cures and prevention strategies for patients. 
Therefore, the Committee urges the Director to devote a 
significant amount of resources for translational and clinical 
research designed to develop and deliver new treatments and 
cures with scientific and therapeutic promise to patients with 
serious illnesses.
    Tuberous Sclerosis Complex.--Tuberous sclerosis complex, or 
TSC, is a genetic disorder that attacks many of the body's 
vital organs including brain, heart, kidneys, lungs, eyes, and 
skin. TSC is characterized by tumor growth and lesions of the 
central nervous system that can result in seizures, autism, 
mental retardation, and kidney failure. An estimated 50,000 
Americans are thought to suffer from TSC, making it more 
prevalent than cystic fibrosis and Lou Gehrig's disease. But 
because it is not widely known by the general public, nor 
commonly recognized by medical professionals, the number of 
individuals with TSC could be far greater. The Committee is 
concerned that insufficient funds are being devoted to research 
on TSC, and that because of its far-reaching effects on 
multiple organ systems the key to research breakthroughs may 
rest with several institutes. The Committee therefore strongly 
urges the NIH Director to formulate an NIH-wide research 
agenda, including an appropriate mechanism to coordinate 
research efforts across institute lines, and report by April 
2004.
    Young Investigators and Clinical Scientists.--The Committee 
understands that there is an urgent need for more young 
investigators and clinical scientists, and therefore urges NIH 
to establish a trans-NIH initiative to allocate more funds for 
training and transitional grants and debt repayment programs, 
and revise eligibility guidelines, funding levels and scope to 
further their effectiveness.

                        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, 2003....................................    $628,687,000
Budget estimate, 2004...................................      80,000,000
Committee recommendation................................      89,500,000

    The Committee recommends an appropriation of $89,500,000 
for buildings and facilities [B&F;]. The budget requested 
$80,000,000 and the fiscal year 2003 appropriation was 
$628,687,000.
    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. Funds 
have also been included for the building 10 transition program, 
asbestos abatement, fire protection and life safety, 
rehabilitation of the animal research facility and air quality 
improvement programs. Funds have also been included to 
eliminate barriers to persons with disabilities.

       Substance Abuse and Mental Health Services Administration

Appropriations, 2003....................................  $3,211,740,000
Budget estimate, 2004...................................   3,409,315,000
Committee recommendation................................   3,274,590,000

    The Committee recommends $3,274,590,000 for the Substance 
Abuse and Mental Health Services Administration [SAMHSA] for 
fiscal year 2004. The comparable level for fiscal year 2003 was 
$3,211,740,000 and the administration request was 
$3,409,315,000. The recommendation includes $117,050,000 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 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.
    The Committee continues to strongly support the ongoing 
collaboration between SAMHSA and the National Institutes of 
Health, specifically the National Institute of Mental Health, 
the National Institute on Drug Abuse, and the National 
Institute on Alcohol Abuse and Alcoholism. The Committee urges 
SAMHSA to make concerted efforts 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 troubled by SAMHSA's letter to the 
National Academy of Sciences Institute of Medicine recommending 
that it include traditional advocacy groups and the alcoholic 
beverage industry as peer reviewers for the NAS/IOM report on a 
national strategy to reduce and prevent underage drinking prior 
to the report's release. The Committee provided funding to the 
NAS for this report in fiscal year 2002 because it values the 
NAS's reputation for objectivity, independence, and competence, 
and it has confidence that the NAS will offer the most 
appropriate science-based findings and recommendations. SAMHSA 
should not recommend the involvement of groups with potential 
conflicts of interest in the peer review process. The Committee 
believes the NAS has developed appropriate policies for the 
conduct of the peer review process that will ensure a balanced, 
objective and science-based report.

                   CENTER FOR MENTAL HEALTH SERVICES

Appropriations, 2003....................................    $856,487,000
Budget estimate, 2004...................................     834,006,000
Committee recommendation................................     855,711,000

    The Committee recommends $855,711,000 for mental health 
services. The comparable level for fiscal year 2003 was 
$856,487,000 and the administration request was $834,006,000. 
The recommendation includes $21,850,000 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.

Programs of Regional and National Significance

    The Committee recommends $237,667,000 for programs of 
regional and national significance. The comparable level for 
fiscal year 2003 was $244,443,000 and the administration 
request was $211,757,000. 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 notes that approximately 22 percent of U.S. 
adults--about 44 million people--are affected by a diagnosable 
mental disorder. Approximately 5 to 7 percent of adults in a 
given year have a serious mental illness. Yet nearly two-thirds 
of adults with diagnosable mental disorders do not seek 
treatment. One in ten children and adolescents suffer from 
mental illness severe enough to cause some level of impairment, 
but fewer than 1 in 5 of these children receive needed 
treatment. The cost of untreated mental illness is immense: 
estimates show that mental illness annually costs employers 
about $300,000,000,000 in absenteeism and lowered productivity. 
When compared with all other diseases (such as cancer and heart 
disease), mental illness ranks first in terms of causing 
disability in the United States, Canada, and Western Europe.
    These figures underscore the urgency of treating mental 
illness. The U.S. Surgeon General's Report on Mental Health 
identified stigma as a major barrier to people receiving mental 
health treatment. Stigma can discourage individuals and their 
families from seeking help and can also result in inadequate 
insurance coverage for mental health services. The Committee 
understands that the President's New Freedom Commission on 
Mental Health will be issuing its final report shortly with 
recommendations to improve America's mental health service 
delivery system for individuals with serious mental illness and 
children with serious emotional disturbances. In the interim, 
the Committee believes it is time to launch a national public 
awareness campaign to build public support for treatment, 
recovery and community-based mental health services to overcome 
the stigma associated with mental illness. The Committee has 
provided $2,500,000 to SAMHSA to develop and advertise a public 
service campaign to destigmatize mental illness.
    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 notes that suicide continues to claim almost 
30,000 lives each year, making it one of the top 15 causes of 
death in the United States. An additional 500,000 Americans 
attempt suicide annually. For 15- to 24-year-olds, suicide is 
the third leading cause of death. The Committee continues to 
support State and local efforts to reduce the occurrence of 
this premature and unfortunate loss of life. 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 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 continues to recognize the importance of 
consumer/peer-run programs that help people with mental 
illnesses live successfully in the community. These low-cost 
services have an impressive record of assisting people with 
mental disorders to decrease their dependence on expensive 
social services and avoid psychiatric hospitalization. The 
Committee provides $2,000,000 above the budget request 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 funding of $4,895,000 
to continue the elderly treatment and outreach program. 
Demographic projections show that by the year 2010, there will 
be approximately 40 million Americans over the age of 65. The 
Committee notes that more than 1 in 5 will experience mental 
disorders. This grant program will help local communities 
establish the infrastructure necessary to better serve the 
mental health needs of older adults.
    The Committee supports $6,059,000 for the jail diversion 
grant program. The Committee recognizes that up to 1 million 
individuals with mental illnesses will spend time either in 
jail or prison during the current year. This is a most 
unfortunate statistic, when individuals could be more 
appropriately treated in a community health setting. Therefore, 
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 notes that an estimated 842,000 adults and 
children are homeless in the United States in any given week. 
Approximately 200,000 people are chronically homeless. The 
Committee supports the Department's plan released earlier this 
year to end chronic homelessness. The Committee recommendation 
includes funding at no less than last year's level to support 
programs addressing homelessness.
    The Committee remains concerned about the ongoing problem 
of post-traumatic stress disorder among the refugee immigrant 
population in Hawaii, and it urges vigorous attention to the 
mental health problems of these future citizens.
    The Committee also recognizes the urgency of training 
additional minority mental health professionals, including 
Native Hawaiians, and it encourages SAMHSA to provide 
additional resources to the Minority Fellowship Program.
    Between 7 million to 10 million teenagers suffer from a 
mental health condition which, for many, may lead to serious 
behavioral problems including dropping out of school, substance 
abuse, violence, and suicide. The Committee is aware that some 
school districts, juvenile justice facilities, and community-
based clinics have taken advantage of relatively simple 
screening tools now available to detect depression, the risk of 
suicide, and other mental disorders in teenagers. The Committee 
believes that screening should occur with the consent of the 
adolescent and his or her parents or guardian, and with a 
commitment by the screener to make counseling and treatment for 
those found to be at-risk. The Committee strongly urges SAMHSA 
to make the availability of these screening programs more 
widely known, and to collaborate with the Department of 
Education, Department of Justice, CDC, HRSA, and other 
pertinent agencies to encourage implementation of similar 
teenage screening programs. The Committee expects to receive a 
report on steps being taken to promote this effort prior to the 
fiscal year 2005 appropriations hearings.

Mental Health Performance Partnership Block Grant

    The Committee recommends $437,140,000 for the mental health 
performance partnership block grant, the same amount as the 
comparable fiscal year 2003 level. The administration's request 
was $433,000,000. The recommendation includes $21,850,000 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 $98,052,000 for the children's 
mental health services program, the same as the comparable 
fiscal year 2003 level. The administration's request was 
$106,694,000. 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.

Projects for Assistance in Transition From Homelessness [PATH]

    The Committee recommends $47,073,000 for the PATH Program. 
The comparable fiscal year 2003 level was $43,073,000 and the 
administration's request was $50,055,000.
    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.
    The Committee notes that the PATH program has been 
described by the administration in its performance assessments 
as ``moderately effective.'' The administration notes that the 
program's existing data indicate progress toward meeting long-
term performance measures. Additionally, evaluations have found 
that PATH succeeds at targeting homeless individuals with 
serious mental illness. For example, 35 percent of clients who 
received funded services were diagnosed with schizophrenia or 
some other psychotic disorder. An additional 30 percent were 
diagnosed with an effective disorder such as major depression 
or bipolar disorder. The Committee shares the administration's 
assessment and intends to continue supporting this important 
and effective program.

Protection and Advocacy

    The Committee recommends $35,779,000 for the protection and 
advocacy program. The comparable fiscal year 2003 level was 
$33,779,000 and the administration's request was $32,500,000. 
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.
    The Children's Health Act of 2000 provided additional 
authorities to State P&A; systems in their efforts to protect 
the rights of individuals with mental illness and severe 
emotional impairment. State P&A; systems also have a significant 
role in addressing the community integration needs of 
individuals identified in the Olmstead decision. The Committee 
has provided additional resources to support State P&A; systems 
in their effort to address these critical issues.

                  CENTER FOR SUBSTANCE ABUSE TREATMENT

Appropriations, 2003....................................  $2,071,210,000
Budget estimate, 2004...................................   2,341,816,000
Committee recommendation................................   2,131,003,000

    The Committee recommends $2,131,003,000 for substance abuse 
treatment programs. The comparable fiscal year 2003 funding 
level is $2,071,210,000 and the administration's request was 
$2,341,816,000. The recommendation includes $79,200,000 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 is concerned with the devastating impact 
substance abuse has on our country. A conservative estimate of 
those in need of substance abuse treatment is between 13 and 16 
million people. In contrast, studies conclude that 
approximately 3 million receive care for substance abuse in 1 
year. As a result our Nation faces a ``treatment gap'' of more 
than 10 million people--those who need treatment, but do not 
receive the services necessary to address their problems. It is 
estimated that more than 100,000 people have sought treatment 
but were unable to find it.
    The Committee commends the President for highlighting 
substance abuse treatment in his 2003 State of the Union 
address and for providing additional funding in his budget 
request to address the treatment gap. The Committee is aware 
that the economic cost to society of substance abuse has 
reached more than $250,000,000,000 a year. Over the next 20 
years, it is estimated that substance abuse is likely to cost 
the Medicare program $1,000,000,000,000 for hospital care. Yet 
treatment is remarkably successful: research shows that 
treatment reduces drug use, criminal activity, homelessness, 
and behaviors that are high risk for developing HIV/AIDS 
infection. Similarly, clients in drug addiction treatment 
report increases in employment and income, as well as 
improvements in mental and physical health. Treatment is also 
extremely cost-effective: every $1 invested in substance abuse 
treatment has a return of $7 in reduced health costs, crime and 
lost productivity. The Committee believes that additional 
funding for substance abuse treatment is desperately needed and 
for this reason has provided $50,000,000 above last year's 
level for the substance abuse prevention and treatment block 
grant.
    The Committee has noted with interest the administration's 
Access to Recovery initiative to provide vouchers to States for 
substance abuse treatment services. However, due to tight 
budget constraints the Committee has not provided funding for 
the administration's initiative. In addition, the Committee has 
concerns that many implementation issues have not been 
resolved, such as the role of professional assessment, 
certification requirements, and the administrative costs of 
setting up a separate voucher program for treatment. The 
Committee is supportive of the administration's desire to 
expand the pathways to treatment, but believes that more 
details need to be resolved before major resources are provided 
to a new program.
    While the Committee commends SAMHSA for the work done to 
address the treatment gap, it is concerned that the request for 
additional treatment resources come at the expense of substance 
abuse prevention activities. The Committee strongly believes 
that treatment and prevention are both key to reducing 
substance abuse. The Office of National Drug Control Policy has 
included prevention along with treatment and market disruption 
as its three priorities for its national drug control strategy. 
The ONDCP has recognized prevention as our first line of 
defense, and notes ``it is critical to teach young people how 
to avoid drug use because of the damage drugs can inflict on 
their health and on their future.'' The Committee strongly 
agrees, and has made the restoration of SAMHSA's drug 
prevention programs a priority.

Programs of Regional and National Significance

    The Committee recommends $327,071,000 for programs of 
regional and national significance [PRNS]. The comparable 
fiscal year 2003 level was $317,278,000 and the 
administration's request was $556,816,000.
    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 has not provided funding for the Access to 
Recovery initiative due to budget constraints. The Committee 
also believes that more details need to be resolved before 
major resources are provided to this new program.
    The Committee is concerned about the incidence of drug 
addiction among pregnant and parenting women. The national 
treatment infrastructure has not kept pace with the demand or 
complexity of needs experienced by women and their children. 
Only 21 percent of treatment facilities offer programs for 
pregnant and postpartum women. In addition, only 6 percent of 
treatment programs include prenatal care and only 12 percent 
provide childcare. Mothers with substance abuse problems and 
their children require distinct, family-oriented treatment 
services that address the injuries of sexual and physical 
violence, major depression and other underlying issues. 
SAMHSA's evaluation of both the Residential Women and Children 
[RWC] and Pregnant and Postpartum Women [PPW] programs showed 
significantly reduced alcohol and drug use, as well as 
decreased criminal behavior. Rates of premature delivery, low 
birth weight, and infant mortality were improved for 
participating women. In addition, treatment costs were offset 
three to four times by savings from reduced costs of crime, 
foster care, Temporary Assistance to Needy Families [TANF], and 
adverse birth outcomes. 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.
    The Committee has provided funding at no less than last 
year's level for CSAT's program of clinically based treatment 
and related services for adult, juvenile and family drug courts 
and individuals returning from the community who are on 
probation, parole, or unsupervised release. The Committee is 
aware of the rapid increases in the use of drug courts 
throughout the country as an alternative to the traditional 
court system. These courts make substance abuse treatment 
available, when appropriate, as an alternative to 
incarceration, and are considered a cost-effective approach to 
helping drug users regain control of their lives.
    The Committee recommends funding at no less than last 
year's level to CSAT's grants for homeless individuals program, 
a collaboration between CSAT and CMHS addressing the substance 
abuse and mental health treatment needs of homeless 
individuals. The Committee notes that as many as half of 
homeless adults have histories of alcohol abuse or dependence, 
one-third have histories of drug abuse and one-quarter have 
lifetime histories of serious mental illness. The Committee 
encourages these Centers to devote as much additional funding 
as possible for new awards.
    Programs of regional and national significance include 
critical support for substance abuse treatment services for the 
Nation's homeless population. The homeless have unique needs 
and life circumstances that have received inadequate attention 
in terms of substance abuse treatment. Therefore, the Committee 
continues to advocate coordinated and seamless service delivery 
for the homeless that includes mental health, primary care, and 
other social services that will support positive treatment 
outcomes. The Committee recommendation includes funding at no 
less than last year's level to continue to make progress in 
this area.
    The Committee has provided funding at no less than last 
year's level on targeting specific treatment approaches for 
adolescents. The Committee is aware of the lack of available 
treatment programs specifically designed to address the needs 
of adolescents. The Committee believes that adolescents would 
respond more favorably to treatment services offered in such a 
manner.
    The Committee recommendation includes no less than 
$35,000,000 for programs funded under targeted capacity 
expansion [TCE] for general populations. These programs are 
designed to address gaps in treatment capacity by supporting 
rapid and strategic responses to demands for treatment services 
in communities with serious, emerging drug problems.
    The Committee expresses its support for the following 
programs and has included funding at no less than last year's 
level: minority HIV/AIDS, addiction technology transfer 
centers, pharmacologic activities, young offender reentry, and 
targeted treatment capacity expansion. The Committee has also 
recommended funding at the administration's request for 
programs addressing co-occurring disorders, aging adults, 
criminal justice activities, and knowledge, development and 
application activities.
    The Committee is concerned that States have been declared 
ineligible to apply for certain targeted capacity expansion 
grants. The Committee expects SAMHSA to submit to the Committee 
a plan in the fiscal year 2005 budget request to address this 
issue for all TCE and other appropriate grants.
    The Committee recognizes the need for a qualified and 
stable workforce to staff treatment centers. The unmet need for 
treatment services is exacerbated by a workforce crisis in the 
field of addictions treatment and prevention. The Committee 
urges SAMHSA to evaluate workforce recruitment, training 
shortages and retention.

Substance Abuse Prevention and Treatment Block Grant

    The Committee recommends $1,803,932,000 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 comparable level for 
fiscal year 2003 was $1,753,932,000 and the administration 
request was $1,785,000,000. 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 the transition from the current block grant 
to a performance partnership grant [PPG] framework, in which 
States are granted program flexibility in exchange for 
implementing a common set of performance measures. The 
Committee's recommendation reflects its belief that the most 
effective and efficient method to support substance abuse 
programs in every State is to direct the bulk of available new 
resources into the PPG. The Committee wishes to express its 
strong support for preserving the current block grant and 
future PPG as the foundation of our publicly funded substance 
abuse system in every State and territory in the United States. 
Similarly, the Committee is concerned with any effort that 
could erode the strength of the current and future block grant. 
At a time when States are facing fiscal crises, with some 
cutting substance abuse services, the maintenance of treatment 
infrastructure and capacity at the local level is extremely 
important. The Committee encourages SAMHSA to make the 
implementation of the PPG its number one priority for substance 
abuse programming and to allocate commensurate resources to 
support the transition to reflect this priority status.

                 CENTER FOR SUBSTANCE ABUSE PREVENTION

Appropriations, 2003....................................    $197,111,000
Budget estimate, 2004...................................     148,186,000
Committee recommendation................................     194,306,000

    The Committee recommends $194,306,000 for programs to 
prevent substance abuse. The comparable fiscal year 2003 level 
was $197,111,000 and the administration request was 
$148,186,000. This amount funds substance abuse prevention 
programs of regional and national significance.
    The Committee has restored $46,120,000 to the Center for 
Substance Abuse Prevention in recognition of CSAP's key role in 
improving the capacity and effectiveness of substance abuse 
prevention at the State and community levels. The Monitoring 
the Future study showed broad decreases in drug use from 2001 
to 2002, with students in all grades showing declines in 
prevalence for the use of illicit drugs. The use of ecstasy 
showed significant declines for the first time after rising 
rapidly in recent years. The proportion of 8th and 10th graders 
reporting the use of any illicit drug in the prior year 
declined significantly. The use of marijuana among eighth-
graders is at its lowest rate since 1994. 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 believes this is not the time 
to reduce CSAP's funding.
    In addition, 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 CSAP's study of 
data from its High Risk Youth program demonstrate an overall 
decrease of approximately 25 percent in the frequency of 
substance abuse among 11- to 17-year olds participating in the 
program. New and emerging drug trends, such as ecstasy, coupled 
with the need to sustain prevention efforts over time so that 
each new cohort of youth has the benefit of effective 
prevention, necessitate the restoration of funding for CSAP. 
The Committee is concerned that the trend of the administration 
to request insufficient funding levels for CSAP not only 
endangers recent drug prevention efforts, it also hampers the 
ability of SAMHSA to plan for and fund longer-term grants, 
especially in critical areas such as emerging drug trends. With 
the restored funding, 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 $194,306,000 for programs of 
regional and national significance [PRNS]. The comparable 
fiscal year 2003 level was $197,111,000 and the administration 
request was $148,186,000. 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.
    The Committee notes that over the past 10 years there has 
been an alarming increase in the use and availability of 
ecstasy and other club drugs among our Nation's youth. 
According to SAMHSA's Drug Abuse Warning Network, ecstasy-
related emergency room admissions in the United States 
increased significantly from 253 in 1994 to 5,542 in 2001. The 
Committee urges SAMHSA to pay close attention to this and other 
emerging drug use issues. The Committee has included $5,000,000 
to continue and expand on the program funded last year.
    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 $10,000,000 to strengthen system-wide 
approaches to identify and serve women at risk of delivering 
FAS/FAE children, with an emphasis on teen mothers.
    The Committee strongly supports CSAP's evidence-based 
practices, especially the community-initiated prevention grant 
program. This program supports field testing of effective 
substance abuse interventions in the local community that 
prevent, reduce, or delay substance use and substance abuse 
related problems. The Committee has provided funding for this 
program at no less than last year's level for identifying the 
mix of environmental and other strategies to most effectively 
reduce youth drug and alcohol use. The Committee also continues 
to support the high risk youth program at no less than last 
year's level of funding.

                           PROGRAM MANAGEMENT

    The Committee recommends $93,570,000 for program management 
activities of the agency. The recommendation includes 
$16,000,000 in transfers available under section 241 of the 
Public Health Service Act. The comparable level for fiscal year 
2003 was $85,983,000 and the budget request was $85,307,000.
    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 is concerned that SAMHSA has not yet provided 
Congress information detailing the resources each State will 
need for data infrastructure and other needs to support a 
transition to a performance partnership grant as called for in 
the Children's Health Act of 2000. The Committee expects SAMHSA 
to work with the State and local substance abuse community in 
order to accurately determine the resources needed for the new 
and expanded data collection requirements and to report this 
information to Congress expeditiously.
    In an effort to reach a more accurate assessment of the 
substance abuse treatment gap, the Committee expects SAMHSA to 
encourage other Federal agencies that fund substance abuse 
treatment services to participate in a client level data system 
administered by SAMHSA.

               Agency for Healthcare Research and Quality

Appropriations, 2003....................................    $303,695,000
Budget estimate, 2004...................................     279,000,000
Committee recommendation................................     303,695,000

    The Committee recommends $303,695,000 for the Agency for 
Healthcare Research and Quality [AHRQ]. This amount is the same 
as the comparable funding level for fiscal year 2003. The 
administration request was $279,000,000. 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 $245,695,000 for research on health 
costs, quality and outcomes [HCQO]. The comparable amount for 
fiscal year 2003 was $247,695,000. 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. 
The Committee does not approve the administration's proposal to 
shift $10,000,000 to the Department of Commerce for the Current 
Population Survey and directs that none of AHRQ's funds be used 
or transferred for this purpose.
    For fiscal year 2004, 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 $29,000,000 over the comparable fiscal year 2003 
level. The Committee understands that $50,000,000 of the 
recommendation will support an initiative to promote the 
development, adoption, and diffusion of information technology 
[IT] in health care. The Committee fully supports the 
Department's emphasis on information technology as a way to 
improve patient safety. The U.S. health care system lags behind 
others in the utilization of the internet and information 
technology applications. Greater investments in computer 
technology advances such as computerized physician order entry, 
automated medication dispensing and computerized patient 
records have enormous potential to greatly improve health care 
safety, efficiency and quality. In addition, these types of IT 
improvements have frequently been shown to have the ancillary 
benefit of improving cost savings.
    Since fiscal year 2001 the Committee has provided 
$165,000,000 to AHRQ for research into ways to reduce medical 
errors. The Committee understands that the Department is 
preparing an interim report, due in September, on the results 
of medical error research and demonstration projects. The 
Committee looks forward to receiving this report and hopes it 
will detail the effectiveness of different strategies for 
reducing medical errors, as well as suggest ways of promoting 
the use of effective strategies in hospitals and other clinical 
settings.
    While the Committee recognizes the urgency of minimizing 
medical errors, it believes that improving patient safety is 
only one part of a strategy to improve the overall quality of 
health care in this country. In its report ``Crossing the 
Quality Chasm: A New Health System for the 21st Century,'' the 
Institute of Medicine noted that a gap exists between the 
health care services that should be provided based on current 
professional knowledge and technology, and those that many 
patients actually receive. While there has been a dramatic 
growth in spending on medical research and technology, the IOM 
noted that ``our health care system frequently falls short in 
its ability to translate knowledge into practice, and to apply 
new technology safely and appropriately.'' Recent studies 
indicate that fewer than half of U.S. patients with 
hypertension, depression, diabetes and asthma are receiving 
appropriate treatment. In addition, a recent study suggests 
that while Americans pay higher prices for health care than any 
other country, according to many measures we are getting less 
care than people in other industrialized countries. For this 
reason, the Committee is concerned that that the current 
funding level will not allow AHRQ to award any new non-patient 
safety grants. The Committee believes that limiting AHRQ's 
research to patient safety will impair promising research into 
strategies to reduce health care costs, improve access to 
effective services, and translate medical research into 
practice at precisely the time that such research is needed to 
improve the efficiency of health care. The Committee urges the 
Secretary to commit increased resources to non-patient safety 
research at AHRQ in its fiscal year 2005 budget request.
    Chiropractic Care.--The Committee believes additional 
research is necessary to further quantify the already-known 
benefits of chiropractic care. The results of several patient-
based studies suggest that chiropractic care may result in 
significant savings of healthcare dollars and reduce physician 
visits and hospital stays. The Committee encourages AHRQ to 
develop objective outcome-based assessment tools and a 
systematic data gathering and analysis process leading to the 
development of ``best practices'' for enhancing the physical, 
mental, and social aspects of health in a diverse patient 
population.
    Drug Metabolism.--The Committee is very concerned that a 
high percentage of admissions to psychiatric hospitals are 
necessitated by moderate to severe adverse drug effects. 
Genetic testing has been promoted as a means to improve drug 
safety and efficacy, particularly since microarray technology 
now allows testing across various drug response pathways in a 
timely and cost effective manner. The practicality of applying 
genetic information in clinical practice, however, depends on 
the determination of whether genotype predicts dose response or 
adverse events, affects clinical outcomes, and alters the cost 
of patient care significantly. The Committee urges the Agency 
to support evidence-based research projects focused on the 
relationship between metabolic genes and drug efficacy and 
safety. The Committee also urges the Agency to disseminate 
evidence-based reports to physicians and other health care 
professionals.
    Mental Health and Older Americans.--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 the Agency 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.
    Primary Immunodeficiencies Diseases.--The Committee remains 
concerned with the underdiagnosis of this class of diseases. 
Research has shown that screening of health records in a 
hospital emergency department can result in significant 
increases in the identification of these patients. The 
Committee urges AHRQ to support evidence-based research 
projects focused on the diagnosis of PI in a large urban health 
care system and to disseminate evidenced based reports to 
physicians and other health care professionals.
    Social Work Research.--In support of the AHRQ priority of 
``translating research into practice'' the Committee recommends 
that AHRQ work with social work leaders to increase the number 
of social work researchers undertaking health services 
research. Social work research addresses health disparities, 
mental illness and co-occurring disorders, delivery of health 
and mental health care in community settings and health care 
for older Americans. The Committee encourages dissemination of 
evidence-based reports to social work health care 
professionals.
    Treatment of Chronic Rhinosinusitis.--The National Health 
Interview Survey indicates that ``sinusitis'' is the most 
common chronic health complaint in the United States. An 
estimated 31 million Americans experience rhinosinusitis each 
year, accounting for 18 million annual visits to primary care 
physicians at an estimated direct healthcare cost of almost 
$6,000,000,000. Studies are needed of overall clinical 
effectiveness of the treatment of chronic rhinosinusitis, 
comparing the effectiveness of medical and surgical treatment 
options, and assessing the impact of co-morbid disease such as 
asthma, allergy, immunodeficiency, etc. on treatment 
effectiveness. The Committee recommends that AHRQ consider 
supporting research studies comparing treatment options of 
chronic rhinosinusitis.

                   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. The comparable fiscal year 2003 
level was $53,300,000. 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 2003 level. This activity supports the 
overall management of the Agency.

                Centers for Medicare & Medicaid Services


                     GRANTS TO STATES FOR MEDICAID

Appropriations, 2003....................................$112,090,218,000
Budget estimate, 2004................................... 124,892,197,000
Committee recommendation................................ 124,892,197,000

    The Committee recommends $124,892,197,000 for Grants to 
States for Medicaid. This amount is $12,801,979,000 more than 
the fiscal year 2003 appropriation and the same as the 
administration's request. This amount excludes $51,861,386,000 
in fiscal year 2003 advance appropriations for fiscal year 
2004. In addition, $58,416,275,000 is provided for the first 
quarter of fiscal year 2005, 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, 2003.................................... $81,462,700,000
Budget estimate, 2004...................................  95,084,100,000
Committee recommendation................................  95,084,100,000

    The Committee recommends $95,084,100,000 for Federal 
payments to health care trust funds. Amount is the same as the 
administration's request and is an increase of $13,621,400,000 
from the fiscal year 2003 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 $94,518,000,000 for the Federal 
payment to the Supplementary Medical Insurance Trust Fund. This 
payment provides matching funds for premiums paid by Medicare 
Park B enrollees. This amount is the same as the 
administration's request and is $13,613,000,000 more than the 
fiscal year 2003 amount. The increase includes $3,035,000,000 
to cover an anticipated shortfall in the amount appropriated in 
fiscal year 2003.
    The recommendation also includes $197,000,000 for hospital 
insurance for the uninsured. This amount is the same as the 
administration's request and is $28,000,000 less than the 2003 
amount.
    The Committee also recommends $168,000,000 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 both the administration's request and the fiscal 
year 2003 appropriation.
    The Committee recommendation includes $201,100,000 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 
$36,400,000 more than the fiscal year 2003 level.

                           PROGRAM MANAGEMENT

Appropriations, 2003....................................  $2,564,891,000
Budget estimate, 2004...................................   2,733,507,000
Committee recommendation................................   2,707,603,000

    The Committee recommends $2,707,603,000 for CMS program 
management, which is $25,904,000 less than the amount requested 
by the administration and $142,712,000 more than the fiscal 
year 2003 enacted level.

Research, Demonstrations, and Evaluations

    The Committee recommends $67,400,000 for research, 
demonstrations, and evaluation activities. This amount is 
$4,000,000 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 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.
    The Committee understands that States are working to 
rebalance their long term care systems, but information on the 
techniques and aggregate costs is lacking. Therefore, the 
Committee expects CMS to work with three to eight States and 
research the program management techniques used by these States 
to provide adequate services while effectively managing 
aggregate costs as States rebalance their long term care 
systems to reduce reliance on institutional services and 
increase community based services. CMS should also work with 
these States to gather and report on the changes in aggregate 
costs and per person expenditure to the Medicaid program and 
the numbers of individuals receiving institutional care and 
community based care. CMS should give preference to States 
implementing statewide initiatives.

Medicare Operations

    The Committee recommends $1,776,889,000 for Medicare 
operations, which is the amount requested by the administration 
and $110,209,000 more than the comparable fiscal year 2003 
appropriation. 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.

State Survey and Certification

    The Committee recommends $252,743,000 for Medicare State 
survey and certification activities, which is the same as the 
fiscal year 2003 level. The Committee understands that this 
level of effort will be supplemented by support contracts 
funded through the Quality Improvement Organizations activity.
    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 $580,571,000 for Federal 
administration costs, which is an increase of $8,815,000 to the 
fiscal year 2003 level. This funding level allows for a 2 
percent pay raise in January 2004, as proposed by the 
administration.
    The Committee urges CMS to articulate clear guidelines and 
to set expeditious timetables for consideration of new 
technologies, procedures and products for Medicare coverage 
including standards regarding Medicare coverage of positron 
emission tomography [PET]. The effect of these delays in 
instituting Medicare coverage could delay benefits of these 
technologies and procedures to Medicare patients. The Committee 
also expects CMS to avoid requiring new technologies to repeat 
clinical trials and testing already successfully completed by 
the new technologies in the process of gaining FDA approval or 
in NIH clinical trials and which serve as signals to private 
insurers to cover new technologies. The Committee urges CMS not 
to require substantially different levels of evidence to 
approve various new products for Medicare coverage, requiring, 
for example, very little documentation for approval of MRA 
(magnetic resonance angiography), while at the same time 
continuing to demand voluminous amounts of data to make a 
coverage decision on PET. The Committee urges the 120-person 
Medicare Coverage Advisory Committee to make a decision on 
coverage of PET. Because of the possible duplication of efforts 
among HHS agencies and related unnecessary costs to the 
Medicare program and the Department, the Committee again asks 
that the Secretary take a leadership role in resolving this 
matter expeditiously.
    The Committee is aware that a proposed rule to revise the 
Medicare hospital conditions of participation was issued in 
December, 1997, and has never been finalized. Among other 
things, the proposed rule would have removed many of the overly 
prescriptive requirements in current regulations regarding the 
types of practitioners who may perform particular functions in 
a hospital, deferring instead to applicable State law; the 
Committee urges the Centers for Medicare and Medicaid Services 
[CMS] to finalize these regulations.
    The Committee expects the Secretary to issue ``L'' codes, 
with appropriate safeguards to prevent fraud and abuse, based 
on fair and reasonable reimbursement levels to cover Total Body 
Orthotic Management for Non-Ambulatory severely disabled 
nursing home residents. This responds to a long-standing 
Committee concern about an unintended consequence of HCFA 
Ruling 96-1. The Committee notes the May 2002, congressionally 
authorized GAO report entitled ``Orthotics Ruling Has 
Implications for Beneficiary Access and Federal and States 
Costs'' that identifies a nursing home population that has been 
denied this care as a result of 96-1, but recommends that a 
restoration of such care be accompanied by appropriate 
controls, consistent with those established for existing ``L'' 
codes, that protect the integrity of the Medicare Program.
    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 13 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 requests a briefing as 
to his timeline for action by August 1, 2003. By October 1, 
2003, 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 $30,000,000, compared to 
$65,000,000 requested by the administration, to remain 
available for 2 years, as the first-year investment in CMS's 
efforts to make significant improvements to key aspects of 
managing the agency and the Medicare program. Funding in fiscal 
year 2004 will target system-related improvements.

                Administration for Children and Families


  PAYMENTS TO STATES FOR CHILD SUPPORT ENFORCEMENT AND FAMILY SUPPORT 
                                PROGRAMS

Appropriations, 2003....................................  $2,779,348,000
Budget estimate, 2004...................................   3,245,970,000
Committee recommendation................................   3,292,270,000

    The Committee recommends $3,292,270,000 be made available 
in fiscal year 2004 for payments to States for child support 
enforcement and family support programs. The comparable funding 
level for fiscal year 2003 is $2,779,348,000 and the budget 
request includes $3,245,970,000 for this program. The Committee 
recommendation provides the full amount requested under current 
law. The budget request includes savings of $47,000,000 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 noncustodial 
parents, determine paternity when necessary, and establish and 
enforce orders of support. The appropriation, when combined 
with the $1,100,000,000 in advance funding provided in last 
year's bill and an estimated $179,300,000 from offsetting 
collections, supports a program level of $4,572,270,000.
    The Committee also has provided $1,200,000,000 in advance 
funding for the first quarter of fiscal year 2005 for the child 
support enforcement program, the same as the budget request.

               LOW-INCOME HOME ENERGY ASSISTANCE PROGRAM

Appropriations, 2003....................................  $1,688,950,000
Budget estimate, 2004...................................   2,000,000,000
Committee recommendation................................   2,000,000,000
    The Committee recommends $2,000,000,000 for fiscal year 
2004 for LIHEAP. The comparable funding level for fiscal year 
2003 is $1,688,950,000 and the budget request includes 
$2,000,000,000 for this program. LIHEAP is made up of two 
components: the State grant program and the contingency fund.
    The Committee recommendation includes $2,000,000,000 for 
fiscal year 2004 for the State grant program. The comparable 
funding level for fiscal year 2003 is $1,688,950,000 and the 
budget request includes $1,700,000,000 for this program. 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 does not include resources for fiscal year 
2004 for the contingency fund. The budget request includes 
$300,000,000 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 2004 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, 2003....................................    $478,048,000
Budget estimate, 2004...................................     461,626,000
Committee recommendation................................     428,056,000

    The Committee recommends $428,056,000 for fiscal year 2004 
for refugee and entrant assistance. The comparable funding 
level for fiscal year 2003 is $478,048,000 and the budget 
request includes $461,626,000 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 80,000, 
this appropriation, together with prior-year funds available 
for fiscal year 2004 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.
    The Committee is committed to ensuring that the American 
public is safe and not exposed to potential security risks. 
However, the Committee also is concerned about the additional 
hardships imposed on individuals fleeing their homes from civil 
strife, persecution, and torture as they await a multitude of 
security procedures in potentially dangerous temporary 
locations and refugee camps. As a result of these delays, 
almost 40,000 refugees, who were eligible under the admissions 
ceiling for fiscal year 2002, were not allowed to resettle in 
the United States. In addition, current estimates indicate that 
actual refugee admissions for fiscal year 2003 will be equally 
short of the admissions ceiling.
    These unused slots resulted in program savings due to fewer 
transitional, medical, and support services provided than 
estimated under prior appropriations. The Committee 
recommendation will not affect the ability of programs to meet 
fully the demand for services under the admissions ceiling, as 
sufficient carryover funds are available to offset the proposed 
reduction. The Committee intends to closely monitor the 
situation to ensure that sufficient funding is available to 
meet the critical needs of individuals fleeing persecution.
    In order to carry out the refugee and entrant assistance 
program, the Committee recommends $180,000,000 for transitional 
and medical assistance, including State administration and the 
voluntary agency program; $9,935,000 for victims of 
trafficking; $140,000,000 for social services; $4,804,000 for 
preventive health; and $49,155,000 for targeted assistance.
    Due to the realignment of the former Immigration and 
Naturalization Service [INS], and pursuant to section 462 of 
the Homeland Security Act of 2002, funds are now 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 
recommends $34,227,000 for unaccompanied children.
    The Committee also recommends $9,935,000 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.
    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, 2003....................................  $2,086,344,000
Budget estimate, 2004...................................   2,099,729,000
Committee recommendation................................   2,099,729,000
    The Committee recommends $2,099,729,000 for fiscal year 
2004 for child care and development block grant. The comparable 
funding level for fiscal year 2003 is $2,086,344,000 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 is aware that the authorization for the child 
care and development block grant program expired on September 
30, 2003. The block grant was last reauthorized in 1996 as part 
of the Personal Responsibility and Work Opportunity 
Reconciliation Act. The Act established the child care and 
development fund, which consists of mandatory funding provided 
under the Social Security Act and discretionary funding 
supported by annual appropriations under the child care and 
development block grant program. The Committee believes that 
significant increases in mandatory funding for child care 
should be supported by the reauthorization of the Welfare 
Reform Law to pay for additional work requirements and to 
respond to the needs of low income, working poor families. The 
Welfare Reform Law established policies that have resulted in a 
significant increase in working Americans.
    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 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, 2003....................................  $1,700,000,000
Budget estimate, 2004...................................   1,700,000,000
Committee recommendation................................   1,700,000,000
    The Committee recommends $1,700,000,000 for fiscal year 
2004 for the social services block grant. The comparable 
funding level for fiscal year 2003 is $1,700,000,000 and the 
budget request includes $1,700,000,000 for this program.
    The CARE Act of 2003 included bill language allowing States 
to transfer up to 10 percent of their annual allocations under 
the Temporary Assistance for Needy Families to the Social 
Services Block Grant program. Under current law and the budget 
request, in 2004 States would be limited to transfers of up to 
4.25 percent. The Committee recognizes that the block grant is 
a vital source of support for many vulnerable children and 
families, the elderly and single adults and continues to 
support this important State flexibility.

                CHILDREN AND FAMILIES SERVICES PROGRAMS

Appropriations, 2003....................................  $8,645,276,000
Budget estimate, 2004...................................   8,687,382,000
Committee recommendation................................   8,780,002,000

    The Committee recommends $8,780,002,000 for fiscal year 
2004 for children and families services programs. The 
comparable funding level for fiscal year 2003 is $8,645,276,000 
and the budget request includes $8,687,382,000 for this 
program. In addition, $6,000,000 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 $6,815,570,000 for fiscal year 
2004 for Head Start. The comparable funding level for fiscal 
year 2003 is $6,667,533,000 and the budget request includes 
$6,815,570,000 for this program. The Committee recommendation 
includes $1,400,000,000 in advance funding that will become 
available on October 1, 2004.
    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.
    The Committee recommends continued support sufficient to 
maintain the current funding level for existing grantees and to 
provide a new grant competition in fiscal year 2004 under the 
Tribal College and University Head Start Partnership program. 
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 is disappointed that the Head Start 
Bureau neglected to direct sufficient funding to allow current 
grantees to extend their programs thus allowing them a full 5 
year program, but believes that continued support of new 5-year 
grant competitions can help remedy this situation and improve 
outcomes for American Indian Head Start programs.
    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 continue to provide sufficient funds 
for Migrant Head Start programs proportionate to the overall 
increase in the Head Start appropriation.
    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 cautions 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 is cognizant that the goal of the Head Start 
program is to ensure the social competence and school readiness 
of children upon completion of the program. It has long been 
proven that investments in Head Start yield significant savings 
by long-term reduction of incarceration rates and rates of 
participation in public assistance. Much of these savings are 
due to the social and emotional lessons learned from 
participation in Head Start. The Committee expects the 
Department to continue to promote learning and brain 
development to accelerate and improve the cognitive development 
of Head Start children. The Committee expects the Department to 
monitor Head Start programs to ensure that a majority of 
children participating in Head Start programs meet the minimum 
educational performance measures and standards upon completion 
of the program as outlined in the Head Start Act, as amended in 
1998.
    The Committee commends the outstanding successes of the 
Head Start program and appreciates the Head Start Bureau's 
dedication to the continued improvement of the comprehensive 
services provided to eligible children and families. However, 
the Committee is concerned that proposed assessments will focus 
only on literacy and math. While these skills are an important 
part of the Head Start curriculum, the Committee is concerned 
that the assessments will not fully represent the comprehensive 
nature of the program, specifically the nutrition, social, 
emotional, and cognitive aspects of the curriculum. The 
Committee is troubled by the potential use of these assessments 
in deciding grant status, particularly for children in the 
Early Head Start program. The Committee is aware that many 
child development experts believe that testing children under 
the age of 6 does not show an accurate picture of their 
development, and could be potentially detrimental to them. The 
Head Start Bureau shall report to the Committee by April 2004 
on the steps the Bureau has taken to ensure that the proposed 
assessment is age-appropriate and on the proposed use of the 
assessment results. The report should include the extent to 
which funding decisions will be based upon the assessments, the 
impact such a decision will have on rural programs facing 
greater obstacles, and the ways in which the Bureau intends to 
incorporate the comprehensive physical, social, and emotional 
benefits of the program into funding decisions.

Consolidated Runaway and Homeless Youth Program

    The Committee recommends $89,978,000 for fiscal year 2004 
for the consolidated runaway and homeless youth program. The 
comparable funding level for fiscal year 2003 is $89,978,000 
and the budget request includes $88,043,000 for this program. 
The Committee recommends $49,473,000 for basic centers and 
$40,505,000 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 300,000 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. The 
Committee looks forward to the release of performance outcome 
data available through the new management information system.
    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. This section is up for reauthorization this year.
    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.
    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. The Committee has deferred action on this 
program pending the enactment of authorizing language. 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.

Child Abuse Prevention Programs

    The Committee recommends $48,171,000 for fiscal year 2004 
for child abuse prevention programs. The comparable funding 
level for fiscal year 2003 is $55,715,000 and the budget 
request includes $48,314,000 for this program The 
recommendation includes $21,870,000 for State grants and 
$26,301,000 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 $12,126,000 for fiscal year 2004 
for abandoned infants assistance. The comparable funding level 
for fiscal year 2003 is $12,126,000 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 $290,088,000 for fiscal year 2004 
for child welfare services. The comparable funding level for 
fiscal year 2003 is $290,088,000 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 $7,449,000 for fiscal year 2004 
for child welfare training. The comparable funding level for 
fiscal year 2003 is $7,449,000 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 $27,227,000 for fiscal year 2004 
for adoption opportunities. The comparable funding level for 
fiscal year 2003 is $27,227,000 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 $42,720,000 for fiscal year 2004 
for adoption incentives. The comparable funding level for 
fiscal year 2003 is $42,720,000 and the budget request includes 
$43,000,000 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, 2004.

Adoption Awareness

    The Committee recommends $12,822,000 for fiscal year 2004 
for adoption awareness. The comparable funding level for fiscal 
year 2003 is $12,822,000 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, $9,841,000 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 $2,981,000 to continue this important 
activity.

Compassion Capital Fund

    The Committee recommends $34,772,000 for fiscal year 2004 
for the compassion capital fund. The comparable funding level 
for fiscal year 2003 is $34,772,000 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 $31,812,000 for fiscal year 2004 
for the social services research. The comparable funding level 
for fiscal year 2003 is $34,749,000 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 is pleased with the results of ACF's work 
with the State information technology consortium, an effort 
that is helping States with the difficult task of streamlining 
service delivery, while also meeting TANF record-keeping and 
reporting requirements. As a result of this collaborative 
effort, States and ACF are now able to share systems 
information on TANF, child support enforcement, child welfare, 
and child care activities. The Committee is also pleased with 
the CSE program's work with the consortium, an effort that is 
improving the child support collection process by using web-
based technologies to speed the flow of information between 
relevant agencies and the court system. 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 $33,200,000 for fiscal year 2004 
for community-based resource centers. The comparable funding 
level for fiscal year 2003 is $33,200,000 and the budget 
request includes $33,403,000 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.

Disabled Voter Services

    The Committee recommends $15,000,000 be made available in 
fiscal year 2004 for election assistance for individuals with 
disabilities. The comparable funding level for fiscal year 2003 
is $15,000,000 and the budget request does not provide funds 
for this program. Of these funds, $10,000,000 is to promote 
disabled voter access, and the remaining $5,000,000 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, individuals with 
disabilities in the election process.

Developmental Disabilities Programs

    The Committee recommends $150,763,000 for fiscal year 2004 
for developmental disabilities programs. The comparable funding 
level for fiscal year 2003 is $144,763,000 and the budget 
request includes $140,442,000 for this program.
    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.

State Councils

    The Committee recommends $73,515,000 for fiscal year 2004 
for State councils. The comparable funding level for fiscal 
year 2003 is $71,135,000 and the budget request includes 
$69,800,000 for this program.
    State Councils on the Developmental Disabilities program 
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.

Protection and Advocacy Grants

    The Committee recommends $38,644,000 for fiscal year 2004 
for protection and advocacy grants. The comparable funding 
level for fiscal year 2003 is $36,263,000 and the budget 
request includes $35,000,000 for this program.
    This formula grant program provides funds to States to 
establish protection and advocacy systems to protect the legal 
and human rights of persons with developmental disabilities who 
are receiving treatment, services, or rehabilitation within the 
State.

Projects of National Significance

    The Committee recommends $11,642,000 for fiscal year 2004 
for projects of national significance to assist persons with 
developmental disabilities. The comparable funding level for 
fiscal year 2003 is $12,403,000 and the budget request includes 
$11,642,000 for this program.
    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.
    Within the Committee recommendation, $4,000,000 is 
available to expand activities of the Family Support Program. 
The Committee is aware that the term ``family support'' is 
defined in Title II of the Developmental Disability Act as 
``supports, resources, services, and other assistance provided 
to families of children with disabilities that are designed to 
support families in the efforts of such families to raise their 
children with disabilities in the home; strengthen the role of 
the family as primary caregiver for such children; prevent 
involuntary out-of-the-home placement of such children and 
maintain family unity; and reunite families with children with 
disabilities who have been placed out of the home, whenever 
possible.'' 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. 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.

University-Affiliated Programs

    The Committee recommends $26,962,000 for fiscal year 2004 
for university-affiliated programs. The comparable funding 
level for fiscal year 2003 is $24,962,000 and the budget 
request includes $24,000,000 for this program.
    This program provides operational and administrative 
support for a national network of university-affiliated 
programs and satellite centers. Grants are made annually to 
university-affiliated programs and satellite centers for 
interdisciplinary training, exemplary services, technical 
assistance, and information dissemination activities.

Native American Programs

    The Committee recommends $45,457,000 for fiscal year 2004 
for Native American programs. The comparable funding level for 
fiscal year 2003 is $45,457,000 and the budget request includes 
$45,119,000 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 $717,620,000 for fiscal year 2004 
for the community services programs. The comparable funding 
level for fiscal year 2003 is $734,509,000 and the budget 
request includes $552,312,000 for this program.
    Within the funds provided, the Committee recommends 
$645,762,000 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 2004: community economic 
development, $32,546,000; individual development accounts, 
$24,828,000; rural community facilities, $7,203,000; and 
community food and nutrition, $7,281,000. The Committee did not 
provide funds for the national youth sports program.
    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. Of the total provided, the Committee has included 
$5,464,000 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.
    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.

Family Violence Prevention and Services

    The Committee recommends $144,802,000 for fiscal year 2004 
for family violence prevention and services programs. The 
comparable funding level for fiscal year 2003 is $144,364,000 
and the budget request includes $142,422,000 for this program.

Runaway Youth Prevention Program

    The Committee recommends $15,399,000 for fiscal year 2004 
for the runaway youth prevention program. The comparable 
funding level for fiscal year 2003 is $15,399,000 and the 
budget request includes $14,999,000 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.

Domestic Violence Hotline

    The Committee recommends $3,000,000 for fiscal year 2004 
for the national domestic violence hotline. The comparable 
funding level for fiscal year 2003 is $2,562,000 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 $126,403,000 for fiscal year 2004 
for battered women's shelters program. The comparable funding 
level for fiscal year 2003 is $126,403,000 and the budget 
request includes $124,423,000 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 $33,779,000 for fiscal year 2004 
for early learning opportunities program. The comparable 
funding level for fiscal year 2003 is $33,779,000 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 $1,400,000 for fiscal year 2004 
for the operation of the Department's Center for Faith-Based 
and Community Initiatives. The comparable funding level for 
fiscal year 2003 is $1,490,000 and the budget request includes 
$1,400,000 for this program.

Mentoring Children of Prisoners

    The Committee recommends $9,935,000 for fiscal year 2004 
for mentoring children of prisoners. The comparable funding 
level for fiscal year 2003 is $9,935,000 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 $41,727,000 for fiscal year 2004 
for independent living training vouchers. The comparable 
funding level for fiscal year 2003 is $41,727,000 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 2004 
for promotion of responsible fatherhood and healthy marriage. 
The budget request includes $20,000,000 for this new program 
designed to promote responsible fatherhood and responsible 
marriage. Legislation has not been enacted that would create 
this new program. The purpose of this proposed program was 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 $179,584,000 for fiscal year 2004 
for program administration. The comparable funding level for 
fiscal year 2003 is $171,873,000 and the budget request 
includes $179,584,000 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 2005 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, 2003....................................    $404,350,000
Budget estimate, 2004...................................     504,978,000
Committee recommendation................................     404,350,000

    The Committee recommends $404,350,000 for fiscal year 2004 
for promoting safe and stable families. The comparable funding 
level for fiscal year 2003 is $404,350,000 and the budget 
request includes $504,978,000 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 $99,350,000 in discretionary 
appropriations.

       PAYMENTS TO STATES FOR FOSTER CARE AND ADOPTION ASSISTANCE

Appropriations, 2003....................................  $4,855,000,000
Budget estimate, 2004...................................   5,068,300,000
Committee recommendation................................   5,068,300,000

    The Committee recommends $5,068,300,000 for fiscal year 
2004 for payments to States for foster care and adoption 
assistance. The comparable funding level for fiscal year 2003 
is $4,855,000,000 and the budget request includes 
$5,068,300,000 for this program. In addition, the Committee 
recommendation concurs with the administration's request of 
$1,767,700,000 for an advance appropriation for the first 
quarter of fiscal year 2005. The Committee's recommendation 
assumes enactment of proposed legislation creating an 
alternative funding option for States.
    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, 2003....................................  $1,367,057,000
Budget estimate, 2004...................................   1,343,701,000
Committee recommendation................................   1,360,193,000

    The Committee recommends an appropriation of $1,360,193,000 
for aging programs. The fiscal year 2003 comparable level was 
$1,367,057,000 and the administration request was 
$1,343,701,000.

Supportive Services and Senior Centers

    The Committee recommends an appropriation of $355,673,000 
for supportive services and senior centers, which is the same 
as the comparable level for fiscal year 2003. The 
administration request was $357,000,000. 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 comparable fiscal year 2003. 
The administration requested $21,562,000 for this program. 
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.
    Within the appropriation for this program, $5,500,000 is 
provided 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. These activities will help 
older adults learn more about managing medications safely and 
help reduce unnecessary hospitalizations and illnesses.

Protection of Vulnerable Older Americans

    The Committee recommends $18,559,000 for grants to States 
for protection of vulnerable older Americans. Within the 
Committee recommendation, $13,361,000 is for the ombudsman 
services program and $5,198,000 is for the prevention of elder 
abuse program. The amount recommended for each of these 
programs is the same as the comparable fiscal year 2003 level. 
Both programs provide formula grants to States to prevent the 
abuse, neglect, and exploitation of older individuals. The 
ombudsman program focuses on the needs of residents of nursing 
homes and board and care facilities, while elder abuse 
prevention targets its message to the elderly community at 
large.
    The Committee 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 toward 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 $149,025,000 for the national 
family caregiver support program, which is the same as the 
comparable fiscal year 2003 level. The administration request 
was $141,500,000. 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 $6,209,000 to carry 
out the Native American Caregiver Support Program, which is the 
same as the comparable fiscal year 2003 amount. The 
administration requested $5,500,000 as part of its request for 
the National Family Caregiver Support Program. 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 2003, 
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 $387,292,000. The comparable level for 
fiscal year 2003 was $384,592,000 and the budget request was 
$390,000,000. For home-delivered meals, the Committee 
recommends $180,985,000, which is the same as the comparable 
level for fiscal year 2003. The administration request was 
$178,500,000. 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 $148,697,000 for the 
nutrition services incentives program, the same as the 
comparable fiscal year 2003 funding level. The administration 
request was $149,670,000.
    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. 
The Committee commends the administration for recognizing that 
the NSIP should remain distinct from existing nutrition 
programs. 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. The Committee believes that funds 
should continue to be allocated based on the number of meals 
served in a State in the previous year and States should 
continue to have the option to receive commodities in lieu of 
cash if they choose. In addition, funds should not be subject 
to transfer and to administrative match requirements.

Aging Grants to Indian Tribes and Native Hawaiian Organizations

    The Committee recommends $27,495,000 for grants to native 
Americans, which is the same as the fiscal year 2003 comparable 
level. 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.

Training, Research and Discretionary Projects

    The Committee recommends $17,843,000 for training, 
research, and discretionary projects. The comparable fiscal 
year 2003 level was $29,336,000. The Committee has provided 
funding in Aging Network Support Activities for several items 
that in previous years were funded in this account.
    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 2004 that address a variety of issues, 
including elder abuse, native American issues and legal 
services.

Aging Network Support Activities

    The Committee recommends $13,373,000 for aging network 
support activities. The comparable amount for fiscal year 2003 
was $13,286,000. The Committee recommendation includes 
$1,199,000 for the Eldercare Locator and $1,180,000 for the 
pension information and counseling projects. In addition, the 
Committee has provided funding at no less than last year's 
level for the National Long Term Care Ombudsman Resource Center 
and the National Center on Elder Abuse. These programs were 
funded as demonstration activities through the fiscal year 2003 
appropriation. The reauthorization of the Older Americans Act 
authorized both of these activities under section 202 of the 
Act. The Committee recommendation includes funding at no less 
than last year's level for the Health Care Anti-Fraud, Waste 
and Abuse Program, which uses the skills of retired nurses, 
doctors, accountants and other professionals to train other 
seniors and to serve as expert resources to detect and stop 
Medicare fraud, waste and abuse. This program was funded as a 
demonstration activity through fiscal year 2003. The Committee 
expects that these funds will be used to make grants and that 
administrative costs will be minimized. In addition, the 
Committee expects that an improved system will be developed and 
implemented in coordination with CMS and the OIG to track cases 
referred by this initiative.
    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 13,000 people in 
14 States and has helped recoup more than $40,000,000 on behalf 
of older individuals.

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 $12,412,000, for Alzheimer's disease demonstration 
grants to States.
    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 35 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 $2,842,000 for the White House 
Conference on Aging, which is the same level as the 
administration request. These funds are available until 
September 30, 2006. 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 $17,869,000 to support Federal 
staff that administer the programs in the Administration on 
Aging, which is the same as the comparable 2003 level. These 
funds provide administrative and management support for 
programs administered by the agency.

                        Office of the Secretary


                    GENERAL DEPARTMENTAL MANAGEMENT

Appropriations, 2003....................................    $350,973,000
Budget estimate, 2004...................................     353,951,000
Committee recommendation................................     348,659,000

    The Committee recommends $348,659,000 for general 
departmental management [GDM]. The comparable level for fiscal 
year 2003 was $350,973,000 and the administration request was 
$353,951,000. 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 $4,015,000 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 has included a new general provision which 
prohibits the Department from carrying out or administering the 
Department's human resources consolidation plan. This 
prohibition also extends to the Indian Health Service and the 
Food and Drug Administration. This action was taken at the 
request of the Subcommittees on the Interior and on Agriculture 
and Rural Development because of their concerns regarding the 
impact that the human resources consolidation would have on the 
agencies in their Subcommittees' jurisdiction. The agencies 
within the jurisdiction of the Labor-HHS Subcommittee have 
unique personnel requirements necessary to carry out the 
research and health missions mandated by the Public Health 
Service Act. The Committee believes that centralizing human 
resource offices, at the same time that the Department is 
implementing the Federal Government's plan to outsource various 
support activities, could disrupt critical research at the 
National Institutes of Health and public health functions at 
the Centers for Disease Control and Prevention and other public 
health agencies. The Committee believes that centralizing human 
resource offices may lessen the special expertise needed to 
hire the best public health personnel and dilute the 
independence of decision-making within the agencies. The 
Committee believes that before the Department undertakes a 
human resources consolidation plan, a study should be conducted 
to determine best practices in improving efficiencies in human 
resources and administrative functions to achieve the cost-
saving aspects of the plan without disputing the hiring 
decisions made by the public health agencies. Therefore the 
Committee directs the Secretary to contract with the National 
Academy of Public Administration to undertake such a study and 
has included sufficient funds for this purpose.
    Commissioned Corps.--The Committee has provided $3,000,000 
within the total for activities related to the transformation 
and modernization of the Public Health Service [PHS] 
Commissioned Corps. The Committee provided $2,000,000 in fiscal 
year 2003, bringing the total provided for the transformation 
of the Commissioned Corps to $5,000,000. These funds will allow 
an increase in recruitment for Corps health professionals, 
expand and enhance the Commissioned Corps Readiness Force, 
provide medical readiness education and training to Corps 
personnel, and establish a PHS Auxiliary system to provide 
locally-grouped professionals who can be deployed along with 
Corps teams.
    Data Collection.--The Committee is aware that much of the 
health data used by the public and private sectors is provided 
by the Department, especially by the National Center for Health 
Statistics. The Department plays a leadership role in assuring 
the collection and reporting of racial, ethnic and primary 
health-related data through written policy and sustained 
action. The Committee expects the Secretary to designate a 
central authority within the Department to oversee its policies 
in this area, as well as in dissemination, implementation and 
compliance activities. Federal datasets must meet at least the 
minimum standards set by the Office of Management and Budget in 
1997 and subsequent standards for maintaining, collecting and 
presenting Federal data on race and ethnicity. In addition, the 
Committee reminds the Department of OMB's requirements that the 
standards be adopted for use in household surveys, 
administrative forms and records, and other data collection 
purposes.
    Direct Support Professionals.--The Committee recognizes the 
growing crisis in recruiting and retaining quality Direct 
Support Professionals [DSPs] to serve people with mental 
retardation and other developmental disabilities living in the 
community. The Committee encourages the Secretary, acting 
through the Assistant Secretary for Planning and Evaluation, to 
conduct a study on the shortage of DSPs, including an 
examination of root causes, vacancy and turnover rates, and the 
impact this shortage is having on community services for people 
with mental retardation and other developmental disabilities.
    Embryo Adoption Awareness.--A recent study has shown that 
there are nearly 400,000 frozen embryos in fertility clinics in 
the United States, a figure several times higher than previous 
estimates. The Committee understands that only approximately 2 
percent of these frozen embryos are donated to other couples in 
order to bear children. The Committee believes that, if 
educated about the possibility, many more couples may chose to 
donate their embryos and more infertile couples may chose to 
adopt such embryos. In fiscal year 2002 the Committee directed 
the Department to launch a public awareness campaign regarding 
the existence of these spare embryos. The Committee believes 
that increasing public awareness of this option 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.
    Mammography.--The Committee believes it is important to 
improve the quality of mammography, particularly the 
interpretation of mammograms, and to ensure access to 
mammography for women. The Committee strongly urges the 
Department to enter into an agreement with the Institute of 
Medicine to conduct a study and make recommendations on ways to 
improve the Mammography Quality Standards Act, mammography 
quality and access, and physicians' interpretation of 
mammograms. The study should also address recruitment and 
retention of personnel, improvements in data collection, and 
making available safe and effective new screening and 
diagnostic tools for breast cancer.
    Racial and Ethnic Disparities.--The Committee is strongly 
committed to ensuring the overall improved health of the 
American people, and urges the Department to take the steps 
necessary to implement recommendations developed by the 
Institute of Medicine's ``Unequal Treatment: Confronting Racial 
and Ethnic Disparities in Health Care'' study. The 
recommendations offer significant guidelines and opportunities 
for improving health and eliminating health disparities. The 
Committee expects the Secretary to report on the progress of 
this action during next year's appropriations hearings, and to 
include a progress update in the Department's Budget 
Justification.
    Social Worker Shortage.--The Committee urges the Department 
to study and quantify the current and future supply and demand 
for professional social workers serving older adults across the 
continuum of long-term care services. The Department should 
report these findings to the Committee and furnish 
recommendations for addressing any identified future shortage 
areas, including cooperative strategies involving Federal 
agencies, professional associations, and schools of social 
work.

Adolescent Family Life

    The Committee has provided $31,241,000 for the Adolescent 
Family Life Program [AFL], which is the same as the 
administration request. The comparable fiscal year 2003 level 
was $30,922,000.
    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 continues the 
prevention projects begun in fiscal year 1998, as well as new 
prevention projects. The Committee again expects the Department 
to fund new prevention projects which enable smaller 
communities to begin the organization and implementation of 
coalitions to implement abstinence-based education programs. 
The Committee again expects the Department, when announcing 
grant competitions, to provide a reasonable length of time for 
applicants to complete application packages, provide extensive 
technical assistance to applicants, with special assistance 
given to new applicants, and revise the terminology and 
instructions in grant applications to assure that the 
information being requested is as clear as possible.

Physical Fitness and Sports

    The Committee recommends $1,222,000 for the Federal staff 
which supports the President's Council on Physical Fitness and 
Sports. The comparable fiscal year 2003 level was $1,215,000 
and the administration request was $1,230,000.
    The President's Council on Physical Fitness and Sports 
serves as a catalyst for promoting increased physical activity/
fitness and sports participation for Americans of all ages and 
abilities, in accordance with Executive Order 13265, as 
amended. The programs sponsored by PCPFS are supported largely 
through private sector partnerships.

Minority Health

    The Committee recommends $48,740,000 for the Office of 
Minority Health. The comparable level for fiscal year 2003 was 
$56,224,000 and the administration request was $47,010,000.
    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 in the Office of Minority Health which 
funds the New Minority Males Consortium. This consortium is 
composed of five historically black colleges and universities 
[HBCUs] and has begun implementation of campus and community-
based projects to educate and inform minority males about 
certain diseases prevalent among African American, Latino, and 
other minority males. The Committee encourages OMH to dedicate 
adequate funds to support institutional activities and to 
further expand this effort to include additional HBCUs and 
other minority serving institutions.
    The Committee continues to recognize the need to recruit 
and train more minorities in the health professions. The 
Committee encourages the Office of Minority Health to support 
annual conferences that have a proven record of increasing the 
number of under-represented minorities entering the health 
professions.
    The Committee commends the Secretary for designating the 
elimination of health disparities as a major priority for the 
Department, and is encouraged that the agencies within DHHS are 
moving forward in this area as they implement, monitor and 
evaluate strategic plans for eliminating health disparities. 
The Committee expects the Office of Minority Health and the 
National Center for Minority Health and Health Disparities at 
the National Institutes of Health to play a joint role in 
coordinating and monitoring the implementation of the 
Department's elimination of health disparities strategic plans. 
The Committee expects the Secretary to report to Congress on 
the implementation of the strategic plans during next year's 
appropriations hearings, and to include a progress update in 
future Budget Justifications.

Office on Women's Health

    The Committee recommends $29,721,000 for the Office on 
Women's Health. The comparable level for fiscal year 2003 was 
$28,658,000 and the administration request was $28,908,000.
    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 $50,000,000. These funds are available to 
key operating divisions of the Department with capability and 
expertise in HIV/AIDS services to assist minority communities 
with education, community linkages, and technical assistance.

                      OFFICE OF INSPECTOR GENERAL

Appropriations, 2003....................................     $36,808,000
Budget estimate, 2004...................................      39,497,000
Committee recommendation................................      39,497,000

    The Committee recommends an appropriation of $39,497,000 
for the Office of Inspector General. The fiscal year 2003 
comparable level was $36,808,000 and the administration request 
was $39,497,000. 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 the Inspector 
General in fiscal year 2004; the total funds provided to the 
Office by this bill and the authorizing bill would be 
$199,497,000 in fiscal year 2004.
    The Office of Inspector General conducts audits, 
investigations, inspections, and evaluations of the operating 
divisions within the Department of Health and Human Services. 
The OIG functions with the goal of reducing the incidence of 
waste, abuse, and fraud. It also pursues examples of 
mismanagement toward the goal of promoting economy and 
efficiency throughout the Department.
    The Committee commends the Office of Inspector General for 
their continued good work to reduce waste, fraud and abuse in 
Department programs. The Committee expects efforts to reduce 
Medicare mispayments will be continued and expanded. With the 
possible introduction of a outpatient prescription drug 
benefit, the Committee asks the OIG to prepare for its 
consideration any needed oversight to minimize potential 
program losses due to fraud, waste and abuse in the 
administration of this important new benefit.

                        OFFICE FOR CIVIL RIGHTS

Appropriations, 2003....................................     $33,423,000
Budget estimate, 2004...................................      34,250,000
Committee recommendation................................      34,250,000

    The Committee recommends $34,250,000 for the Office for 
Civil Rights. This is the same as the administration request. 
The comparable fiscal year 2003 level was $33,423,000. 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, 2003....................................      $2,483,000
Budget estimate, 2004...................................       2,499,000
Committee recommendation................................................

    The Committee does not recommend appropriated funds for 
policy research. The Committee has provided $23,499,000 through 
transfers available under section 241 of the Public Health 
Service Act. The comparable program level for fiscal year 2003 
was $20,483,000.
    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, 2003....................................    $310,017,000
Budget estimate, 2004...................................     316,365,000
Committee recommendation................................     329,868,000

    The Committee provides an estimated $329,868,000 for 
retirement pay and medical benefits for commissioned officers 
of the U.S. Public Health Service. The fiscal year 2003 
comparable level was $310,017,000 and the administration 
request was $316,365,000.
    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.
    The Committee notes that, according to the budget request, 
the various agencies and operating divisions across the 
Department are expected to absorb $22,371,000 in retirement 
medical cost payments for Commissioned Corps Officers. Medical 
cost payments have been funded by this account in the past. The 
transfer of responsibility for these payments to the 
Department's discretionary budgets was mandated in the 
Department of Defense Reauthorization Act of Fiscal Year 2002. 
However, the Committee recognizes that the corresponding funds 
were not transferred to the operating divisions to cover these 
costs. Therefore, the Committee has included bill language 
mandating that the Retirement Pay and Medical Benefits for 
Commissioned Officers account continue to cover these costs in 
fiscal year 2004 as it has done in the past.

            PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY FUND

Appropriations, 2003....................................  $1,887,247,000
Budget estimate, 2004...................................   1,896,149,000
Committee recommendation................................   1,856,040,000

    The Committee recommends $1,856,040,000 for the Public 
Health and Social Services Emergency Fund. The comparable level 
for fiscal year 2003 was $1,887,247,000. The Committee has 
provided funding for Poison Control and Emergency Medical 
Services for Children in HRSA instead of in this account as 
proposed by the administration. The Committee has fully funded 
the administration request when these amounts are included.
    The Committee provides $940,000,000 to CDC for upgrading 
State and local capacity. This amount maintains funding at the 
level provided last year. The Committee recognizes that 
bioterrorism events will occur at the local level and will 
continue to require local capacity, preparedness and initial 
response. It was the intent of the Congress 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. The threats posed by bioterrorism and 
other public health emergencies (as evidenced by the outbreak 
of Severe Acute Respiratory Syndrome--SARS) have not abated. 
Because it is essential to the Nation's public health readiness 
that bioterrorism funding be made available at the local level, 
the Committee encourages 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.
    The Committee is concerned over reports that some Federal 
bioterrorism dollars have been used to supplant State and local 
funding for public health. The intent of the Congress has 
always been clear--funding for bioterrorism efforts is to 
supplement, not supplant State and funding of public health 
programs. During this crucial time, bioterrorism funding has 
been made available to build public health capacity at both 
State and local levels. Use of these funds to supplant State 
and local dollars only endangers efforts to build a system to 
respond to threats.
    Within the total for State and local capacity, the 
Committee has included $40,000,000 for the Health Alert Network 
[HAN]. Prior to HAN, one-half of local public health 
departments did not even have e-mail. Now, HAN is a well-
functioning system and has been used regularly, most recently 
to distribute current information about SARS and monkeypox. 
Continued expansion and refinement of HAN now falls under the 
umbrella of the Public Health Information Network under 
development by CDC. The Committee believes that this is 
appropriate. 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, the Committee recommends $158,116,000 
for upgrading CDC capacity and $18,040,000 for anthrax vaccine 
research.
    The Committee has 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 $61,820,000 for the 
Office of the Secretary. The Committee recommendation also 
includes $100,000,000 for activities to ensure an adequate 
supply of vaccine in the event of an influenza pandemic.
    The Committee provides $578,064,000 to HRSA for 
bioterrorism activities. Of this amount, $518,052,000 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 provides $60,012,000 for 
curriculum development and training on the detection and 
treatment of diseases caused by bioterrorism.
    Funds for bioterrorism prevention and response are 
distributed through grants to 50 States and four metropolitan 
areas. The Committee strongly recommends that these funds be 
distributed based on a formula that includes factors for risk 
of a terrorist event. Risk is challenging to quantify, but the 
Committee suggests that the Secretary consider the following, 
among other factors: (1) Site of headquarters or major offices 
of multinational organizations; (2) site of major financial 
markets; (3) site of previous incidents of international 
terrorism; (4) some measure of population density versus just 
population; (5) internationally recognized icons; (6) percent 
of national daily mass transit riders; (7) proximity to a major 
port, including major port ranked on number of cargo containers 
arriving at the port per year.
    The Committee understands that it is the responsibility of 
HRSA to obtain guidance from the National Institute for 
Occupational Safety and Health [NIOSH] and the Occupational 
Safety and Health Administration [OSHA] on the appropriate 
personal protective equipment, including respiratory 
protection, and decontamination equipment for hospitals in the 
event of a terrorist incident. Such guidance will primarily 
focus on preparedness for biological terrorism, but also will 
include preparedness for a chemical or radiological incident. 
The Committee believes that uniform guidance will minimize 
hospital guesswork, assure uniformity in preparedness across 
jurisdictions, and allow for greater ease of mutual aid.

      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 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 2.2 percent of Public Health Service 
funds for evaluation activities (sec. 206).
    The Committee recommendation retains language restricting 
transfers of appropriated funds among accounts and requiring 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 Medicare+Choice 
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 2003 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 that 
allows the NIH to expand the number of Morris K. Udall 
Parkinson's Disease Centers (sec. 217).
    The Committee has included a new general provision which 
prohibits the Department from carrying out or administering the 
Department's human resources consolidation plan (sec. 218).

                   TITLE III--DEPARTMENT OF EDUCATION

                    EDUCATION FOR THE DISADVANTAGED

Appropriations, 2003.................................... $13,738,273,000
Budget estimate, 2004...................................  14,184,000,000
Committee recommendation................................  14,103,356,000

    The Committee recommends an appropriation of 
$14,103,356,000 for education for the disadvantaged. The 
comparable funding level for fiscal year 2003 is 
$13,738,273,000 and the budget request includes $14,184,000,000 
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 within 12 years, 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.

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 15,000,000 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.
    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 $12,350,000,000 for this program. The 
comparable funding level for fiscal year 2003 is 
$11,684,311,000 and the budget request includes $12,350,000,000 
for Title I grants to LEAs. Since the No Child Left Behind Act 
was passed in 2001, the Committee has supported an increase of 
41 percent in the appropriation for this program. These Federal 
resources represent the significant commitment this Committee 
has made to provide the resources necessary to help all 
children succeed in school.
    The Committee has included bill language that requires the 
Secretary to use the most appropriate and reliable data 
available on July 1, 2003 for calculating grants under the 
Title I Grants to LEAs program.
    The 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 $7,107,282,000. The comparable 
funding level for fiscal year 2003 is $7,107,282,000 and the 
budget request includes $7,172,971,000 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.
    For concentration grants, the Committee recommends an 
appropriation of $1,365,031,000. The comparable funding level 
for fiscal year 2003 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 2002 level 
through the EFIG and targeted formulas. The Committee 
recommends allocating all of the increase proposed this year 
through the EFIG formula. The Committee notes that analysis 
conducted by the Congressional Research Service has 
demonstrated that the EFIG formula delivers a larger share of 
Title I funds to high-poverty school districts--those with 
child poverty rates in excess of 25 percent--than any other 
Title I formula, followed closely by the targeted grants 
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 Committee recommends an appropriation of $2,207,448,000 
for education finance incentive grants. The comparable funding 
level for fiscal year 2003 is $1,541,759,000 and the budget 
request includes $793,499,000 for the EFIG funding stream.
    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 $1,670,239,000. The comparable 
funding level for fiscal year 2003 is $1,670,239,000 and the 
budget request includes $3,018,499,000 for this funding stream.

William F. Goodling Even Start Family Literacy Program

    The Committee recommends $175,000,000 for fiscal year 2004 
for the Even Start program. The comparable funding level for 
fiscal year 2003 is $248,375,000 and the budget request 
includes $175,000,000 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.
    States receive funds on the basis of their proportion of 
Title I LEA grant allocations and make competitive 4-year 
grants to partnerships of local educational agencies and 
community-based organizations. Grant funds must be equitably 
distributed among urban and rural areas. The local share of 
program costs must increase from 10 percent in the first year 
to 40 percent in the 4th year, 50 percent in years 5 through 8, 
and 65 percent after 8 years.
    The Committee notes with interest the results from the 
Program Assessment Rating Tool used with respect to the Even 
Start program. In particular, the Committee is concerned that 
while State educational agencies and local grantees have 
developed a framework for monitoring and evaluating program 
performance, the Department has yet to utilize fully this 
framework in order to establish benchmarks and numerical 
targets by which program performance can be measured. The 
Committee encourages the Department to move expeditiously to 
address these deficiencies. The Committee requests that the 
Department include in its 2005 Congressional Justification a 
complete description of steps taken and planned to develop a 
robust program performance system for the Even Start program.

Reading First State Grants

    The Committee recommends $1,000,000,000 for the Reading 
First State Grants program. The comparable funding level for 
fiscal year 2003 is $993,500,000 and the budget request 
includes $1,050,000,000 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. Since President Bush took 
office, Federal funding for reading programs has grown by 
almost 250 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. Under the budget request, $5,650,000 is 
available to support Targeted Assistance Grants to those SEAs 
and LEAs that meet specified performance outcome goals.
    The Committee encourages the Department to move quickly to 
develop performance targets and an evaluation framework for 
assessing the effectiveness of this program. The Committee 
requests that the Department include in its 2005 Congressional 
justification a summary report of implementation issues and 
performance outcomes identified in State annual performance 
reports or in other evaluation and monitoring activities 
undertaken by the Department.

Early Reading First

    The Committee recommends $85,000,000 for the Early Reading 
First program. The comparable funding level for fiscal year 
2003 is $74,512,000 and the budget request includes 
$100,000,000 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.
    The Committee encourages the Department to move quickly to 
develop performance targets and an evaluation framework for 
assessing the effectiveness of this program. The Committee 
requests that the Department include in its 2005 Congressional 
Justification a summary report, based on State annual 
performance reports of basic program information, including the 
percentage of young children participating in the program with 
the skills they need to be successful readers. In addition, the 
Committee requests that this report provide information on how 
grantees are using Early Reading First funds in coordination 
with other federally-funded and supported programs that address 
early care and development of children.

Improving Literacy Through School Libraries

    The Committee recommends $12,419,000 for the Improving 
Literacy Through School Libraries program. The comparable 
funding level for fiscal year 2003 is $12,419,000 and the 
budget request includes $27,500,000 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.
    The Committee encourages the Department to establish 
performance targets and an evaluation framework for assessing 
the effectiveness of this program. The Committee is aware that 
the authorizing statute allows the Secretary to use up to one 
percent of the appropriation for evaluation activities and 
notes that these funds would be helpful in developing a 
framework for evaluating the effectiveness of this program.

Migrant Education Program

    The Committee recommends $395,413,000 for the Migrant 
Education program. The comparable fiscal year 2003 funding 
level is $395,413,000 and the budget request includes 
$396,000,000 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 $48,682,000 for the Title I 
neglected and delinquent program. The comparable funding level 
for fiscal year 2003 is $46,682,000 and the budget request 
includes $48,000,000 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 up to 15, 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. The Committee 
is aware that a study by the National Council on Crime and 
Delinquency concluded, with assistance, States could provide 
meaningful outcome data including recidivism, diploma and 
degree completions and employment.

Evaluation

    The Committee recommends $8,842,000 for evaluation of Title 
I programs. The comparable funding level for fiscal year 2003 
is $8,842,000 and the budget request includes $9,500,000 for 
such activities. The budget request includes bill language that 
would allow the Secretary to use up to $1,000,000 from the 
appropriation to respond to technical assistance requests from 
States and school districts regarding implementation of Part A 
of Title I. The Committee has provided the requested authority.
    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.

Comprehensive School Reform

    The Committee recommends no funds for this program. The 
comparable funding level for fiscal year 2003 is $233,473,000 
and the budget request did not include any funds for the 
comprehensive school reform program.
    This program has provided 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 has allocated 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 $13,000,000 for the high school 
equivalency program [HEP]. The comparable funding level for 
fiscal year 2003 is $23,347,000 and the budget request is 
$13,000,000 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 $15,000,000. The comparable funding level 
for fiscal year 2003 is $15,399,000 and the budget request is 
$15,000,000 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, 2003....................................  $1,188,226,000
Budget estimate, 2004...................................   1,015,500,000
Committee recommendation................................   1,188,226,000

    The Committee recommends an appropriation of $1,188,226,000 
for impact aid for the Department of Education. The comparable 
funding level for fiscal year 2003 is $1,188,226,000 and the 
budget request includes $1,015,500,000 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.
    Basic Support Payments.--The Committee recommends 
$1,025,292,000 for basic support payments. The comparable 
funding level for fiscal year 2003 is $1,025,292,000 and the 
budget request includes $867,500,000. Under statutory formula, 
payments are made on behalf of all categories of federally 
connected children. However, the budget includes a legislative 
proposal which would eliminate Federal aid provided for certain 
categories of federally connected students. The categories of 
students affected by this proposal include: students who do not 
live on Federal property but who have a parent on active duty 
in the uniformed services of the United States, or a parent who 
is a foreign military officer accredited by a foreign 
government; students who reside in a low-rent housing project 
assisted under the United States Housing Act of 1937; students 
who live on Federal property but otherwise do not fit into any 
of the categories described above; and students who do not 
reside on Federal property but who have a parent employed on 
Federal property located partly or wholly in the same State as 
the LEA. This proposal would eliminate Federal aid for roughly 
800,000 federally connected students. The Committee rejects 
this proposed change.
    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 
$50,668,000 for this purpose. The comparable funding level is 
$50,668,000 and the budget request includes $40,000,000. The 
budget request includes a legislative proposal to eliminate 
funding for ``b'' children who are disabled. The Committee 
rejects this approach and notes that roughly 20,000 such 
students currently generate Federal payments associated with 
the excess cost of educating these eligible children.
    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 
$7,948,000. The comparable funding level for fiscal year 2003 
is $7,948,000 and the budget request proposes $8,000,000 for 
this purpose.
    Construction.--Payments are made to eligible LEAs to be 
used for construction and renovation of school facilities, or 
for debt service related to the construction of school 
facilities. The Committee recommends $44,708,000 for this 
program. The comparable fiscal year 2003 funding level is 
$44,708,000 and the budget request includes $45,000,000 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 
$59,610,000 for this activity. The comparable funding level for 
fiscal year 2003 is $59,610,000 and the budget request proposes 
to fund this program at $55,000,000.

                      SCHOOL IMPROVEMENT PROGRAMS

Appropriations, 2003....................................  $5,883,092,000
Budget estimate, 2004...................................   5,042,834,000
Committee recommendation................................   5,731,453,000

    The Committee recommends an appropriation of $5,731,453,000 
for school improvement programs. The comparable funding level 
in fiscal year 2003 for this account is $5,883,092,000 and the 
budget request includes $5,042,834,000.

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 $2,850,000,000 for State grants for 
improving teacher quality. The comparable funding level for 
fiscal year 2003 is $2,930,825,000 and the budget request 
proposes $2,850,000,000.
    Since the No Child Left Behind Act was enacted, the 
Committee has increased funding by more than 32 percent for 
programs that specifically support high quality professional 
development for teachers and school leadership. The Committee 
recommendation for fiscal year 2004 includes roughly 
$3,400,000,000 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 $14,902,000 to support 
professional development activities for early childhood 
educators and caregivers in high-poverty communities. The 
comparable funding level for fiscal year 2003 is $14,902,000 
and the budget request includes $15,000,000 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.
    The Committee is aware that the first round of grantees 
will be submitting performance reports to the Department this 
year. The Committee urges the Department to review the 
performance reports as soon as they are available and include 
in its 2005 Congressional Justification a summary report on 
grantee progress on each of the achievement indicators 
established under the program. In addition, the Committee urges 
the Department to identify any implementation issues that 
grantees face in meeting the objectives of this program, as 
well as describe how these funds are coordinated with other 
Federal funds available for early care and development 
programs.

Mathematics and Science Partnerships

    The Committee recommends $100,344,000 for the mathematics 
and science partnerships program. The comparable funding level 
for fiscal year 2003 is $100,344,000 and the budget request 
includes $12,500,000 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 Committee notes that the authorizing statute requires 
grantees to develop an evaluation and accountability plan to 
measure their performance and to submit annual reports to the 
Department on such plans. The Committee encourages the 
Department to work with the National Science Foundation, 
States, and local grantees to develop a framework for 
evaluating this program. The Committee requests that the 2005 
Congressional Justification include a description of steps 
taken and planned for using annual reports and other means as a 
basis for evaluating this program (including developing a 
baseline and performance targets.)

Innovative Education Program Strategies State Grants

    The Committee recommends $345,000,000 for innovative 
education program strategies State grants. The comparable 
funding level for fiscal year 2003 is $382,498,000 and the 
budget request includes $385,000,000 for this purpose.
    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 each State receiving Federal 
assistance under this program is required to compile and 
summarize evaluation information submitted by local educational 
agencies, which includes a description of how Federal financial 
assistance affected student academic achievement and 
information on the use of funds, the types of services 
furnished, and students served. The Committee requests that the 
Department include in the 2005 Congressional Justification a 
summary report of such evaluation information, a summary of 
actions taken or planned to help States evaluate the affect of 
this program on student achievement and its plan for developing 
a baseline and performance indicators for this program.

Educational Technology State Grants

    The Committee recommends $695,947,000 for educational 
technology State grants. The comparable funding level for 
fiscal year 2003 is $695,947,000 and the budget request 
proposes $700,500,000 for this program.
    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 
professional development.
    The Committee encourages the Department to develop 
baselines and performance targets for this program, so the 
impact of Federal funds can be assessed. The Committee looks 
forward to reviewing such information as part of the 2005 
Congressional Justification.

Preparing Tomorrow's Teachers to use Technology

    The Committee recommendation does not include any funds for 
this program. Last year's bill included $62,094,000 for this 
program and the budget request proposed to eliminate the 
Preparing Tomorrow's Teachers to use Technology [PT3] program.
    Funds available are used to assist consortia of private and 
public entities to prepare prospective teachers to use 
technology effectively in the classroom. Consortia consist of 
at least one institution of higher education, one State or 
local educational agency, and one other entity.
    The Committee notes that under the primary source of 
Federal funding for educational technology--the Educational 
Technology State Grants program--LEAs must use at least 25 
percent of its formula allocation for high-quality professional 
development in the integration of technology into curricula, 
unless it can demonstrate to the satisfaction of the State that 
it already provides such professional development opportunities 
to all teachers in core academic subjects. The Committee 
encourages the Department to work with States to ensure that 
this provision of the No Child Left Behind Act is implemented 
appropriately.

21st Century Community Learning Centers

    The Committee recommends an appropriation of $1,000,000,000 
for the 21st Century Community Learning Centers program. The 
comparable funding level for fiscal year 2003 is $993,500,000 
and the budget request includes $600,000,000 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 uses 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.
    The Committee understands that the purpose of the 21st 
Century Community Learning Centers program is to provide 
participating students with opportunities for academic 
enrichment and a broad array of services and programs that 
reinforce the regular school day curriculum and facilitate 
social development. The Committee recognizes the importance of 
such opportunities, including youth development activities, 
drug and violence prevention programs, arts education, civic 
engagement, and character education programs in reinforcing 
students' academic performance and attracting them to 
participate in after-school programs. The Committee is aware 
that the students most in need of academic improvement are the 
least likely to participate in an after-school program if they 
perceive it to be little more than an extension of the school 
day.
    The Committee rejects the proposed reduction in this 
program, which was based on the initial findings from an 
evaluation of centers funded in the first 3 years of the 
program. While the Committee appreciates and is committed to 
the notion that the allocation of Federal resources should be 
based on high-quality, science-based evaluations, it does not 
agree that more than 500,000 children and their families should 
be denied the opportunity to receive educational, developmental 
and related services based on the first-year findings from the 
Department's evaluation. The Committee looks forward to 
subsequent reports, which will include a more complete data set 
and additional information upon which to make a more informed 
assessment of the impact of the 21st-Century Community Learning 
Centers program.
    The Committee notes the positive impact and implementation 
findings from the report, and therefore urges the Department to 
utilize this information, as well as those from other 
evaluations to strengthen the program. Under the No Child Left 
Behind Act, the Department may retain up to 1 percent to 
carryout national activities, including technical assistance to 
States in implementing the State-based competitive grant 
program and for assistance to local program operators, while 
State Educational Agencies may reserve up to 3 percent for 
training and technical assistance and local program evaluation. 
The Committee encourages the Department to work with States in 
helping them most effectively use these funds to strengthen 
centers funded through this program. In particular, the 
Committee urges the Department to take appropriate actions to 
ensure that 21st Century Community Learning Centers provide a 
wide array of proven and effective services and opportunities 
for students that both complement their regular academic 
program and provide additional opportunities for students to be 
safe and successful during non-school hours. The Committee 
requests that, as part of the 2005 Congressional Justification, 
the Department include a discussion of the actions undertaken 
and planned for addressing these issues and strengthening this 
program.
    The Committee also urges the Department to include 
developmental and prevention indicators, in addition to 
academic indicators, in any performance goal, objective or 
indicator for the 21st Century Community Learning Centers 
program. The Committee looks forward to reviewing such 
information in the program performance information section of 
the 2005 Congressional Justification and the Department's 
annual program performance report.

State Assessments and Enhanced Assessment Instruments

    The Committee recommends $390,000,000 for State 
assessments. The comparable funding level for fiscal year 2003 
is $384,484,000 and the budget request includes $390,000,000 
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 2003 is 
$380,000,000 and it rises to $390,000,000 in fiscal year 2004. 
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.

Javits Gifted and Talented Education

    The Committee recommends $11,177,000 for the Javits Gifted 
and Talented Students Education Program. The comparable fiscal 
year 2003 funding level is $11,177,000 and the President's 
budget proposes to eliminate 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 $17,144,000 for the Foreign 
Language Assistance program. The comparable funding level for 
fiscal year 2003 is $16,144,000 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 the only 
Federal program designed to help schools meet the need for 
foreign language instruction is unavailable to the poorest 
schools. The Committee 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.
    The Committee notes that the Department asserts that it has 
no information indicating that the Foreign Language Assistance 
program is having a significant impact on the quality of 
foreign language instruction. However, the Committee is aware 
that applicants under this program must demonstrate to the 
Secretary that they have a project evaluation plan. Further, 
the Secretary requires successful applicants to submit annual 
performance reports that document the grantee's yearly progress 
toward meeting expected programmatic outcomes, which are used 
to measure the success of the grantee's project, and contribute 
to a broader knowledge base about high-quality, effective 
foreign language programs. The Committee encourages the 
Department to work with current and future grantees under this 
program to better utilize performance outcome data provided by 
grantees and to establish a framework (including a baseline and 
performance targets) for evaluating this program. The Committee 
expects to see more complete program performance information 
included in the 2005 Congressional Justification.

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 $60,000,000. The comparable 
fiscal year 2003 funding level is $54,642,000 and the budget 
request includes $50,000,000 for this program.
    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.
    The latest estimates indicate that more than 900,000 
children and youth in the United States experience 
homelessness. While the Committee notes the significant 
progress States and local educational agencies have made in 
increasing enrollment of homeless children and youth from 55 
percent in 1996 to 87 percent in 2001, the Committee is aware 
that significant enrollment barriers--from transportation 
issues to lack of school records--continue to limit access to a 
free and appropriate education for homeless children and youth. 
The Committee urges the Department to reserve sufficient funds 
to work with States, as requested, in reducing barriers 
remaining and also to address the issue of data collection 
related to the education 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 $7,286,000. 
The comparable fiscal year 2003 funding level is $7,286,000 and 
the budget request includes $7,334,000 for these services.
    The funds provided will continue operation of 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 
2003 funding level is $30,798,000 and the budget request 
includes $18,300,000 for these programs.
    The Committee urges the Department to provide at least 
$1,000,000 for the early childhood education program and at 
least $1,000,000 for school construction/renovation activities. 
The Committee also encourages the Department to consider 
funding educational activities regarding the historical 
underpinnings of Native Hawaiian law.
    The Committee bill includes language allowing funds to be 
used for construction and renovation of Native Hawaiian 
educational facilities.

Alaska Native Educational Equity

    The Committee recommends $36,000,000 for the Alaska Native 
educational equity assistance program. The comparable fiscal 
year 2003 funding level is $31,798,000 and the budget request 
includes $14,200,000 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.

Rural Education

    The Committee recommends $167,653,000 for rural education 
programs. The comparable fiscal year 2003 funding level is 
$167,653,000 and the budget request proposed to eliminate 
funding 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 the 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.

                            INDIAN EDUCATION

Appropriations, 2003....................................    $121,573,000
Budget estimate, 2004...................................     122,368,000
Committee recommendation................................     121,573,000

    The Committee recommends $121,573,000 for Indian Education 
programs. The comparable fiscal year 2003 funding level is 
$121,573,000 and the budget request includes $122,368,000 for 
such activities.

Grants to Local Education Agencies

    For grants to local education agencies, the Committee 
recommends $96,502,000. The comparable fiscal year 2003 funding 
level is $96,502,000 and the budget request includes 
$97,133,000. 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 $19,870,000 for special programs 
for Indian children. The comparable fiscal year 2003 funding 
level is $19,870,000 and the budget request includes 
$20,000,000 for authorized activities. Funds are used for 
demonstration grants to improve Indian student achievement 
through early childhood and preschool education 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 $5,201,000 for national 
activities. The comparable fiscal year 2003 amount is 
$5,201,000 and the budget request includes $5,235,000 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, 2003....................................  $1,099,049,000
Budget estimate, 2004...................................     807,400,000
Committee recommendation................................     774,133,000
    The Committee recommends an appropriation of $774,133,000 
for programs within the innovation and improvement account. The 
comparable fiscal year 2003 funding level for these programs is 
$1,099,049,000 and the budget request includes $807,400,000.

Troops-to-Teachers

    This program supports the Defense Department's Troops to 
Teachers program, which helps prepare retiring and former 
military personnel to teach 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.
    The Committee recommendation does not include additional 
resources for the Troops-to-Teachers program. The Committee 
takes this action because of the recent military activity, 
which has reduced the supply of available retiring and former 
military personnel; the fact that last year's appropriation is 
available for obligation for 2 fiscal years; and the tight 
budget constraints under which the Committee must operate. The 
comparable funding level for fiscal year 2003 is $28,812,000 
and the budget request includes $25,000,000 for this program. 
The Committee continues to support activities designed to 
support the goal of ensuring that every child is taught by a 
highly qualified teacher, and that support is demonstrated by 
the significant increases in this program and others that 
contribute to achievement of that goal. Since fiscal year 2001, 
funding for this program has grown by more than 800 percent.
    The Committee notes that the Department has acknowledged 
that a rigorous, scientific evaluation of the program has not 
yet been conducted. The Committee encourages the Department to 
undertake such an evaluation and to develop program performance 
information, including benchmarks and performance indicators, 
which can be used to assess the effectiveness of this program. 
The Committee looks forward to seeing a discussion of such 
issues in the 2005 congressional justification.

Transition to Teaching

    The Committee recommends $41,727,000 for the transition to 
teaching program. The comparable fiscal year 2003 funding level 
is $41,727,000 and the budget request includes $49,400,000 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.
    The Committee notes that program performance information, 
including benchmarks and performance indicators, are not 
available for this program. The Committee encourages the 
Department to work with current grantees to develop such 
information and to utilize grantee interim and final evaluation 
reports during this activity. The Committee looks forward to a 
more complete discussion of program performance for this 
program in the 2005 congressional justification.

National Writing Project

    The Committee recommends $18,890,000 for the national 
writing project. The comparable funding level for fiscal year 
2003 is $16,890,000 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 additional funds provided over the fiscal year 2003 
appropriation, the Committee intends that $500,000 shall be 
used to support a pilot program on the integration of 
technology training in the NWP program.
    The Committee is aware that the NWP has contracted for two 
evaluations of the program, both of which have identified 
significant benefits to teachers and students exposed to the 
NWP. A survey by Inverness Research Associates found that more 
than 95 percent of National Writing Project teachers stated 
that what they learned during their writing project training 
translates into improved writing skills for their students 
teachers survey. The survey also found that National Writing 
Project programs leveraged more than $5 in other investment for 
each $1 in Federal money during the 2000-2001 program year.

Teaching of Traditional American History

    The Committee recommends $120,000,000 for the teaching of 
traditional American history program. The comparable fiscal 
year 2003 funding level is $99,350,000 and the budget request 
includes $100,000,000 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.
    The Committee is aware that performance data generated by 
the first cohort of grant recipients will be available to the 
Department this year. The Committee encourages the Department 
to use these reports, as well as other information, to develop 
a framework for evaluating the effectiveness of this program.

School Leadership

    The Committee recommends $12,419,000 for the school 
leadership program. The comparable fiscal year 2003 funding 
level is $12,419,000 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 recognizes the critical role that principals play in 
creating an environment that fosters effective teaching and 
high academic achievement. The Committee encourages the 
Department to utilize program performance data available in 
grantee performance reports in order to develop a framework for 
evaluating this program. The Committee looks forward to 
reviewing such information in the 2005 congressional 
justification.

Advanced Credentialing

    The Committee recommends $9,935,000 for the National Board 
for Professional Teaching Standards. The comparable fiscal year 
2003 funding level is $9,935,000 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 2004 
appropriation will support the 5th year of its current 5-year 
grant.
    The Committee is aware of recent research which has 
documented the value of National Board Certification. 
Researchers at the University of North Carolina at Greensboro 
demonstrated that teachers with the National Board 
Certification outperformed their non-certified peers on 11 of 
the 13 key dimensions of teaching expertise measured by their 
study. The Committee also is aware of actions the National 
Board has taken to provide objective, scientifically based 
research into the effects realized by its activities. The 
Committee looks forward to additional information that will be 
provided through high-quality evaluation studies, including one 
that will compare the learning gains made by the students of 
National Board Certified Teachers, teachers who sought but did 
not achieve National Board Certification, and a random sample 
of teachers who have never gone through the National Board 
Certification process.

Charter Schools Grants

    The Committee recommends $220,000,000 for the support of 
charter schools. The comparable fiscal year 2003 funding level 
is $198,700,000 and the budget request proposes $220,000,000 
for this program. The Committee has been very supportive of 
charter schools; the Committee has more than doubled funding 
for this program since the fiscal year 1999 appropriation of 
$100,000,000. This support has helped increase the number of 
charter schools in operation during 2002 to roughly 2,700, from 
the 1,010 in existence during the 1999-2000 school year.
    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.

Credit Enhancement for Charter School Facilities

    The Committee does not recommend funds to assist charter 
schools with their facility needs. The comparable funding level 
for fiscal year 2003 is $24,838,000 and the budget request 
includes $100,000,000 for this purpose.
    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 $28,000,000 for the voluntary 
public school choice program. The comparable funding level for 
fiscal year 2003 is $25,831,000 and the budget request includes 
$25,000,000 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.
    The Committee encourages the Department to utilize grantee 
annual performance reports to establish a framework for 
evaluating the effectiveness of this program and looks forward 
to reviewing such information in the 2005 congressional 
justification. The Committee also notes that the Department 
plans to reserve $1,000,000 to continue an evaluation of this 
program, which at a minimum, must include how, and the extent 
to which, the program promotes educational equity and 
excellence; the characteristics of the students participating 
in the programs; and the effect of the programs on the academic 
achievement of students participating in the programs, and on 
the overall quality of participating schools and districts. The 
Committee encourages the Department to move quickly to complete 
this evaluation and looks forward to reviewing information from 
it as soon as possible.

Magnet Schools Assistance

    The Committee recommends $109,285,000 for the magnet 
schools assistance program. The comparable fiscal year 2003 
funding level is $109,285,000 and the budget request includes 
$110,000,000 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.
    The Committee notes that grantees' application are required 
to describe, among other things, how a grant awarded under this 
part will be used to promote desegregation, including how the 
proposed magnet school programs will increase interaction among 
students of different social, economic, ethnic, and racial 
backgrounds; the manner and extent to which the magnet school 
program will increase student academic achievement in the 
instructional area or areas offered by the school; and how 
grant funds under this part will be used to improve student 
academic achievement for all students attending the magnet 
school programs and to implement services and activities that 
are consistent with other programs under the NCLB Act. 
Therefore, the Committee expects the Department to provide 
meaningful program performance information on the extent to 
which this program improves student academic achievement, as 
well as eliminates, reduces, and prevents minority group 
isolation. The Committee looks forward to reviewing more 
complete program performance information in the 2005 
congressional justification.

Choice Incentive Fund

    The Committee recommends no funding for this proposed new 
program. The budget request includes $75,000,000 for this 
purpose.

Fund for the Improvement of Education

    The Committee recommends an appropriation of $165,877,000 
for the Fund for the Improvement of Education [FIE]. The 
comparable funding level for fiscal year 2003 is $472,646,000 
and the budget request includes $59,000,000 for comparable 
activities.
    The recommendation includes no funds for comprehensive 
school reform demonstrations, as requested by the 
administration.
    Within the recommendation, the Committee includes funds for 
the Education Publications Center, Recognition Programs, and 
Helping Your Child Learn. The Committee notes that the mandated 
studies authorized by section 5414 of the No Child Left Behind 
Act are required to be completed within 18 months of enactment 
of that Act. Therefore, the Committee does not provide 
additional resources in fiscal year 2004 for this work, as 
these studies are required to be completed prior to the 
beginning of fiscal year 2004. The Committee recommendation 
includes $4,000,000 for Reach Out and Read, as requested by the 
administration.
    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 expects that the Department will provide an 
additional $300,000 for this purpose to address issues related 
to school safety and healthy school buildings, as described in 
the administration's budget request for Safe and Drug-Free 
Schools and Communities National Programs.
    The administration recommended eliminating funding for 
activities listed below.
    The Committee recommends $25,334,000 to award a contract to 
Reading Is Fundamental, Inc. [RIF] to provide reading-
motivation activities. The comparable funding level for fiscal 
year 2003 is $25,334,000 and the budget request includes 
$24,000,000 for this purpose. RIF, a private nonprofit 
organization, encourages reading both inside and outside school 
by allowing youngsters to select books to keep at home. Federal 
funds provide up to 75 percent of the costs of books. The 
Committee notes that positive work that this program has done 
in leveraging private resources, targeting priority populations 
and generating greater interest in reading among program 
participants.
    The Committee recommends $20,483,000 for the Star Schools 
program. The comparable funding level for fiscal year 2003 is 
$27,341,000. The Star Schools program is designed to improve 
instruction in math, science, foreign languages, and other 
subjects such as vocational education, to underserved 
populations by means of telecommunications technologies. The 
Committee notes that the Department based its proposal to 
eliminate this program on the grounds that the program has 
limited impact, lacks evidence of effectiveness and is 
duplicative of the education technology and improving teacher 
quality State grant programs. However, the Department's 2002 
Annual Program Performance Report shows that this program 
exceeded its 2002 performance target for the number of courses 
with challenging content aligned with academic standards. 
Further, the Committee notes that the Star Schools is unique 
because it fosters services across State and regional 
boundaries to deliver direct support for classrooms, 
particularly in isolated and underserved areas, which is cost 
effective and provides services that individual States would 
have a difficult time replicating.
    The Committee recommends $14,406,000 for the Ready to Teach 
programs administered by the Department of Education. The 
comparable funding level for fiscal year 2003 is $14,406,000. 
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 the digital educational 
programming grant program, 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 notes that the Department has stated that no 
Federal funding is requested to continue the Ready to Teach 
programs because there is no basis for determining their 
effectiveness and States may use funds from block grants to 
fund similar activities. The Committee reiterates that the No 
Child Left Behind Act requires grantees under this program to 
submit an annual report that ``contains such information as the 
Secretary may require.'' The Committee encourages the 
Department to utilize information available from grantees to 
assess the effectiveness of this program.
    The Committee has provided $9,000,000 for the Education 
through Cultural and Historical Organizations [ECHO] Act of 
2001, as authorized by Public Law 107-110. Programs 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 2003 is $6,954,000.
    The Committee has included $35,279,000 for arts in 
education. The comparable funding level for fiscal year 2003 is 
$33,779,000. Within the total, $6,225,000 is for the John F. 
Kennedy Center for the Performing Arts; $7,250,000 is for VSA 
arts; $10,000,000 is for the competitive art education model 
grant program for the development and model projects that 
effectively strengthen and integrate the arts and cultural 
partnerships into the core curriculum; $7,500,000 is for grants 
for professional development for music, dance, drama, and 
visual arts educators to be administered by the U.S. Department 
of Education; $304,000 is for national evaluation and 
dissemination of information regarding funded model programs 
and professional development projects; and $4,000,000 is for 
cultural partnerships for at-risk youth. When awarding grants 
for professional development of music educators, the Department 
is urged to put a priority on preparing and retaining teachers 
in underserved rural and urban areas, including music teachers 
who enter the profession through alternative certification.
    The Committee is aware that numerous high-quality studies 
have demonstrated the positive academic and social effects of 
learning in the arts. However, this work also has suggested 
additional areas of research that need to be explored in 
greater detail, including the longitudinal effects and nature 
of learning in the arts. The Committee again recommends 
additional funding for evaluation and dissemination activities 
in order to explore these issues, as well as to disseminate 
information about best practices in effective arts education 
and arts-integrated instruction.
    The Committee recommends $42,224,000 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 2003 is $42,224,000. The 
Committee is aware that research overwhelmingly demonstrates 
that parent involvement in children's learning is positively 
related to student achievement.
    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 is concerned that the Department is not 
implementing effectively this provision and notes that the 
grant announcement for fiscal year 2003 funds does not even 
mention this statutory requirement. The Committee directs the 
Department to take appropriate steps to ensure that this 
statutory requirement is met in current and all future grant 
competitions. Further, the Committee is concerned about the 
ability of grantees to achieve the purpose of this program. 
Under the current competition, a novice applicant--essentially 
an organization that has not received Federal funds within the 
past 5 years--receives a bonus of 10 points, while an applicant 
that demonstrates that it has quality project personnel with 
relevant training and experience is eligible for up to 10 
points. The Committee supports efforts to reach a broader 
applicant audience and believes workshops, technical assistance 
and outreach are appropriate ways to assist novice applicants 
in understanding and meeting the requirements of Federal grant 
programs. However, the Committee does not believe that 
unqualified organizations should receive bonus points under 
discretionary grant competitions.
    The Committee includes $2,980,000 for the women's 
educational equity program. The comparable funding level for 
fiscal year 2003 is $2,980,000. This program supports projects 
that assist in the local implementation of gender equity 
policies and practices.

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 2003 is $22,850,000 and the 
budget request includes $22,000,000 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 strongly supports the objectives of the Ready 
To Learn Program and is pleased with the success of its two 
original children's productions, Between the Lions and Dragon 
Tales, and recommends continued support of these two programs. 
The Committee is concerned, however, that not all programs 
acquired by Ready To Learn meet the education, research, and 
curriculum-based goals that Congress envisioned for the 
program. The Committee is aware of the PBS/Markle Foundation 
Study which finds that in its PBS Kids television lineup, 
including Ready to Learn shows, too many shows are animated, 
easy to finance, but fail to advance PBS's educational mission. 
Of particular concern is the study's finding that in 2001, 
``Over half (58 percent) of its series were classified as 
Social/Emotional, the same `soft' curriculum claimed by nearly 
all the commercial broadcast series made to meet the FCC's 
educational programming mandate.'' Ready to Learn is a mission 
beyond entertainment, and all shows in the Ready to Learn 
viewing block should adhere not only to a high production 
value, but a worthiness of purpose which meets the original 
intent of the program.
    The Committee also is concerned about the accountability of 
funds appropriated thus far for Ready To Learn broadcast 
programs and requests that the Department provide a detailed 
accounting of these funds to the Committee not later than 60 
days after the enactment of the Department of Education 
Appropriations Act, 2004.

Dropout Prevention

    The Committee recommends no funds for the dropout 
prevention program. The comparable funding level for fiscal 
year 2003 is $10,929,000 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. The Committee notes that in 
fiscal year 2002, States reserved roughly $76,000,0000 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 encourages 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.

Close Up Fellowships

    The Committee recommendation does not include any funding 
for this program. The comparable funding level for fiscal year 
2003 is $1,490,000 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 made considerable 
efforts to identify and develop non-Federal sources of funding 
for sustaining its operations. The Committee notes that the 
Close Up Foundation raised more than $1,047,340 during the 
2001-2002 program year in non-Federal funds dedicated to 
economically disadvantaged students and their teachers, almost 
10 percent more than their performance target for that period.

Advanced Placement

    The Committee recommends $24,000,000 for Advanced 
Placement. The comparable funding level for fiscal year 2003 is 
$23,347,000 and the budget request includes $22,000,000 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, 2003....................................    $884,925,000
Budget estimate, 2004...................................     756,250,000
Committee recommendation................................     818,547,000

Safe and Drug-Free Schools and Communities

    The Committee recommends a total of $818,547,000 for 
activities to promote Safe Schools and Citizenship Education. 
The comparable fiscal year 2003 funding level is $884,925,000 
and the budget request includes $756,250,000 for these 
activities.
    State Grant Program.--The Committee recommends $422,017,000 
for the safe and drug-free schools and communities State grant 
program. The comparable fiscal year 2003 funding level is 
$468,949,000 and the budget request includes $422,017,000. Due 
to budget constraints, the Committee reluctantly accepts the 
administration's proposed reduction in funding for the State 
Grants portion of the Safe and Drug Free Schools and 
Communities [SDFSC] program. The Committee understands that the 
changes authorized by the No Child Left Behind Act were 
intended to strengthen State and local efforts funded by this 
program and should show improved results in safe and drug free 
learning environments. The Committee intends to review this 
program's funding throughout the current budget process and in 
future years, as it recognizes the critical role that such 
funding plays in establishing safe and drug free learning 
environments.
    The Committee fully expects that the Uniform Management 
Information and Reporting System, required by the No Child Left 
Behind Act, will be developed and implemented so that data and 
other pertinent information is collected in a uniform manner 
both within a particular State and across all States, and that 
it be reported by every State to the Secretary of Education. 
The Committee looks forward to reviewing such information in 
future program performance reports and congressional 
justifications.
    The Committee embraces the notion that federally-funded 
activities should be undertaken to the extent that they are 
science-based and appropriate, given the issues identified by a 
local needs assessment. However, the Committee is concerned 
about the apparent, undue emphasis on the implementation of 
specific programs deemed to be science-based. The Committee 
notes that the Principles of Effectiveness are intended to be 
implemented as a whole, with States and local education 
agencies conducting needs assessment and choosing programs, 
strategies, and activities that actually meet their particular 
needs and are adjusted over time. Such agencies should not 
simply adopt a specific program because it has been proven to 
be effective under the right conditions. The Committee expects 
the 2005 congressional justification to include information 
about the actions taken by the Department to implement this 
provision of NCLB, consistent with this intent.
    National Programs.--The Committee has included $155,180,000 
for the national programs portion of the safe and drug-free 
schools program. The comparable funding level for fiscal year 
2003 is $155,180,000 and the budget request includes 
$172,233,000 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 $10,000,000 for Project SERV. However, the 
Committee notes that the Department currently has roughly 
$9,000,000 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 is disappointed that the Department 
once again refused to provide funding for the National 
Recognition Awards in fiscal year 2003, despite an explicit 
recommendation to do so in last year's Senate report language. 
Therefore, 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 is troubled by the Department's 
implementation of the Department of Education Appropriations 
Act, 2003. Contrary to congressional intent as expressed in 
House Report 108-10, the Department created a new drug testing 
initiative under Safe and Drug Free National Programs that was 
neither proposed in the President's budget nor contemplated by 
congressional action with respect to fiscal year 2003 
appropriations. The Committee expects the Deputy Under 
Secretary to suspend activities related to this new initiative 
until the requirements related to reprogramming and new 
programs are met.
    The Committee expects that the Department will provide 
$300,000 for the continued operation of the National 
Clearinghouse for Educational Facilities, the Nation's sole 
source for comprehensive information about school planning, 
design, financing, construction and maintenance. These funds 
will be used to address issues related to school safety and 
healthy school buildings, as described in the administration's 
budget request. The Committee has included additional funds for 
the Clearinghouse through the Fund for the Improvement of 
Education.
    The Committee notes that by the time they reach 
adolescence, most young people have been tested and protected 
from a wide array of diseases and health disorders. But very 
few are screened for one of the most devastating threats 
teenagers face: depression and the serious, often life-
threatening problems it foments. Between 7 million to 10 
million teenagers suffer from a mental health condition which, 
for many, may lead to serious problems including dropping out 
of school, substance abuse, violence and suicide. Two-thirds of 
these young people receive no counseling or treatment, usually 
because their illness is undetected by parents, friends, and 
teachers. The Committee is aware that some school districts 
have taken advantage of relatively simple screening tools now 
available to detect depression, the risk of suicide, and other 
mental disorders in teenagers. The Committee believes that 
screening should occur with parental and student consent, and 
with a commitment to make counseling and treatment available 
for students found to be at-risk. The Committee strongly urges 
the Secretary to make the availability of screening programs 
more widely known, and to encourage school districts, juvenile 
justice facilities and community-based organizations to 
implement similar teenage screening programs. The Committee 
expects to receive a report on steps being taken to promote 
this effort prior to the fiscal year 2005 appropriations 
hearings.

Community Service for Expelled or Suspended Students

    The Committee recommends no additional funds for formula 
grants to States to carry out programs under which students who 
are expelled or suspended from school are required to perform 
community service. The comparable funding level for fiscal year 
2003 is $49,675,000 and the budget request did not include any 
funds for this purpose.

Alcohol Abuse Reduction

    The Committee recommends $30,000,000 for grants to LEAs to 
develop and implement programs to reduce underage drinking in 
secondary schools. The comparable funding level for fiscal year 
2003 is $24,838,000 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 $28,700,000 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 2003 funding level is 
$17,386,000 and the budget request includes $100,000,000 for 
this purpose.
    The Committee is aware of the positive effects of mentoring 
programs that have been identified in prior evaluations of such 
activities. In particular, the Committee notes the findings 
from an evaluation conducted by Public/Private Ventures [P/PV], 
which include: mentored children were 46 percent less likely 
than other youth to initiate drug use, 27 percent less likely 
to initiate alcohol use, skipped half as many days of school as 
similar youth, received slightly higher grades and reported 
more positive relationships with their friends and parents. In 
addition, the Committee notes that evaluations have found that 
certain best practices in mentoring programs--such as high 
quality screening of and training for mentors, support and 
guidance in establishing strong mentoring relationships, and 
monitoring of program implementation--have led to better 
outcomes for mentored youth. The Committee encourages the 
Department to consider these issues when considering 
applications submitted for program funds.

Character Education

    The Committee recommends $24,838,000 to provide support for 
the design and implementation of character education programs. 
The comparable funding level for fiscal year 2003 is 
$24,838,000 and the budget request includes $25,000,000 for 
this purpose. The Committee notes that the Department is still 
developing program performance information for the character 
education program. The Committee encourages the Department to 
utilize its discretionary funds to conduct a national 
evaluation on this program. Further, the Committee expects the 
Department to utilize grantee evaluations to develop baselines 
and performance targets for evaluating the effectiveness of 
this program.

Elementary and Secondary School Counseling

    The Committee recommends $34,000,000 to establish or expand 
counseling programs in elementary schools. The comparable 
fiscal year 2003 funding level is $32,289,000 and the 
President's budget proposes to eliminate funding for this 
program. The Committee notes that the American School Counselor 
Association recommends a maximum student-to-counselor ratio of 
250 to 1, while the current average student-to-counselor ratio 
in America's public schools is 490 to 1. The Committee 
appreciates the additional flexibility provided by the NCLB 
Act, but does not believe this flexibility alone is sufficient 
to help close this gap. The Committee notes that grantees 
funded during fiscal year 2001 met 86 percent of their stated 
results-based goals and objectives.

Carole M. White Physical Education Program

    The Committee recommends $70,000,000 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 2003 is $59,610,000 
and the administration's budget proposes to eliminate funding 
for this program. The Carol M. White Physical Education 
Program, authorized by the NCLB Act, established 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.
    Numerous studies have documented that the combination of 
regular exercise and healthy eating are crucial both to 
improving health and well-being as well as to reducing 
preventable health care costs. The Committee believes more must 
be done to encourage these behaviors at the earliest age 
possible. Therefore, the Committee calls for steps to be taken 
to better coordinate physical education programs, such as PEP, 
and child nutrition programs and nutrition education efforts, 
such as those funded by the Department of Agriculture.
    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 $28,812,000 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 2003 funding 
level is $28,812,000 and the administration request includes 
$27,000,000 for this purpose.
    Civic Education program funds support both the We the 
People programs and the Cooperative Education Exchange. The 
Committee recommends $16,890,000 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 total for the We the People program, the 
Committee recommends the following: that $2,980,000 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 Democratic at the 
National Conference of State Legislatures; that $1,490,000 be 
used for continuation and expansion of the school violence 
prevention demonstration program; and that $500,000 be used for 
the Native American civic education program.
    The Committee recommends $11,922,000 for the Cooperative 
Education Exchange program. Within this amount, the Committee 
has included $4,470,750 for the Center for Civic Education and 
$4,470,750 for the National Council on Economic Education. The 
remaining $2,980,500 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 $25,000,000 for education and 
training for incarcerated youth offenders. The comparable 
funding level for fiscal year 2003 is $23,348,000. 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 expects a detailed 
report in the 2005 congressional justification on 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.

Physical Education Initiative

    The Committee does not recommend any funding for this new, 
proposed program. The administration proposed $10,000,000 for 
this new program. The Committee notes that this proposed 
program is not specifically authorized, unlike the existing 
Carol M. White Physical Education Program that was created when 
the Congress enacted and the President signed the No Child Left 
Behind Act. Further, the Committee notes that this initiative 
is duplicative of the existing Carol M. White Physical 
Education Program, which funds the initiation, expansion, and 
improvement of physical education programs for all kindergarten 
through 12th grade students, which may include program elements 
addressing healthy eating habits and good nutrition and 
professional development for teachers of physical education to 
stay abreast of the latest research, issues, and trends in the 
field of physical education.

                      ENGLISH LANGUAGE ACQUISITION

Appropriations, 2003....................................    $685,515,000
Budget estimate, 2004...................................     665,000,000
Committee recommendation................................     665,000,000

    The Committee recommends an appropriation of $665,000,000 
for English language acquisition. The comparable funding level 
for fiscal year 2003 is $685,515,000 and the budget request 
includes $665,000,000 for related 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. While the appropriation is $20,515,000 less 
than the fiscal year 2003 appropriation, the State grant 
portion of this account will increase by more than $50,000,000 
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, 2003.................................... $10,033,917,000
Budget estimate, 2004...................................  10,690,104,000
Committee recommendation................................  11,027,464,000

    The Committee recommends $11,027,464,000 for special 
education programs authorized by the IDEA. The comparable 
fiscal year 2003 funding level is $10,033,917,000 and the 
budget request includes $10,690,104,000 for such programs.

Grants to States

    The Committee recommends $9,858,533,000 for special 
education grants to States, as authorized under part B of the 
IDEA. The comparable fiscal year 2003 funding level is 
$8,874,398,000 and the budget request includes $9,528,533,000. 
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 
approximately 19 percent of the average per-pupil expenditure, 
compared with roughly 17 percent under the fiscal year 2003 
appropriation. Since fiscal year 2000, increasing 
appropriations have raised the Federal share of average per 
pupil expenditures from 12 percent to an estimated 19 percent 
in fiscal year 2004--almost 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 2003 funding level is $387,465,000 
and the budget request includes $390,000,000. 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 $447,000,000 for grants for the 
infants and families program under part C of the IDEA. The 
comparable fiscal year 2003 funding level is $434,159,000 and 
the budget request includes $447,000,000 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 Improvement

    The Committee recommends $44,000,000 for State improvement 
grants. The comparable fiscal year 2003 funding level is 
$51,364,000 and the budget request includes $44,000,000 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

    The Committee recommends $77,210,000 for research and 
innovation. The comparable funding level for fiscal year 2003 
is $77,210,000 and the budget request includes $78,380,000 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.
    The Committee commends the Office of Special Education 
Programs [OSEP] for its consistent efforts to support and 
conduct work on behalf of individuals with learning 
disabilities. The Committee expects OSEP to ensure that the 
National Research Center on Learning Disabilities [NRCLD] 
conducts and synthesizes research on how to best implement and 
take to scale identification methods that rely on students' 
response to scientific research-based instruction. The Center 
also should disseminate to and assist the local education 
agencies with replicable models that produce measurable 
positive improvements in student learning. The Committee looks 
forward to learning more about effective instruction and 
interventions to enhance student learning. The Committee 
encourages OSEP to coordinate efforts within the Department of 
Education, NIH, NSF and other Federal agencies working on 
related activities.

Technical Assistance and Dissemination

    The Committee recommends $53,133,000 for technical 
assistance and dissemination. The comparable fiscal year 2003 
funding level is $53,133,000 and the budget request includes 
$53,481,000 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 $91,899,000 for the personnel 
preparation program. The comparable fiscal year 2003 funding 
level is $91,899,000 and the budget request includes 
$90,000,000 for this program. Funds support competitive awards 
to help address State-identified needs for qualified personnel 
to work with children with disabilities, and to ensure that 
these personnel have the skills and knowledge they need to 
serve these children.
    The Committee is particularly concerned about the shortage 
of qualified special education teachers and higher education 
faculty. Therefore, it urges the Department to use funds 
available from expiring awards under this program to make new 
grants above the 2003 funding level for leadership personnel. 
The Committee also urges the Department to use a portion of 
such funding for the preparation of personnel who serve 
children with low-incidence disabilities, particularly those 
with sensory disabilities such as low vision, blindness, and 
deafness.

Parent Information Centers

    The Committee recommends $26,328,000 for parent information 
centers. The comparable fiscal year 2003 funding level is 
$26,328,000 and the budget request includes $26,000,000 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 $39,361,000 for technology and 
media services. The comparable fiscal year 2003 funding level 
is $37,961,000 and the budget request includes $32,710,000 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. 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 Committee also recommends $1,500,000 for the Readline 
Program. Last year, this program received $1,490,000. The 
administration proposed eliminating 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 Readline 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, 2003....................................  $2,953,633,000
Budget estimate, 2004...................................   2,918,423,000
Committee recommendation................................   3,004,360,000

    The Committee recommends $3,004,360,000 for rehabilitation 
services and disability research. The comparable fiscal year 
2003 funding level is $2,953,633,000 and the budget request 
includes $2,918,423,000.

Vocational Rehabilitation State Grants

    The Committee provides $2,584,162,000 for vocational 
rehabilitation grants to States. The Committee recommendation 
provides the full amount authorized by the Rehabilitation Act 
of 1973. The budget request proposes to eliminate separate 
funding of several categorical programs. The Committee rejects 
this approach and believes changes of this nature should be 
considered during the reauthorization process.
    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 $12,068,000 for the client 
assistance program. The comparable fiscal year 2003 funding 
level is $12,068,000 and the budget request includes 
$11,897,000 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 $39,371,000 for training 
rehabilitation personnel. The comparable fiscal year 2003 
funding level is $39,371,000 and the budget request includes 
$42,629,000 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 O+P programs.

Demonstration and Training Programs

    The Committee bill includes $20,895,000 for demonstration 
and training programs for persons with disabilities. The 
comparable fiscal year 2003 funding level is $20,895,000 and 
the budget request includes $24,492,000 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.
    The Committee recognizes that Fetal Alcohol Syndrome, the 
most preventable cause of mental retardation, results from 
maternal alcohol consumption during pregnancy. Affected 
children have a life long disability of mental impairments and 
behavioral problems that reduce their ability to respond to 
education. The burden to society is estimated at $4,000,000,000 
per year. The Committee is pleased with the efforts of the 
Office of Special Education and Rehabilitative Services within 
the Department of Education to collaborate with other 
government organizations represented on the Interagency 
Coordinating Committee on Fetal Alcohol Syndrome. The Committee 
is encouraged by the progress made to involve educational 
psychologists and other educational and childcare professionals 
in developing awareness about FAS. The Committee encourages the 
Department of Education to expand activities related to Fetal 
Alcohol Syndrome; specifically the early identification of 
affected children.

Migrant and Seasonal Farmworkers

    The Committee recommends $2,335,000 for migrant and 
seasonal farmworkers. The comparable fiscal year 2003 funding 
level is $2,335,000. 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. The Committee 
understands that States will begin reporting on migrant and 
seasonal farmworkers served through the basic State grant 
program. The Committee looks forward to reviewing such 
information as it will provide more concrete information upon 
which to determine whether a separate funding stream is still 
required to adequately serve this population.

Recreational Programs

    The Committee provides $2,579,000 for recreational 
Programs. The comparable fiscal year 2003 funding level is 
$2,579,000 and the budget request did 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.
    The Committee notes that the primary purpose of this 
program is to initiate recreational and related activities for 
individuals with disabilities. These programs are designed to 
aid individuals with disabilities in employment, mobility, 
independence and community integration. The Committee notes 
that almost three out of four programs whose last year of 
Federal funding ended in fiscal years 1998 through 2000 are 
still in operation and continue to meet the recreational needs 
of individuals with disabilities. These results show that this 
limited investment is having a national impact, as each new 
grant supports seed money for recreational programs throughout 
the United States.

Protection and Advocacy of Individual Rights

    The Committee recommends $16,890,000 for protection and 
advocacy of individual rights. The comparable fiscal year 2003 
funding level is $16,890,000 and the budget request includes 
$17,880,000. However, included in the request is $2,680,000 to 
continue funding for the Protection and Advocacy for Assistive 
Technology program.
    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 $21,928,000 for projects with 
Industry. The comparable fiscal year 2003 funding level is 
$21,928,000 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 $37,904,000 for the supported 
employment State grant program. The comparable fiscal year 2003 
funding level is $37,904,000 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 $22,151,000 for independent living 
State grants. The comparable funding level for fiscal year 2003 
is $22,151,000 and the budget request includes $22,296,000 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 $69,545,000 for independent living 
centers. The comparable fiscal year 2003 funding level is 
$69,545,000 and the budget request includes $69,500,000 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 $27,818,000 for independent living 
services to older blind individuals. The comparable fiscal year 
2003 funding level is $27,818,000 and the budget request 
includes $25,000,000 for these activities.
    States participating in the program must match every $9 of 
Federal funds with not less than $1 in non-Federal resources. 
Assistance is provided to persons aged 55 or older to adjust to 
their blindness, continue living independently and avoid 
societal costs associated with dependent care. Services may 
include the provision of eyeglasses and other visual aids, 
mobility training, braille instruction and other communication 
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 $894,000 for program improvement 
activities. The comparable fiscal year 2003 funding level is 
$894,000 and the budget request includes $850,000. In fiscal 
year 2004, 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 $994,000 for evaluation 
activities. The comparable fiscal year 2003 funding level is 
$994,000 and the budget request includes $1,000,000 for such 
activities.
    These funds support evaluations of the impact and 
effectiveness of programs authorized by the Rehabilitation Act. 
The Department awards competitive contracts for studies to be 
conducted by persons not directly involved with the 
administration of Rehabilitation Act programs.

Helen Keller National Center

    The Committee recommends $8,717,000 for the Helen Keller 
National Center for Deaf-Blind Youth and Adults. The comparable 
fiscal year 2003 funding level is $8,660,000 and the budget 
request includes $8,717,000 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 48 agencies. At 
the recommended level, the center would serve approximately 102 
persons with deaf-blindness at its headquarters facility and 
provide field services to approximately 1,850 individuals and 
families.

National Institute on Disability and Rehabilitation Research

    The Committee recommends $109,285,000 for the National 
Institute on Disability and Rehabilitation Research [NIDRR]. 
The comparable fiscal year 2003 funding level is $109,285,000 
and the budget request includes $110,000,000 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 is disappointed by NIDRR's actions to adjust 
fiscal year 2002 program performance targets downward after the 
end of the fiscal year. These actions diminish the value of the 
program performance measurement process. If such actions are 
required in the future, the Committee expects NIDRR to 
highlight and fully explain in all appropriate documents the 
need for adjusting a performance target after it has been 
established.

Assistive Technology

    The Committee recommends $26,824,000 for assistive 
technology. The comparable fiscal year 2003 funding level is 
$26,824,000 and the budget request proposes to eliminate 
funding for this program. However, under the PAIR program, the 
administration proposes to fund Protection and Advocacy 
activities previously funded through this program at 
$2,680,000.
    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 $26,824,000 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 2003. The budget request proposes to eliminate 
State Tech Act funding in fiscal year 2004, at a time when 
States are operating in a new policy landscape that includes 
the Olmstead decision, final section 508 standards and the 
Ticket to Work and Work Incentives Improvement Act. 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 2003 bill.
    The Committee recommendation does not include additional 
resources for title III programs, as requested by the 
administration. The Committee will review the program funding 
level in the fiscal year 2005 budget, once appropriated funds 
have been awarded through a grant competition. The Committee 
will ensure that sufficient resources are available to continue 
this important program, once it becomes more clear how funds 
have been expended under this program. Loan programs offer 
individuals with disabilities attractive options that 
significantly enhance their ability to purchase assistive 
technology devices and services.

           Special Institutions for Persons With Disabilities


                 AMER